http://hdl.handle.net/2123/6115 2013-05-19T03:59:31Z http://hdl.handle.net/2123/9057 Title: Evaluation of the Nimbin Integrated Services Project Authors: Longman, J M; Barraclough, F L; Barclay, L M Abstract: This report is an evaluation of a Nurse Practitioner-led integrated service for mental health and drug and alcohol clients, in a small town in rural NSW. 2013-04-30T00:00:00Z http://hdl.handle.net/2123/8987 Title: I'm Safe, I'm Home: A process evaluation Authors: Cohen, Gillian E Abstract: “I’m Safe, I’m Home: A Process Evaluation” is the first evaluation of the Domestic Violence Support Western Sydney Service (DVSWSS) program, a three year trial of a new intervention to prevent homelessness caused by domestic violence. Funded by the NSW Homelessness Action Plan to run between 2010-2012 in parallel to the traditional refuge system, DVSWSS offers medium term “wrap around” support for women and children escaping domestic violence to restart their lives in private accommodation. The evaluation describes how DVSWSS is run to overcome implementation difficulties and how it assisted over 650 people, exceeding targets by 13 per cent. DVSWSS cost effectively provides client-centred, individually tailored support across 38 services and 12 local government areas in Greater Western Sydney. The report serves both as a manual for wider dissemination of the program, and describes in detail the policy implications and opportunities arising from this program. 2012-10-01T00:00:00Z http://hdl.handle.net/2123/8977 Title: Spatio-temporal differences in the history of health and noise complaints about Australian wind farms: evidence for the psychogenic, “communicated disease” hypothesis. Authors: Chapman, Simon; St.George, Alexis; Waller, Karen; Cakic, Vince Abstract: Background and objectives With often florid allegations about health problems arising from wind turbine exposure now widespread in parts of rural Australia and on the internet, nocebo effects potentially confound any future investigation of turbine health impact. Historical audits of health complaints across periods when such claims were rare are therefore important. We test 4 hypotheses relevant to psychogenic explanations of the variable timing and distribution of health and noise complaints about wind farms in Australia. Setting All (n=51) Australian wind farms (with 1634 turbines) operating from 1993–2012 . Methods Records of complaints about noise or health obtained from wind farm companies regarding residents living near 51 Australian wind farms, expressed as proportions of estimated populations residing within 5km of wind farms, and corroborated with complaints in submissions to 3 government public enquiries and news media records and court affidavits . Results There are large spatio-temporal variations in wind farm noise and health complaints.33/51(64.7%) of Australian wind farms including 17/34(50%) with turbine size >1MW have never been subject to noise or health complaints. These 33 farms have some 21,592 residents within 5km of their turbines and have operated complaint-free for a cumulative total of 267 years. Western Australia and Tasmania Have seen no complaints. Only 131 individuals across Australia representing approximately 1 in 250 residents living within 5km of wind farms appear to have ever complained, with 94(72%) of these being residents near 6 wind farms which have been targeted by anti wind farm groups . About 1 in 87 (126/10901) of those living near turbines >1MW have ever complained. The large majority 104/131(79%) of health and noise complaints commenced after 2009 when anti wind farm groups began to add health concerns to their wider opposition. In the preceding years, health or noise complaints were rare despite large and small turbined wind farms having operated for many years. Conclusions In view of scientific consensus that the evidence for wind turbine noise and infrasound causing health problems is poor, the reported spatio-temporal variations in complaints are consistent with psychogenic hypotheses that health problems arising are “communicated diseases” with nocebo effects likely to play an important role in the aetiology of complaints. 2013-03-14T00:00:00Z http://hdl.handle.net/2123/8960 Title: Target the fence-sitters Authors: Leask, Julie Abstract: Past waves of vaccine rejection in industrialized nations have a lot to teach us about preventing future ones. 2011-05-26T00:00:00Z http://hdl.handle.net/2123/8946 Title: What should be done about policy on alcohol pricing and promotions? Australian experts’ views of policy priorities: a qualitative interview study Authors: Fogarty, Andrea S; Chapman, S Abstract: ABSTRACT Background Alcohol policy priorities in Australia have been set by the Preventative Health Task Force, yet significant reform has not occurred. Public health experts aware of these priorities are not reported as in agreement in news media discussions and Government has not adequately supported the legislative recommendations made. We investigate policy experts’ views on alcohol policy priorities with a view to establishing levels of accord and providing suggestions for future advocates. Methods We conducted semi-structured in depth interviews with alcohol policy experts and advocates around Australia. Open-ended questions examined participants’ thoughts on existing policy recommendations, obvious policy priorities and specifically, the future of national reforms to price and promotions policies. All transcripts were analysed for major themes and points of agreement or disagreement. Results Twenty one alcohol policy experts agreed that pricing policies are a top national priority and most agreed that “something should be done” about alcohol advertising. Volumetric taxation and minimum pricing were regarded as the most important price policies, yet differences emerged in defining the exact form of a proposed volumetric tax. Important differences in perspective emerged regarding alcohol promotions, with lack of agreement about the likely form regulations should take, where to start and who the policy should be directed at. Very few discussed online advertising and social networks. Conclusions Despite existing policy collaborations, a clear ‘cut through’ message is yet to be repeatedly endorsed by all alcohol control advocates. There is a need to articulate in greater detail the specifics of policy reforms to minimum pricing, volumetric taxation and restrictions on alcohol advertising, particularly regarding sporting sponsorships and new media. 2013-02-19T00:00:00Z http://hdl.handle.net/2123/8602 Title: Australian journalists’ reflections on local coverage of a health-related story from the developing world Authors: Imison, Michelle; Chapman, Simon Abstract: Given the limited Australian media coverage of health news from low- and middle-income countries (LMICs), the 2009 story of conjoined Bangladeshi twins Trishna and Krishna was conspicuous for its scale. This paper draws on interviews with journalists who reported the story and considers what those seeking to increase the news exposure given to LMIC health issues might learn from this coverage. It considers, in particular, the extent to which the twins’ story fitted with prevailing journalistic norms and beliefs about both health and news, and suited professional expectations and routines, especially in relation to choice of sources and access to material. Finally, the paper surveys opportunities for broader and deeper coverage of such news in the future. 2012-07-01T00:00:00Z http://hdl.handle.net/2123/8369 Title: Reaching “an audience that you would never dream of speaking to”: influential public health researchers’ views on the role of news media in influencing policy and public understanding. Authors: Chapman, Simon; Haynes, Abby; Derrick, Gemma; Sturk, Heidi; Hall, Wayne D; St.George, Alexis Abstract: While governments and academic institutions urge researchers to engage with news media, traditional academic values of public disengagement have inhibited many from giving high priority to media activity. In this interview-based study, we report on the views about news media engagement and strategies used by 36 peer-voted leading Australian public health researchers in six fields. We consider their views about the role and importance of media in influencing policy; their reflections on effective or ineffective media communicators; and strategies used by these researchers about how to best retain their credibility and influence while engaging with the news media. A willingness and capacity to engage with the mass media was seen as an essential attribute of influential public health researchers. 2012-05-22T00:00:00Z http://hdl.handle.net/2123/8366 Title: The case for a smokers' licence. Authors: Chapman, Simon Abstract: The history of tobacco control has seen the introduction of policies initially considered radical, but which rapidly came to be considered normal and essential to the goals of reducing use and the burden of disease that tobacco causes. No other consumer product is subject to total advertising bans. None are required to be sold in plain packaging, as will be the case in Australia from December 2012. Again uniquely, 47 nations now require large graphic warnings on tobacco packaging. Smokefree public transport, workplaces, restaurants, bars, and stadiums are now the rule rather than the exception in an increasingly large number of nations. The legally binding World Health Organisation’s Framework Convention on Tobacco Control which requires such measures has been ratified by 174 nations. Despite these developments, the sale of tobacco and cigarettes is subject to trivial controls compared with other dangerous products that threaten either public or personal health or safety. In this paper, I outline a proposal for a major new development with potential to reduce tobacco use: the smokers’ license, and consider its likely benefits and the main objections. 2012-05-21T00:00:00Z http://hdl.handle.net/2123/8362 Title: A disease in search of a cause: a study of self-citation and press release pronouncement in the factoid of wind farms causing “vibroacoustic disease”. Authors: Chapman, Simon; St.George, Alexis Abstract: Background In recent years, claims have proliferated that wind turbines cause a large variety of diseases. Two of these, “Wind Turbine Syndrome” (WTS) and “Vibroacoustic disease” (VAD) are frequently mentioned. Seventeen reviews of the evidence for wind turbines causing harm have concluded the evidence to be poor yet some regulatory authorities are now referencing health concerns as part of the rationale for set-back guidelines from residences, greatly reducing siting opportunities. Methods and Findings Google returns 158,000 hits for WTS and 298,000 for VAD. We conducted a search for all papers and citations on WTS or VAD, and searched for evidence for any association between wind turbine exposure and VAD. No papers on WTS were found in indexed journals. Thirty five papers on VAD were found, none reporting on an association between VAD and wind turbines. Of the 35 papers on VAD, 34 had a first author from a single Portuguese research group. Seventy four per cent of citations to these papers were self-citations by the group. Median self-citation rates in science are around 7%. Two unpublished case reports presented at conferences were found alleging that VAD was “irrefutably demonstrated” to be caused by wind turbines. Conclusions VAD has received virtually no scientific recognition beyond the group who invented the term. The claim that wind turbines cause VAD is a factoid that has gone “viral” in cyberspace and may be contributing to nocebo effects among those living near turbines. 2012-05-18T00:00:00Z http://hdl.handle.net/2123/8340 Title: Planned caesarean section (CS) for second birth following a first vaginal birth (VB) Authors: Chen, Jian Sheng Abstract: Introduction There is international concern over rising rates of CS and its impacts on maternal and neonatal health outcomes. Of interest are the factors driving the increase in primary caesareans in a 2nd birth. Objectives To examine effects of previous birth factors on subsequent planned CS. Methods Women with both 1st and 2nd births were identified from NSW birth data from 2000-2009. The study population included only women with VB at 1st birth and excluded those who had an indisputable indication for CS in the 2nd birth (multiple pregnancy, breech presentation or placenta praevia). Logistic regression was used for the analysis. Results Of the 114,287 women, 4,787 (4.2%) had planned CS at 2nd birth. After adjusting for 2nd pregnancy risk factors including interval between two births, year at birth, maternal age, hospital location, private care, hypertension, diabetes, infant size and antepartum hemorrhage, independent 1st birth risk factors for planned CS (in order of effect size) were 3rd-4th degree tear, severe neonatal morbidity, a perinatal death, severe maternal morbidity, instrumental birth, large infant, labour induction, epidural, use of oxytocics and episiotomy. The leading four 1st birth risk factors increased the risk of planned CS by more than 100%, for example odds ratio of 3rd-4th degree tear: 5.00 (95% CI 4.58-5.44). Conclusion Women who had obstetric interventions and adverse pregnancy outcomes in the first birth were at increased risk of planned CS in the second birth. The results indicate the importance of ‘getting the first birth right’ in reducing CS rate. Description: Co-authors: Christine L. Roberts, Jane B. Ford, Amanda Ampt and Judy M. Simpson 2012-05-02T00:00:00Z http://hdl.handle.net/2123/7914 Title: Environmental tobacco smoke in outdoor areas: a rapid review of the research literature. Authors: Chapman, Simon; Hyland, Andrew Abstract: Restrictions on smoking outdoors have been introduced for reasons of public amenity and to promote litter reduction. This review considers the evidence about whether outdoor secondhand smoke (SHS) might also pose health risks to others. Six published studies have assessed outdoor levels of SHS using metred PM2.5 as a marker of exposure. The magnitude of PM2.5is dependent on the number of smokers present, proximity of the measurement device to the source of the SHS, the extent to which the outdoor space is physically constrained (e.g., walls, partial roof, umbrellas), and wind. The data show peak outdoor PM2.5 levels in semi-enclosed areas with several smokers present can be comparable to those recorded in indoor smoky environments. However, outdoor PM2.5 levels are more transient as the smoke plume is less confined and can rapidly dissipate. SHS can be a major source of PM2.5, particularly in indoor environments. The average PM2.5 level in bars where smoking occurs is 303 µg/m3 and 157 µg/m3 in restaurants. Because of repeated and cumulative exposure to SHS in outdoor settings like beer gardens and outdoor eating areas, occupational exposures to PM2.5 from SHS are likely to be far higher than those experienced by patrons who are present for far shorter periods. We estimate that occupational exposure to SHS in waitstaff working in outdoor patio areas where smoking is allowed could average 1.6 to 9.8 µg/m3 per year. It is thus plausible that occupational exposure to PM2.5 in outdoor work settings where smoking is allowed could exceed the Australian National Environment Protection Measure for Ambient Air Quality benchmark annual average target of 8µg/m3 . An increase of 5µg/m3 to 10 µg/m3 in average annual PM2.5 exposure is associated with a 3-6% increase in all-cause mortality. Personal monitoring studies have not yet been conducted to corroborate modelled estimates of staff exposure in these settings. Such studies should be conducted to test the modelled exposure estimates we have calculated. 2011-11-25T00:00:00Z http://hdl.handle.net/2123/7766 Title: Patients who choose not to dialyze Authors: Morton, Rachael Lisa Abstract: Introduction and aims: Some patients with Stage 5 chronic kidney disease (CKD) choose supportive non-dialytic management or conservative care in preference to dialysis. The aims of this study were to estimate the national proportion of incident CKD Stage 5 patients referred to Nephrologists who choose not to dialyse, and investigate their characteristics. Methods: A prospective national multi-centre study of information given to incident CKD Stage 5 patients in Australian renal units, identified between 1st July and 30th September 2009. Patients with CKD who had not been referred to a nephrologist were excluded. Multi-level logistic regression models were used to determine which patient and unit characteristics were associated with receiving information about the option of conservative care and determine which characteristics were associated with commencement of conservative care compared to renal replacement therapy. Results: Sixty-six (90%) of 73 Australian renal units participated in the study. 102 of 721 (14%) of incident CKD Stage 5 patients chose not to dialyse, mean age 79 years (standard deviation 8.7). Nine of 50 (18%) of renal units managing conservative patients had a formal conservative care pathway. In multivariable analysis, age (p<0.001), language (p=0.0396), time known to a nephrologist (p<0.001), and the presence of a support person (p<0.001) were associated with the presentation of information about conservative care options. After adjusting for the patient’s gender, insurance status, size of the renal unit and presence of a formal conservative care pathway, patients over 60 years, OR 3.78(95% CI 2.39-5.00), non-English speakers, OR 2.52(95% CI 1.08-5.90), and those known to a nephrologist for more than 3 months, OR 5.83(95% CI 2.90-11.71), were more likely to receive information about conservative care. In unadjusted analysis the absence of a support person was strongly associated with a lower likelihood of receiving information about conservative care, OR 0.54(95% CI 0.34-0.86) however this effect lessened when adjusted for other factors, OR 0.65 (95% CI 0.39-1.09). In the second multivariable analysis that compared commencement of conservative care to renal replacement therapy, age (p<0.0001), gender (p=0.0169) and earlier CKD stage when treatment options were presented (p=0.027) were associated with commencement of conservative care. Patients older than 60 years, OR 7.84(95% CI 2.78-22.06); females, OR 2.01(95% CI 1.13-3.59); and those receiving information about their treatment options in Stage 3/4 CKD compared to Stage 5, OR 2.41 (95% CI 1.25-4.64), were more likely to decline renal replacement therapy. Conclusions: A considerable proportion (14%), of Australian CKD Stage 5 patients managed by Nephrologists choose conservative care, despite a lack of formal care pathways. Earlier presentation of treatment options including conservative care, to an older CKD population may result in more informed patient decision making, with choices being more strongly aligned to patient preferences. Further research is required in this area as many nephrologists feel unprepared or uncomfortable in discussions with patients about palliative treatment. 2011-09-08T00:00:00Z http://hdl.handle.net/2123/7755 Title: A Multi Criteria Decision Analytic (MCDA) approach to combining evidence and patient preferences for cancer prevention and treatment: an application to prostate cancer screening Authors: Salkeld, Glenn 2011-08-23T00:00:00Z http://hdl.handle.net/2123/7704 Title: Media Miracles: The Separation of Conjoined Twins, and Reflections on Minimal Television News Coverage of Health from Low- and Middle-Income Countries Authors: Imison, Michelle; Chapman, Simon Abstract: Australian television news and current affairs remain an important source of information for domestic audiences about both health and low- and middle-income countries. In November 2009, the successful surgical separation in Australia of conjoined infant twins from Bangladesh generated large-scale domestic media interest. In the 66 months to October 2010, only 75 health-related stories about Bangladesh were broadcast on Sydney television, 70 of them (93%) about these twins. Drawing on the television database of the Australian Health News Research Collaboration, this paper presents a thematic analysis of the Australian television news and current affairs coverage of the twins and why their case attained such a profile relative to other coverage of health from this nation. In addition to the predictable newsworthiness of a rare and bizarre medical condition and the made-for-television tension inherent in the saga of their arrival, preparation and eventual lengthy operation, prominent themes centred around the story’s opportunities to praise Australian individuals, medical skill and national character. The focus in this story on identified individuals with an uncommon condition requiring tertiary medical intervention only available in a high-income nation contrasts with a lack of coverage of, or critical consideration for, the well-being of anonymous individuals or less culturally-favoured groups, more long-term and mundane health considerations or any broader social or financial context to health issues in low- and middle-income countries. Reportage of foreign health issues appears contingent on the availability of populist ‘rule of rescue’ news frames, arresting footage and dramatic narratives that resonate with audiences’ expectations of such nations. The analysis offered in this paper illuminates the potential implications of such reporting for the wider news space available to health stories from low- and middle-income countries. 2011-06-28T00:00:00Z http://hdl.handle.net/2123/7703 Title: ‘Disease, Disaster and Despair’? The Presentation of Health in Low- and Middle-Income Countries on Australian Television Authors: Imison, Michelle; Chapman, Simon Abstract: In high-income nations mainstream television news remains an important source of information about both general health issues and low- and middle-income countries (LMICs). However, research on news coverage of health in LMICs is scarce. The present paper examines the general features of Australian television coverage of LMIC health issues, testing the hypotheses that this coverage conforms to the general patterns of foreign news reporting in high-income countries and, in particular, that LMIC health coverage will largely reflect Australian interests. We analysed relevant items from May 2005 – December 2009 from the largest health-related television dataset of its kind, classifying each story on the basis of the region(s) it covered, principal content relating to health in LMICs and the presence of an Australian reference point. LMICs that are culturally proximate and politically significant to Australia had higher levels of reportage than more distant and unengaged nations. Items concerning communicable diseases, injury and aspects of child health generally consonant with ‘disease, disaster and despair’ news frames predominated, with relatively little emphasis given to chronic diseases which are increasingly prevalent in many LMICs. Forty-two percent of LMIC stories had explicit Australian content, such as imported medical expertise or health risk to Australians in LMICs. Media consumers’ perceptions of disease burdens in LMICs and of these nations’ capacity to identify and manage their own health priorities may be distorted by the major news emphasis on exotic disease, disaster and despair stories. Such perceptions may inhibit the development of appropriate policy emphases in high-income countries. In this context, non-government organisations concerned with international development may find it more difficult to strike a balance between crises and enduring issues in their health programming and fundraising efforts. 2010-11-01T00:00:00Z http://hdl.handle.net/2123/7462 Title: Reviewer refusal rates for 300,866 requested reviews in 20 BMJ Group journals Authors: Chapman, Simon Abstract: Data were extracted from the BenchPress editorial management system for 20 journals which each had data for the years 2002-2010.We examined whether there were differences among journals on reviewer refusal rates. Across all journals, nearly one in three requests to review were declined (range 21.2-39.8). 2011-01-01T00:00:00Z http://hdl.handle.net/2123/6236 Title: From ‘our world’ to the ‘real world’: exploring the behaviour of policy-influential Australian public health researchers Authors: Haynes, A.S.; Derrick, G.E.; Redman, S; Chapman, S; Hall, W.D.; Gillespie, J.A.; Sturk, H. Abstract: Research and researchers influence the genesis and development of public health policy in limited but essential ways. Surveys and interviews with 36 peer-nominated “highly influential” Australian public health researchers found they engaged in a breadth of strategies that included rigorous but targeted research design, multilateral collaboration, multiple methods of research dissemination and promotion (including tactical use of the media), and purposeful development of bridging relationships. Researchers’ ability to understand the worlds of research, policy and the media and to speak their languages (or to work with others who fulfilled this role) was a key factor. Advocacy, a fundamental strategy for some, was disparaged by others. Influential behaviours were guided by values and beliefs about the principles underlying traditional science and the contrasting ethos of contemporary research. Description: Pre print 2010-01-01T00:00:00Z http://hdl.handle.net/2123/6116 Title: Challenges in assessing the characteristics of influential public health research. Authors: Derrick, Gjemma E; Hall, Wayne D; Haynes, Abby S; Chapman, Simon; Redman, Sally; Leeder, Stephen R; Sturk, Heidi Abstract: The development of frameworks to effectively measure both the scientific and social impact of research is a topic of international debate. This paper examines how Australian public health researchers in six fields (alcohol, drugs, injury, obesity, skin cancer and tobacco) classified the scientific and social impact of what they judged to be their five most influential papers. We compared classifications of researchers rated as most influential by their peers with those not as highly ranked. Highly ranked researchers more often indicated social impact characteristics (Χ2 = 8.13; P = 0.004) than their less influential colleagues. Traditional measures of scientific impact (publication in high impact journals and high citations) were nominated by all researchers regardless of peer-nominated research influence status. There was strong consensus on who were the most influential researchers in five of the six research fields examined. This would appear to provide a sound platform on which to base more qualitative, interview or portfolio-based investigations into the complexities of wider conceptions of research and researcher influence. Description: Pre print 2010-01-01T00:00:00Z