Trainee Presentations

C Turnour, M Cardona, M Frommer.

Aboriginal health is characterised by a complex policy and reporting environment and a multitude of Commonwealth, State, regional and local policies.

To provide a structured and rigorous approach to the evaluation of Aboriginal health programs, a program evaluation framework was developed for the NSW Centre for Aboriginal Health within the NSW Department of Health in 2006. The framework encompasses: priority setting; program development and implementation; and effectiveness. The key Aboriginal health principles of cultural respect, holistic approach and community engagement and control are emphasised at each step in the framework. The evaluation framework addresses these issues by posing a series of questions to assess each program. It then outlines how to respond to the evaluation questions and synthesize the observations.

Applying the evaluation framework will highlight areas for improvements, strengthen Aboriginal health evaluation capacity and improve the quality of information on program performance. The approach the framework advocates is suitable for internal and external evaluations and could also be applied to other Aboriginal health programs. This presentation describes the principles, structure and application of the framework, and outlines its potential to improve the value and appropriateness of Aboriginal health programs.

Paragraph on Indigenous involvement

The Framework was developed for the NSW Centre for Aboriginal Health. It is a theoretical proposal that emphasises at each step the critical role of Aboriginal community engagement in the evaluation process. An Advisory Group was convened to provide advice on the framework's scope, structure and content. This Group included two Aboriginal members with knowledge of health program delivery and four non-Aboriginal people with knowledge of health service delivery across NSW. Four Aboriginal program managers were interviewed regarding the content of the framework. The Framework should be used as a theoretical proposal and its practical implementation could involve modifications or adaptation through engagement of the relevant Aboriginal service managers and consumers.

L Seehofer, M Lam, C Moreira.

Children from a refugee background have been reported to have greater health needs than the mainstream population. The majority of refugees arriving in Australia resettle in greater western Sydney. In collaboration with a number of other agencies and service providers, Sydney West Area Health Service conducted a pilot health clinic at a local primary school during August and September 2006. Primary school-aged children and their families were offered immunisation and screening for tuberculosis, schistosomiasis, hepatitis B, vitamin D deficiency and anaemia, with referrals or treatment being arranged as appropriate.

About 30 families who had arrived in Australia from the Horn of Africa during 2004 and 2005 attended the health clinic. An evaluation was conducted to determine the need, viability and sustainability of the clinic in the school setting. Qualitative and quantitative research methods were used to investigate community mobilisation, clinic operations and follow-up. A series of interviews, focus groups and questionnaires were undertaken with clinic attendees, school staff and service providers. The number of health interventions provided, costs and resources used were measured. Results are currently being collated and analysed. This presentation will explore the findings of the evaluation and discuss the implications for future clinic operations.

I Evans, K Cannings, P Lewis.

Influenza vaccination of staff at aged care facilities (ACF) is recommended as an effective way of reducing illness and virus transmission amongst both staff and vulnerable elderly residents, however, staff uptake of the vaccine remains low.

To investigate reasons for low uptake, a phone survey of 19 ACF directors in the Northern Sydney Central Coast Area Health Service was undertaken, which asked questions about influenza vaccination policy and practices. Access to influenza vaccination was good for most staff: 75% of facilities offered the vaccine free or at a reduced price, with some flexibility in vaccine clinic times. An average of one third of staff had the vaccine in 2006 (range 3-60%) and directors discussed perceived barriers and possible interventions.

A self-administered written questionnaire was subsequently completed by 239 nursing, administration and domestic staff from the 19 ACF. Forty-five percent of respondents reported having the vaccine in 2006. Many staff expressed a desire for more information about influenza and about the vaccine and its side effects. Those who were not vaccinated cited reasons including good health, previous illness post-vaccination, dislike of needles and lack of access. This information will be used to provide targeted education tools to ACF staff aimed at increasing influenza vaccine uptake.

P Morton, J Mitchell, SESI DPH Equity Initiative Advisory Group.

The local health service has a clear role in addressing the social determinants of health as it is the most community-embedded component of the government public health structure. There is little evidence however as to what local health services can do to reduce inequities.

In January 2007, the South East Sydney Illawarra Area Health Service Division of Population Health (DPH) initiated the 'Equity Initiative' which aims to determine methods of integrating equity into core work practice. Equity had been identified as a priority for the DPH and was also seen as an opportunity to further develop its organisational culture.

For the first phase of the initiative a literature review focusing on equity and organisational change was conducted. The 'cultural transformation' model was chosen to guide the change process and a list of recommendations for integrating equity into local health services was developed. Staff consultations and a planning day built support for the initiative and provided opportunities for staff input.

As a result, 'Recommendations for Action for Integrating Equity' was produced. Although yet to be implemented, these recommendations may provide a guide for other population health divisions interested in addressing health inequity.

A Craig, P Armstrong.

The rapid identification and isolation of suspected cases of pandemic influenza and the activation of public health interventions will be critical for the effective containment of pandemic influenza. In NSW, emergency departments will play a key role in identifying, isolating, treating, and managing suspected cases of pandemic influenza.

On 30 November 2006, all emergency departments (N=210) and public health units in NSW were involved in a simulation exercise, called Exercise Paton, to test their ability to respond to suspected cases of pandemic influenza in the early stage of a pandemic.

Exercise Paton was evaluated, and recommendations made, from feedback received from observers in the field, questionnaires and interviews with stakeholders, and feedback gleaned from statewide debriefing sessions.

Key recommendations relate to infection control, patient management, case and contact data management, management of accompanying people, rapid specimen transportation (from rural areas) and managing surge capacity.

The presentation will focus the outcomes of this exercise reflecting on lessons learnt and will discuss how Exercise Paton has informed biopreparedness planning in NSW. The presentation will be of particular interest to those involved in biopreparedness and disaster planning and those conducting exercises to test health system responses to emergencies.

C Wallace, T Gallaway, R McKetin, E Kelly.

Methamphetamine use may result in, or exacerbate, a number of acute physical and psychological harms.

This study investigated the socio-demographic and health characteristics, patterns of drug consumption and extent of methamphetamine dependence among 140 regular methamphetamine users residing in rural and regional areas of the North Coast of NSW.

Participants were predominantly in their thirties, male (63%), Australian-born (89%), and had low levels of education and high levels of unemployment (81%). A high proportion (54%), were currently receiving drug or alcohol treatment, most of whom (46 of 51) were enrolled in opioid replacement therapy. However, only 25% had received treatment for methamphetamine use in the past year. Almost all injected methamphetamines (95%) and 59% were classified as severely dependent. Polydrug use was common; 26% drank alcohol daily and 59% smoked cannabis daily. A high proportion experienced moderate to severe physical (63%) and mental health (83%) disability; 61% had been diagnosed with depression; 49% with anxiety disorders and 38% had been told by a doctor that they had experienced a drug-induced psychosis.

Implications for planning health services, disseminating credible health information, providing suitable interventions and improving treatment coverage in rural and regional areas are discussed.

S Rudge, M Staff, G Richards.

Commercial fishing was suspended in Sydney Harbour in February 2006 as a result of high dioxin levels identified in some marine species. The source of the dioxin was assumed to be the known contamination in and around Homebush Bay. Homebush Bay, 15 kms west of the centre of Sydney, was home to extensive chemical industry along its shores during much of the 20th century.

Some Sydney Harbour commercial fishers were concerned about their own dioxin levels as they ate substantial quantities of their catch, and requested that the government provide blood testing. The advice from NSW Health was that while the fishers might be expected to have dioxin levels higher than Australian background because of their fish consumption, these levels would not be expected to have reached those which have been demonstrated to be associated with adverse health effects.

This presentation will discuss the process of providing blood testing and giving results to the fishers and their family members amidst significant media interest. Some of the ethical issues associated with testing when the results are likely to demonstrate exposure to a hazard but not be able to quantify the level of risk are also discussed.

R Khan, D Muscatello, W Zheng, T Churches.

The NSW syndromic surveillance system is a near "real-time" emergency department surveillance system called "PHREDSS". Since 2003, it has operated with the aim of providing broad based early warning of public health hazards.

The study aimed to analyse the public health utility of PHREDSS and assess how it can be integrated into public health practice. The method involved documenting and analysing the alerts issued from PHREDSS and the resulting public health action.

During the study period, forty-three alerts were sent. The main syndromes that sparked alerts were gastroenteritis, asthma, injury and poisoning, and drug and alcohol. Action included patient follow-up, inspection of food premises and issue of media releases.

Based on the results of this study, we propose a framework for interpreting the relationships between syndromic surveillance, surveillance functions and information needs for improving population health. There are five main public health domains that syndromic surveillance can feed into: bioterrorism and emerging diseases, communicable disease, environmental health, mental health, injury and poisoning, and drug and alcohol. There is a need to integrate syndromic surveillance with other public health functions. Achieving this will greatly improve population health as information available in near real time can be used to assess and mitigate public health problems.

K Kardamanidis, L Kemp, E Harris

Intervening in early childhood is an effective way of reducing health differentials. Early intervention first requires identification of women whose children are likely to be at risk of poorer life outcomes. In south-western Sydney, pregnant women are assessed for the presence of psychosocial problems by a midwife when booking-in for hospitalisation. Preliminary findings of a sustained nurse home visiting (MECSH) trial suggest that not all women disclose psychosocial problems during the assessment. A suggested reason is that to disclose sensitive information, a trust-relationship between the women and health professional is needed. Such a trust-relationship is unlikely to exist at a first meeting but is more likely to develop over time as in the engagement between a woman and a nurse home visitor.

This project investigates the MECSH child and family health nurses' experiences, feelings and beliefs about disclosure of sensitive information by, and their relationships with women in the trial.

A qualitative study was undertaken with three nurses who have worked on the MECSH program. Two semi-structured interviews were conducted with each nurse, audio-taped, and transcribed verbatim. Emergent and latent themes were identified. Results will be illustrated with quotes and improvements to the antenatal psycho-social assessment process will be proposed.