Journal articles on the topic 'Immigrants Services for Western Australia Perth'

In October 2017, the Department of Primary Industries and Regional Development of Western Australia (WA) promulgated a new regulation on recreational abalone harvesting. A notable change was that, from 2017 on, the annual fishing season in the West Coast Zone was reduced to four days, from every December on Saturdays only. During the last decade, WA’s abalone fishing regulations have been overhauled frequently because of depleting local stocks. Worldwide, the marine heatwave resulting from climate change and illegal overfishing are considered the two principal reasons for abalone’s decline. Today, the highly lucrative abalone market has attracted more participants in recreational fishing in Perth, WA. Based on Asian natural heritage traditions and employing a multispecies sensory ethnographic methodology, this article provides an in-depth case study of the interaction between the local Chinese diaspora and the environment as represented in abalone harvesting practices. Between 2014 and 2016, the authors conducted one-on-one and focus group interviews with Chinese immigrants to Perth, WA, and also participated in abalone harvesting. The analysis reveals a suite of environmental influences on local Chinese diasporic life through heterogeneous forms of interaction between abalone and Perth-area Chinese immigrants.

A satellite endoscopy service was formally established in late January 1997 in oneperipheral hospital, a second service commencing in April 1997, and a third inDecember 1997. More than 500 patients underwent gastrointestinal endoscopicprocedures at these satellite services during 1997. The feedback received to dateindicates that the establishment of this service is supported by patients and theperipheral hospitals. It is expected that this project will achieve all its stated objectives.In addition, the implementation of this service will assist in improved waiting listmanagement at Royal Perth Hospital. The satellite endoscopy service is a uniquedevelopment in Western Australia and has demonstrated definite benefits to patientsin less than six months of operation.

AbstractThere is a paucity of published information about conceptions of Aboriginal child rearing and development among urban dwelling Nyoongar/Aboriginal people in Australia. We detail the unique findings from an Aboriginal early child development research project with a specific focus on the Nyoongar/Aboriginal community of Perth, Western Australia. This research significantly expands the understanding of a shared system of beliefs and values among Nyoongar people that differ in important ways from those of the broader Australian (Western) society. Consistent with the findings of research with other Aboriginal groups in Australia, and internationally, our work challenges assumptions underpinning a range of early childhood development policies and highlights the implications of cultural biases and misunderstandings among non-Aboriginal professionals in child and family services, education and other settings.

Geographically, Western Australia (WA) is one of the largest and most sparsely populated single jurisdictions in the world. Although much of the work of Community Corrections Officers (CCO) in metropolitan Perth is easily recognizable to offender managers in England and Wales, the state’s Indigenous citizens, many living in remote communities, are hugely over-represented in its prisons and pose particular challenges in respect of community supervision. The de-professionalization of CCO training and their supposed inter-changeability with prison officers led to a service that was in danger of ‘losing its way’ and whose performance was comparing unfavourably with that of other Australian states. This article traces the recent history of the post-Mahoney Report Department of Corrective Services, culminating in a return to the title of ‘Probation and Parole’, and asks whether the lessons learned in WA following this re-professionalizing process might be relevant to other jurisdictions.

Background: The Sexual Assault Resource Center (SARC) in Perth, Western Australia provides free 24-hour medical, forensic, and counseling services to persons aged over 13 years following sexual assault. Objective: The aim of this research was to design a data management system that maintains accurate quality information on all sexual assault cases referred to SARC, facilitating audit and peer-reviewed research. Methods: The work to develop SARC Medical Services Clinical Information System (SARC-MSCIS) took place during 2007–2009 as a collaboration between SARC and Curtin University, Perth, Western Australia. Patient demographics, assault details, including injury documentation, and counseling sessions were identified as core data sections. A user authentication system was set up for data security. Data quality checks were incorporated to ensure high-quality data. Results: An SARC-MSCIS was developed containing three core data sections having 427 data elements to capture patient’s data. Development of the SARC-MSCIS has resulted in comprehensive capacity to support sexual assault research. Four additional projects are underway to explore both the public health and criminal justice considerations in responding to sexual violence. The data showed that 1,933 sexual assault episodes had occurred among 1881 patients between January 1, 2009 and December 31, 2015. Sexual assault patients knew the assailant as a friend, carer, acquaintance, relative, partner, or ex-partner in 70% of cases, with 16% assailants being a stranger to the patient. Conclusion: This project has resulted in the development of a high-quality data management system to maintain information for medical and forensic services offered by SARC. This system has also proven to be a reliable resource enabling research in the area of sexual violence.

Research on food insecurity in Australia has typically relied on a single-item measure and finds that approximately 5% of the population experiences food insecurity. This research also finds that demographic characteristics such as household composition and marital status affect levels of food insecurity, independent of income level. The present study examines the prevalence and correlates of food insecurity in a cohort (n = 400) of people experiencing entrenched disadvantage in Perth, Western Australia. Using the US Department of Agriculture Household Food Security Survey Module, we find that food insecurity at the household, adult, and child level is at sharply elevated levels, with 82.8% of the sample reporting household food insecurity, 80.8% and 58.3% experiencing food insecurity among adults and children, respectively. Demographic characteristics do not significantly affect levels of food insecurity, and food insecurity is associated with negative physical and mental health outcomes. Food insecurity is positively correlated with access to food emergency relief services, indicating that these services are being used by those most in need, but do not address the root causes of food insecurity. Policy and practice should focus on increasing stable access to adequate quantities and quality of food and addressing the structural causes of food insecurity.

The widely applied Importance-Performance Analysis (IPA) provides relatively simple and straightforward techniques to assess how well the attributes of a good or service perform in meeting the expectations of consumers, clients, users, and visitors. Surprisingly, IPA has rarely been applied to inform the management of urban public green infrastructure (PGI) or urban nature (UN) spaces. This case study explores the visitor satisfaction levels of people using a PGI space that incorporates UN, close to the central business district of Perth, Western Australia. With diminishing opportunities to acquire new PGI spaces within ever more densely populated urban centers, understanding, efficiently managing, and continuously improving existing spaces is crucial to accessing the benefits and services that PGI and UN provide for humankind. An intercept survey conducted within the Lake Claremont PGI space utilized a self-report questionnaire to gather qualitative and quantitative data (n = 393). This case study demonstrates how the IPA tool can assist urban planners and land managers to collect information about the attributes of quality PGI and UN spaces to monitor levels of service, to increase overall efficiency of site management, to inform future management decisions, and to optimize the allocation of scarce resources. The satisfaction of PGI users was analyzed using the IPA tool to determine where performance and/or resourcing of PGI attributes were not congruent with the expectations of PGI users (generally in the form of over-servicing or under-servicing). The IPA demonstrated that a majority of PGI users perceived the study site to be high performing and were satisfied with many of the assessed attributes. The survey identified the potential for some improvement of the amenity and/or infrastructure installations at the site, as well as directing attention towards a more effective utilization of scarce resources. Optimizing the management of PGI spaces will enhance opportunities for individuals to obtain the physiological, psychological, and emotional benefits that arise from experiencing quality urban PGI spaces. This case study promotes the important contribution that high-quality PGI spaces, which include remnant and restored UN spaces, make to the development of resilient and sustainable urban centers.

Abstract Background There has been concern that patients with malignant disease from remote and regional country areas may have adverse outcomes compared with those from cities. Western Australia (WA) with an area of 2,526,786 square kilometers, is one third the size of Australia. It has a population of 2.6 million of which 92% live in the capital city Perth and the southwest corner. In WA, multiple myeloma is managed in tertiary public hospitals and private physician practice located in Perth. While oral based immunomodulators and alkylators are readily delivered in the regional areas, patients travel to Perth for parenteral chemotherapy and stem cell transplantation. The WA state government subsidizes transport and accommodation for patients from regional areas to travel to Perth for treatment and clinical review via the Patient Assisted Travel Scheme (PATS). Telehealth through video conferencing is also used for review of patients on oral-based anti-myeloma treatment or during surveillance periods to avoid expensive and time-consuming travel to Perth. The Royal Flying Doctor Service (RFDS), a non-profit medical organization, provides prompt transfer of unwell patients from regional and remote areas of WA to Perth. Pathology services in remote regions are provided by the publicly funded PathWest organization. Method We retrospectively reviewed the survival outcomes of patients with multiple myeloma in the WA public healthcare system. Patients diagnosed between 2008 to 2017 were included (n=569). Staging information was extracted from the laboratory information system and the cytogenetic database in PathWest. Patient demographics, complications requiring admission, mortality and follow-up data were extracted from the public hospital patient management systems. Patients were segregated into regional or metropolitan by their residential address postcodes. Patients diagnosed and/or followed-up in the private sector were excluded. Survival was analyzed by Kaplan-Meier curves, Log-rank test and Cox proportional hazards model. Result Median age at diagnosis was 67 years old (range 29 to 98), with 56% above 65 years. 56% were males, 44% were females. Overall median survival was 46 months (95%CI:41,52). 1-year, 3-years and 5-years survival rates were 80%, 56% and 30% respectively. 25% (n=143) of patients resided in regional areas. No statistically significant difference in overall survival time between patients from metropolitan and regional areas was identified (p=0.2): 47 months (95% CI:43,54) and 42 months (95% CI: 33,54) respectively. Subgroup analysis also did not find any significant difference in overall survival of each R-ISS staging between metropolitan and regional areas. Discussion This retrospective study provides real-life survival data of of an Australian-based population in a state with a large land mass and low population density outside the capital city. The overall survival of patients living in regional areas was not significantly different from those living in the capital city. This gives credence to the benefit of the WA government supported regional network of travel, accommodation and Telehealth conferencing overcoming the distance barrier in the provision of comprehensive medical care in the management of a hematological malignancy. Figure. Figure. Disclosures No relevant conflicts of interest to declare.

The aim of the study was to explore the lived experiences of people diagnosed with cancer from rural and remote areas of Western Australia, who utilise supported accommodation services whilst undergoing treatment in the capital city (Perth). Methods A qualitative phenomenological approach was used in this study. Ten participants were recruited using purposive sampling, who were aged between 35–65 years, were diagnosed with cancer within the previous three months and used accommodation services within the past 12 months. Semi-structured in-depth interviews were conducted with a duration of approximately 45–60 min via Zoom, FaceTime or phone call. Interview data was transcribed, thematically analysed and coded into relevant themes. Results: Three overarching themes were derived from the interviews–“It’s harder to have cancer when you have to relocate for treatment,” “The paradoxical experience of staying at the accommodation,” and “Feeling grateful for the support offered’. Conclusions: People diagnosed with cancer who have to relocate during treatment require emotional, logistical, and social supports. Cancer accommodation services are essential in enabling individuals to continue engaging in meaningful occupations and maintain their quality of life. Our study highlights the need for cancer accommodation services to consider the complex needs of individuals completing treatment for cancer in locations away from their usual homes.

Wanslea Family Services (WFS), a non-government family welfare agency in Perth, has provided foster care placements for the Western Australian Department of Family and Children's Services for many years. Data about these children and their families is held in a comprehensive electronic database that covers the period 1991-1999. This 9-year data set is unique in Western Australia and may be unique nationally.An analysis of this data indicates no significant variation across the nine year period for age at admission of children to foster care. In contrast, a statistically significant cubic trend was found for length of episode of care indicating that the duration of foster care placements significantly varied across the nine year period. Analyses of gender for both age at admission and length of foster care showed significant differences but only for particular years. In 1995 females were significantly younger than males while in 1998 males were significantly younger than females. Only in 1998 was length of episode of care significant when it was shorter for males than females. Possible explanations for these results are discussed.

It is likely that young people who are both Aboriginal and Torres Strait Islander and LGBTQA+ would be at increased risk for poor mental health outcomes due to the layered impacts of discrimination they experience; however, there is very little empirical evidence focused on the mental health and wellbeing of Aboriginal and Torres Strait Islander LGBTQA+ young people. The current study represents a qualitative exploration of wellbeing among Aboriginal LGBTQA+ young people. This study consisted of semi-structured interviews and focus groups with Aboriginal LGBTQA+ young people aged 14–25 years old in the Perth metropolitan area of Western Australia. Thematic analysis identified seven major themes that were significant to participants’ wellbeing: identity, family, community, visibility, services, stigma and navigating.

Objective: The aim of this study was to compare levels of emotional and behavioural problems and competencies among immigrant and non-immigrant adolescents, and to determine factors that may contribute to any differences reported. Method: Subjects were selected randomly from students aged 12-16 years attending a high school with a high proportion of immigrants in Perth, Western Australia. Parents completed the Child Behaviour Checklist (CBCL), and students completed the Youth Self-Report (YSR) and a Personal History Questionnaire. Results: On univariate analyses, non-immigrant adolescents had significantly higher CBCL and YSR scores than immigrant adolescents. Multivariate analyses suggested that CBCL scores were predicted by a number of variables other than immigration, including family intactness, socioeconomic status (SES) and gender. Higher YSR scores were predicted by non-intact families, school setting and non-immigrant status, and higher competencies scores were predicted by higher SES and parents not being immigrants. Conclusions: In assessing the effects of immigration on adolescent mental health, it is important to control for factors associated with adolescent behavioural and emotional problems and to use multiple informants. Overall, immigrant adolescents report fewer total and externalising problems and fewer competencies than native-born adolescents. This finding may reflect strict immigration policies or cultural differences in definitions of psychopathology and the social expectations for adolescents' behaviour.

The United Nations’ Sustainable Development Goals (SDGs) are regarded as the key policy agenda for national, regional, and local government to combat climate change impacts and promote sustainable development. For example, in Perth and Peel metropolitan area, the capital city of Western Australia, there has been a shift of policy setting from that of a sprawling city to a denser city, while maintaining and promoting its ecosystem services and achieving sustainable city goals. Residential verge gardens have been widely adopted in recent years by communities and local governments in the Perth metropolitan area. This study reviews the motivations and drivers for the uptake of verge gardens in metropolitan suburbs and identifies potential policy responses. The City of Bayswater local government area was surveyed for this research. The study considers a mixed-methods approach, including site auditing and a questionnaire survey for local residents who have transformed their verges. A total of 534 verge gardens were audited on residential lots, and 166 valid questionnaire responses were received from residents. The site-audit of the verge gardens in Bayswater found that native vegetation is the dominant verge garden of choice, followed by the ornamental garden, with food production (plants/vegetables) seeming to be the least popular option. Regarding the motivations and drivers, the study has found that social (e.g., aesthetics, flowers, social interactions, and social mimicry), environmental (e.g., attracting wildlife and birds and environmental practice waterwise garden), and personal (easy maintenance) drivers are the primary motivators for residents to adopt verge gardens. Whilst the on-ground surveys were prior to COVID-19, the article includes how this topic could relate to pandemic-resilient urban spaces. As local governments look towards supporting the sustainable outcome goals, the observations of this study will be helpful for developing local government policy and community programs in the promotion and uptake of verge gardens in Australian cities.

Park-and-ride (PnR) facilities provided by Australian transport authorities have been an effective way to encourage car drivers to use public transport such as trains and buses. However, as populations grow and vehicle running costs increase, the demand for more parking spaces has escalated. Often, PnR facilities are filled to capacity by early morning and commuters resort to parking illegally in streets surrounding stations. This paper reports on the development of a location-based parking finding service for PnR users. Based on their current location, the system can inform users which is the best station to park their cars during peak period. Two criteria—parking availability and the shortest travel time—were used to evaluate the best station. Fuzzy logic forecast models were used to estimate the uncertainty of parking availability during the peak parking demand period. A prototype using these methods has been developed based on a case study of the Oats Street and Carlisle PnR facilities in Perth, Western Australia. The system has proved to be efficacious and has the potential to be applied to other parking systems.

AbstractObjectiveThe present study explored recipients’ perceptions of food charity and their suggested improvements in inner-city Perth, Western Australia.DesignIn-depth interviews were conducted with charitable food service (CFS) recipients. Transcripts were thematically analysed using a phenomenological approach.SettingInterviews were conducted at two CFS in inner-city Perth.SubjectsFourteen adults.ResultsThe recipients’ journeys to a reliance on CFS were varied and multifactorial, with poverty, medical issues and homelessness common. The length of time recipients had relied on food charity ranged from 8 months to over 40 years. Most were ‘grateful yet resigned’, appreciative of any food and resigned to the poor quality, monotony and their unmet individual preferences. They wanted healthier food, more variety and better quality. Accessing services was described as a ‘full-time job’ fraught with unreliable information and transport difficulties. They called for improved information and assistance with transport. ‘Eroded dignity’ resulted from being fed without any choice and queuing for food in public places, often in a volatile environment. ‘Food memories and inclusion’ reflected a desire for commensality. Recipients suggested services offer choice and promote independence, focusing on their needs both physical and social.ConclusionsAlthough grateful, long-term CFS recipients described what constitutes a voluntary failure. Their service improvement recommendations can help meet their nutritional and social needs. A successful CFS provides a food service that prioritises nutritious, good-quality food and individual need, while promoting dignity and social inclusion, challenging in the current Australian context.

Cultural security is a key element of accessible services for Indigenous peoples globally, although few studies have examined this empirically. We explored the scope, reach, quality, and cultural security of health and social services available to Aboriginal and/or Torres Strait Islander families in Western Australia (WA), from the point of view of staff from the services. We recruited staff from health and social services for Aboriginal people in the Perth, Kalgoorlie, Great Southern, and South West regions of WA between December 2015 and September 2017 to complete online surveys. We examined the proportions of participants that responded saying the service was culturally secure, the reasons for the response, and perceived factors related to a high-quality service. Sixty participants from 21 services responded to the survey. Seventy-three percent stated the service was culturally secure; however, only 36% stated that the staff employed at the service had sufficient knowledge on cultural security. Participants suggested having Aboriginal staff and better cultural awareness training as methods to improve cultural security within the service. Participants highlighted that staffing, funding for resources, and patient financial difficulties in accessing care as key areas for quality improvement. Much greater effort is required in improving knowledge through on-going training of staff in the practice of culturally safe care. Organisations must also be required to meet specific standards in cultural safety.

This Data Descriptor shares the dataset generated by a visitor satisfaction survey of users of a mixed-use public green infrastructure (PGI) space in Perth, Western Australia, that incorporates remnant and reintroduced urban nature (UN). Conducted in the Austral summer of 2016–2017, the survey (n = 393) utilized the technique of Importance-Performance Analysis (IPA) to elucidate perceptions of PGI users regarding performance of the amenity and facilities at the study site. There is a growing body of research that reports the innate, inbuilt affinity of humans to natural systems and living things. As humankind has grown exponentially over the past 50 years, humanity, as a species, is living an increasingly urbanized lifestyle, resulting in spreading urban footprints and increased population densities that are causing humans to become increasingly disconnected from nature. These conflicting phenomena are driving research to understand the contribution that PGI and UN can make to enhancing the quality of life of urban residents. With diminishing opportunities to acquire or create new PGI spaces within ever-more-densely populated urban centers, understanding, efficiently managing, and continuously improving existing PGI spaces is crucial to access the benefits and services that PGI and UN provide. The IPA technique can provide the data necessary to inform an evidenced-based approach to managing and resourcing PGI and UN spaces.

Regular physical activity has multiple benefits for older adults, including improved physical, cognitive, and psychosocial health. This exploratory study investigated the benefits of a 12-week exercise program for older adults (n = 11 control and n = 13 intervention) living in a residential aged care facility in Perth, Western Australia. The program, prescribed and delivered by an accredited exercise physiologist, aimed to maintain or improve participants’ physical capacity. It comprised one-on-one exercise sessions (1 hr × 2 days/week × 12 weeks), involving a components-approach intervention. Physical performance measures (balance, strength, flexibility, and mobility) were assessed preintervention and postintervention. Qualitative interviews postintervention with residents participating in the exercise intervention, and with family members, staff, and research team members, explored barriers and enablers to participation and perceived psychosocial outcomes. Findings indicate the program provided physical benefits and enhanced social engagement for participants, illustrating the value of providing exercise physiology services in the aged care sector.

This article reports on a study of parents’ and children's responses to the service they received at two Family Relationship Centres (FRCs) in Perth, Western Australia. Family members who had attended either the Mandurah or Joondalup FRCs sponsored by AnglicareWA between 2010 and 2012 were invited to complete a survey that asked them for their views on the services they had received. A total of 74 parents, representing 139 children, completed the survey. Findings indicated significant satisfaction with the two-hour group session that introduces the work of the FRCs, with parents reporting they could remember the main messages from the session. A surprising finding, and one that has not been reported elsewhere, is that parents expressed an unwillingness to invite their own children to participate in the work of the Centres, although the majority of the respondents agreed in principle that children should take part. The implications of this finding are briefly discussed.

With the ageing of populations around the world, hospitals seeking to maximise the satisfaction of their patients will need to ensure their services meet the expectations of the growing segment of older patients. Four focus groups were conducted in Perth, Western Australia, to explore those aspects of a hospital stay that are considered to be most important to older patients. The focus group participants nominated nursing care, meals, admission procedures, communication processes and physical facilities as those aspects of hospital service that are of particular importance to older patients. They noted that these issues are likely to be relevant to some degree to all patients but that, due to the needs of older patients, they become especially critical in later years. These findings have similarities with those generated by other studies but are more extensive than described elsewhere and thus provide more detailed guidance for hospital managers seeking to ensure their facilities are senior-friendly.

Objective. To estimate the incidence of interpersonal violence presentations to general practitioners (GPs). Methods. A postal survey of all GPs in Western Australia (WA) was conducted in 2009 using a structured questionnaire. Results. Among the n = 476 respondents (response rate 28%), 379 GPs treated 9572 patients for a violent incident during the past year. The rate of violent presentations in rural WA was double that of metropolitan areas (incident rate ratio (IRR) 1.9, 95% CI 1.8–2.0), whereas the rate of violent episodes in remote GP practices was 7-fold higher (IRR 7.2, 95% CI 6.8–7.6). Halls Creek in remote northern WA was found to be a ‘hot spot’ with a high cluster of violence cases, whereas metropolitan suburbs surrounding Perth had relatively low concentrations of violence presentations. Conclusions. Further understanding of the size and nature of the problem is required in view of the low response rate. High-risk groups, such as women and those living in rural and remote areas, should be targeted for special attention. What is known about the topic? Previous studies of interpersonal violence have been based on victim surveys or crime databases, which are subjected to both under- and over-reporting. Hospital admission and mortality statistics represent severe injuries resulting from violence episodes. However, victims who sought treatment from GPs are not routinely recorded. What does this paper add? Rural and remote GP practices reported a higher incident of violent presentations than their metropolitan counterparts. The finding provides a basis to further investigate the level of GP services for treating interpersonal violence injuries. What are the implications for practitioners? Sentinel surveillance of GPs is recommended. High-risk groups such as women and those living in rural and remote areas should be targeted for attention.

Objective This study investigated the link between socioeconomic status and unplanned dental presentations at the Perth Children’s Hospital (PCH), as well as the link between the socioeconomic status of unplanned dental patients and any previous admissions to the PCH. Methods Records of 351 unplanned visits to the PCH were collected, including reason for attendance (infection, trauma, other), the patient’s residential location (suburb) and the history of any previous presentations at the PCH. The socioeconomic status of each patient was based on the Index of Relative Socio-Economic Disadvantage, divided into quintiles. Geographic information systems (GIS) were used to spatially map the residential locations of the patients with unplanned dental presentations. QGIS was used to map and geocode the data. Analysis of variance and Chi-squared tests were used to determine associations between subgroups and other variables. Results ‘Unplanned dental presentation’ in this study refers to patients who present without an appointment, including by referral from the emergency department of the PCH or outside the PCH. Approximately two-thirds of unplanned dental presentation among patients from low socioeconomic groups were for dental infection, whereas the major reason for presentation among patients from higher socioeconomic groups was trauma. More than half the patients in low socioeconomic groups had at least one previous presentation at the PCH due to other medical issues. Conclusion Children from low socioeconomic groups, or from outside of Perth, were more likely to present with dental infections, which are mostly preventable at the primary care level; these patients often presented a more significant burden to the health system. Public health interventions should aim to promote preventive oral health care, especially for children from low socioeconomic groups. What is known about the topic? In Western Australia, the most common dental problems requiring hospitalisation among children is dental caries, and children from the lowest socioeconomic backgrounds have the highest prevalence of dental hospitalisations. What does this paper add? Children from lower socioeconomic backgrounds were more likely to have an unplanned presentation at the only tertiary children’s hospital in Western Australia due to dental infection. What are the implications for practitioners? Improved access to public dental services, especially in low socioeconomic areas, and the development of more strategies to reduce unplanned dental presentations at a tertiary hospital are needed.

IntroductionPreconception carrier screening (PCS) identifies couples at risk of having children with recessive genetic conditions. New technologies have enabled affordable sequencing for multiple disorders simultaneously, including identifying carrier status for many recessive diseases. The aim of the study was to identify the most effective way of delivering PCS in Western Australia (WA) through the public health system.Methods and analysisThis is a multicentre cohort pilot study of 250 couples who have used PCS, conducted at three sites: (1) Genetic Services of Western Australia, (2) a private genetic counselling practice in Perth and (3) participating general practice group practices in the Busselton region of WA. The primary outcome of the pilot study was to evaluate the feasibility of implementing the comprehensive PCS programme in the WA healthcare system. Secondary outcome measures included evaluation of the psychosocial impact of couples, such as reproductive autonomy; identification of areas within the health system that had difficulties in implementing the programme and evaluation of tools developed during the study.Ethics and disseminationApproval was provided by the Women and Newborn Health Service Human Research Ethics Committee (HREC) at King Edward Memorial Hospital for Women (RGS0000000946) and the University of Western Australia (UWA) HREC (RA/4/20/4258). Participants may choose to withdraw at any time. Withdrawal will in no way affect participating couples' medical care. Study couples will be redirected to another participating health professional for consultation or counselling in the event of a health professional withdrawing. All evaluation data will be deidentified and stored in a password-protected database in UWA. In addition, all hard copy data collected will be kept in a locked cabinet within a secure building. All electronic data will be stored in a password-protected, backed-up location in the UWA Institutional Research Data Store. All evaluative results will be published as separate manuscripts, and selected results will be presented at conferences.

Objective: To describe the epidemiological and other characteristics of emergency department (ED) presentations diagnosed with acute upper respiratory infection (URI). Design and setting: A retrospective study of patients given an ED diagnosis of acute URI from July 2000 to July 2003 at any of the four metropolitan teaching hospitals in Perth, Western Australia. Results: Acute URI accounted for 3.6% (95% CI, 3.5?3.7) of ED presentations, and 80.7% (95% CI, 80.1?81.3) of these were aged less than 15 years. The most common diagnosis was acute upper respiratory infections of multiple and unspecified sites, followed by croup and acute tonsillitis. Of those with croup, 76.0% (95% CI, 74.7?77.3) presented at night, 67.6% (95% CI, 66.2?69.0) were male and the number of presentations with croup was highest in June 2002. The number of diagnoses of acute tonsillitis did not display a great deal of variation from month to month. Overall, hospital admission was 12.3% (95% CI, 11.8?12.8), with a median length of hospital stay of 1 day (IQR 1.0?2.0). An increase in comorbidity, residing in the most disadvantaged areas, and being a re-presentation increased the odds of being admitted. Conclusion: Further investigation is needed into whether alternative medical care services would be appropriate and acceptable for patients with less severe acute URIs.

Involving children and young people in planning, decision making and the evaluation of services and programs inevitably raises the eyebrows of adults working in the areas of service delivery, program development and policy formulation. Some adults may question young people’s ability to see the ‘big picture’ and to make decisions, and even their right to be engaged in the first place. In challenging these ideas, the Western Australian Office for Children and Youth established a Children’s Advisory Group (CAG) in 2004 – the first of its kind to be created within the Western Australia Government, and one of the first such groups to be set up in Australia.The current Children’s Advisory Group (CAG) is a diverse group often primary school children aged 9-12 years from the Perth metropolitan area. They are actively involved in all aspects of the Office’s operation. The CAG has been evaluated throughout its inaugural year of operation, both in terms of process and impact, and has been found to have a significant impact upon government policy and practice. This paper will outline the process for the establishment and implementation of a CAG and the evaluation of a CAG on government policy. It will highlight evaluation findings and discuss future directions.

Introduction: Australia's largest state, Western Australia (WA), comprises a land area of more than 2.5 million square kilometres, an area than larger than that of Texas and Alaska in the United States combined, with a population of more than 2.6 million. Whilst a large proportion of Western Australians live in the capital city Perth, approximately 20% are dispersed across the state in regional and remote areas. The diagnosis and treatment of myeloma require specialist Haematologist management and frequent follow-up. Access to Haematology specialist services and treatment in WA is centred in metropolitan Perth, with outreach services visiting regional and remote areas limited in location and frequency. Some patients are required to travel long distances or relocate to access treatment. The aim of our study was to assess difference in clinical presentation, treatment and outcomes of myeloma patients living in regional or remote Western Australia compared to metropolitan Perth. Methods: A retrospective chart review of new cases of symptomatic multiple myeloma diagnosed between January 2008 and December 2019 and referred to Royal Perth Hospital and Fiona Stanley Hospital, two tertiary metropolitan hospitals was conducted. Data was obtained regarding patient demographics, disease characteristics, treatment, response and survival outcomes, through review of patient paper and electronic medical records. Patients were grouped into those living inside or outside the Perth metropolitan area (metro or non-metro) according to area codes obtained from the WA government data suite. Results: Two hundred and seventy-five cases were identified, 218 (79%) metro and 57 (21%) non-metro. Baseline characteristics for the two groups are listed in Table 1. The median age at diagnosis was 68.4 years (range 30-91.5 years) and 47% were female, with no significant difference between the groups. There were a higher number of patients with lytic bone disease at diagnosis in the non-metro cohort (75.4% non-metro vs 60.2% metro, p=0.03) as well as a higher proportion of patients with international staging system (ISS) stage II or III disease (77.8% non-metro vs 55.8% metro, p=0.005). Sixty three percent of patients overall received first line bortezomib based therapy and 27% first line imid based therapy, with no significant difference by location. Overall 41% of patients underwent autologous stem cell transplantation, 70% of those ≤70 years of age, with no significant difference between the groups (33.3% non-metro vs 42.5% metro, p=0.21). The median overall survival (OS) was 47 months for the entire cohort. Survival was lower in the non-metro cohort, although this did not reach statistical significance (median OS 52 months for metro vs 40 months for non-metro, p=0.05) Figure 1. Progression free survival (PFS) was similar between the two groups (median PFS 23 months metro vs 12 months non-metro, p=0.12) Figure 2. Early mortality at 6 and 12 months was higher in the non-metro cohort (Six-month mortality was 21.1% non-metro vs 8.3% metro, p=0.01. Twelve-month mortality was 28.1% non-metro vs 13.4% metro, p=0.01) Figure 3. There was a trend in cause of early mortality due to infection being higher in the metro cohort, and cause of early mortality due to renal failure being higher in the non-metro cohort, Table 1. Conclusions: In our cohort, patients living in non-metropolitan locations were more likely to present with higher ISS stage and lytic lesions at diagnosis. Rates of early mortality were significantly higher in the non-metropolitan cohort. There was a trend towards shorter overall survival although this did not meet statistical significance. These differences may represent delays in clinical presentation and diagnostic workup and highlight the need for optimisation of follow up of patients in non-metropolitan areas particularly during the early time period post diagnosis. Periods of resource constraint and travel restrictions as is faced currently may accentuate these disparities. In addition, the nature of myeloma therapy is evolving with addition of treatments requiring expertise to deliver, such as monoclonal antibodies and chimeric antigen receptor T cells. As these therapies become commercial further studies are needed to assess adequacy of access for patients from non-metropolitan centres. Disclosures Leahy: Pfizer: Membership on an entity's Board of Directors or advisory committees. Sidiqi:Celgene: Honoraria, Other: Travel grant; Amgen: Honoraria; Janssen: Honoraria.

Background:Aboriginal and Torres Strait Islander Australians experience stroke and traumatic brain injury (TBI) with much greater frequency than non-Aboriginal Australians. Acquired communication disorders (ACD) can result from these conditions and can significantly impact everyday life. Yet few Aboriginal people access rehabilitation services and little is known about Aboriginal peoples’ experiences of ACD. This paper describes the protocol surrounding a study that aims to explore the extent and impact of ACD in Western Australian Aboriginal populations following stroke or TBI and develop a culturally appropriate screening tool for ACD and accessible and culturally appropriate service delivery models.Method/Design:The 3-year, mixed methods study is being conducted in metropolitan Perth and five regional centres in Western Australia. Situated within an Aboriginal research framework, methods include an analysis of linked routine hospital admission data and retrospective file audits, development of a screening tool for ACD, interviews with people with ACD, their families, and health professionals, and drafting of alternative service delivery models.Discussion:This study will address the extent of ACD in Aboriginal populations and document challenges for Aboriginal people in accessing speech pathology services. Documenting the burden and impact of ACD within a culturally secure framework is a forerunner to developing better ways to address the problems faced by Aboriginal people with ACD and their families. This will in turn increase the likelihood that Aboriginal people with ACD will be diagnosed and referred to professional support to improve their communication, quality of life and functioning within the family and community context.

<p><strong>Abstract.</strong> The impact of heat on health can be more significant in urban areas with more population and where the microclimate is often unintentionally modified to create the Urban Heat Island (UHI) effect. Extreme heat and UHI pose a risk to the health of vulnerable individuals, such as the elderly, the very young, and those need care. Vulnerability has become a central concept in climate change research and policy. To assess it, many studies have used equal weighted cumulative indices to aggregate multiple factors into a composite HVI (Heat Vulnerability Index) and analyse the differences and intensity across local areas and regions. However, the aggregation and equal weighting rationality, and the disregard of spatial correlation can result in inaccurate explanation on local vulnerabilities.</p><p>This study develops an enhanced index of population heat vulnerability (HVI) in Perth metropolitan area, Western Australia (WA), using environmental, demographic, and health-related risk factors for heat exposure, sensitivity and adaptive capability. Satellite derived urban heat island data and community profiles were integrated by a spatial risk assessment methodology to highlight potential heat health risk areas and build the foundations for mitigation and adaptation plans. Principal component analysis (PCA) was used to identify the key risk factors for heat vulnerability. Geographically weighted regression (GWR) were used to model the spatial relationships between temperature and other contributing factors to produce weights for calculating HVI. The index was finally mapped to produce a spatial representation of risk. The maps of spatial heat health vulnerability provide information to target heat-related health risks by aiding policy advisors, healthcare professionals, and ancillary services to develop heatwave preparedness plans at a local scale.</p>

Inadequate social protection, stagnant wages, unemployment, and homelessness are associated with Australian household food insecurity. Little is known about the recipients of food charity and whether their needs are being met. This cross-sectional study of 101 food charity recipients in Perth, Western Australia, measured food security, weight status, sociodemographic characteristics and food acquisition practices. Seventy-nine percent were male, aged 21–79 years, 90% were unemployed, 87% received social assistance payments, and 38% were homeless. Ninety-one percent were food insecure, 80% with hunger, and 56% had gone a day or more without eating in the previous week. Fifty-seven percent had used food charity for ≥1 year, and, of those, 7.5 years was the mode. Charitable services were the main food source in the previous week, however 76% used multiple sources. Begging for money for food (36%), begging for food (32%), stealing food or beverages (34%), and taking food from bins (28%) was commonplace. The omnipresence and chronicity of food insecurity, reliance on social security payments, and risky food acquisition suggest that both the social protection and charitable food systems are failing. Urgent reforms are needed to address the determinants of food insecurity (e.g., increased social assistance payments, employment and housing support) and the adequacy, appropriateness and effectiveness of food charity.

Despite growing acknowledgement of the socially determined nature of health disparities among Aboriginal people, how to respond to this within health promotion programs can be challenging. The legacy of Australia’s assimilation policies have left profound consequences, including social marginalisation, limited educational opportunities, normalisation of premature death, and entrenched trauma. These social determinants, in conjunction with a reluctance to trust authorities, create barriers to accessing healthcare services for the prevention, treatment, and rehabilitation of chronic disease. The Heart Health program is a culturally sensitive cardiac rehabilitation program run at the local Aboriginal Medical Service in Perth, Western Australia that has since moved beyond cardiac education to provide a holistic approach to chronic disease management. A participatory action research framework was used to explore Heart Health participant and service provider perspectives on the barriers, enablers, and critical success factors to program participation and behaviour change. Thematic analysis of interview transcripts was undertaken, and through yarning (Aboriginal storytelling) sessions, many participants made unprompted reference to the impacts of white settlement, discrimination, and the forced fracturing of Aboriginal families, which have been explored in this paper reiterating the need for a social determinants lens to be taken when planning and implementing Aboriginal health promotion programs.

This study explored opt-out HIV testing in an Australian general practice. The aims were to: (1) determine the effect of the opt-out approach on the number of HIV tests performed; and (2) explore the acceptability of opt-out HIV testing from the healthcare providers’ perspective. A prospective mixed-methods study of opt-out HIV testing over a 2-year period (March 2014–March 2016) was conducted. Implementation was based on a theoretical framework that was developed specifically for this study. The setting was Homeless Healthcare, a health service in Perth, Western Australia. The number of HIV tests conducted during the control year (usual practice) was compared with the intervention year (opt-out testing). After the intervention, the healthcare providers (n=8) were interviewed about their experiences with opt-out HIV testing. Directed content analysis was used to explore the qualitative data. HIV testing rates were low during both the control year and the intervention year (315 HIV tests (12% of the patient cohort) and 344 HIV tests (10%) respectively). Opt-out HIV testing was feasible and acceptable to the participating healthcare providers. Other health services could consider opt-out HIV testing for their patients to identify people with undiagnosed infections and sustain Australia’s low HIV prevalence.

This research explored adults’ perceptions of how sexualized images typically found on social media might influence adolescent girls’ mental health, what support girls might need should they experience mental health difficulties, and how such difficulties could be prevented or reduced. Qualitative data were collected using semi-structured in-depth interviews with parents of adolescent girls (n = 11) and those who provide support to them: school support service staff (n = 7) and youth mental health service providers (n = 10) located in Perth, Western Australia. All three participant groups perceived sexualized images typically found on social media as exacerbating poor mental health among adolescent girls. Two interrelated themes, emerged with participants describing the ‘potential for comparison’ and ‘pressure to conform’ they believed girls encounter on social media that influences their mental health. Participants also explained how they perceived ‘counteracting negative influences’ related to sexualized images on social media could prevent or reduce the potential for mental health harms among girls, and the importance of adults and services ‘keeping up to date’ and being ‘approachable and trustworthy’ when describing the support they believed girls might need. The findings of this study have important implications for the development of health promotion programs focused on social media use and mental health among adolescent girls.

Objectives The aim of the present study was to provide descriptive planning data for a hospital-based Aboriginal Health Liaison Officer (AHLO) program, specifically quantifying episodes of care and outcomes within 28 days after discharge. Methods A follow-up study of Aboriginal in-patient hospital episodes was undertaken using person-based linked administrative data from four South Metropolitan hospitals in Perth, Western Australia (2006–11). Outcomes included 28-day deaths, emergency department (ED) presentations and in-patient re-admissions. Results There were 8041 eligible index admissions among 5113 individuals, with episode volumes increasing by 31% over the study period. Among patients 25 years and older, the highest ranking comorbidities included injury (47%), drug and alcohol disorders (41%), heart disease (40%), infection (40%), mental illness (31%) and diabetes (31%). Most events (96%) ended in a regular discharge. Within 28 days, 24% of events resulted in ED presentations and 20% resulted in hospital re-admissions. Emergency readmissions (13%) were twice as likely as booked re-admissions (7%). Stratified analyses showed poorer outcomes for older people, and for emergency and tertiary hospital admissions. Conclusions Future planning must address the greater service volumes anticipated. The high prevalence of comorbidities requires intensive case management to address case complexity. These data will inform the refinement of the AHLO program to improve in-patient experiences and outcomes. What is known about the topic? The health gap between Aboriginal and non-Aboriginal Australians is well documented. Aboriginal people have significantly higher hospital utilisation rates, as well as higher rates of complications, comorbidities and discharges against medical advice (DAMA). Aboriginal patients receive most of their specialist services in hospital; however, detailed person-based analyses are limited and planning is often based on crude data. What does this paper add? This is the first analysis of linked data focusing on Aboriginal patient flows and volume and 28-day health system outcomes following hospital admission for all causes in a large metropolitan setting. Because the data were linked, admissions belonging to a single episode of care were combined, ensuring that transfers were not counted as re-admissions. Linkage also allowed follow up across time. The results highlight the main disease groups for which Aboriginal patients are admitted, how this varies by age and the high proportion of patients returning to (any) hospital within 28 days, either through EDs or as booked (pre-arranged) admissions. These data aid in the planning of hospital-based Aboriginal health liaison services. What are the implications for practitioners? The paper outlines the complexity with which many Aboriginal patients present to hospital and the risk of DAMA and re-admission. Clinical and organisational strategies can be put in place in hospitals to address these risks and ensure improved continuity of care with community-based primary health services. The Western Australian South Metropolitan Health Service is reviewing these data and will monitor the impact of the hospital-based AHLO program.

e14000 Background: Indigenous women with breast cancer (BrCa) have higher mortality than Non-Indigenous women. Remoteness, aggressive tumour biology, treatment acceptance and compliance are all contributory factors. A retrospective study of geriatric indigenous women (aged 55 years more) with BrCa has shown high co-morbidity and treatment-related toxicity scores translating to high mortality comparing to the non-indigenous geriatric population (aged 65 years or more). An algorithm allowing prediction of risk of morbidity and mortality to enable optimisation of care for this patient group, catering to needs, values, beliefs and resources of geriatric Indigenous patients is warranted. Methods: To create a predictive algorithm and model of care based on the demographics, social environment, biology, co-morbidity burden and predicted chemotherapy toxicity scores of Indigenous women with BrCa to then be applied to a validatory prospective study.A cohort of 132 indigenous geriatric patients was identified from the Western Australian Cancer Registry from 2001 to 2010 along with remoteness matched geriatric non-Indigenous women in a 1:1 ratio. Data was collated on cancer biology, chemotherapy toxicity, mortality, co-morbidity burden (by the Charlson Co-Morbidity Index -CCI) and predicted chemotherapy toxicity (by CARG toxicity score). An algorithm was created based on these factors to identify patients at greatest risk of morbidity and mortality. Results: Elements identified as predicting morbidity and mortality were; remoteness based on distance from Perth (scored 0-3), lymph node status (scored 0-1), social isolation (scored 0-1), the Carg score (scored 0-3), and the CCI (scored 0-4). The KR Geri-Indigenous Rx Model was created using these components and scored out of 12. Conclusions: The score has been used to create three risk categories, low (1-3) intermediate (4-8) and high risk (9-12). A model of care was designed with staged increases in service elements and intensity for increasing risk category. These include the addition of Indigenous health worker review initially in clinic as well as at home during chemotherapy, initial geriatric assessment and potential geriatrician review, optimization of co-morbidities and medications, consideration of dose adjustments, social worker visits to increase services, increased surveillance, with telehealth contact and GP update with treatment planning as well as on treatment completion. A prospective study based on this model is planned.

Background: The prevalence of psychological and behavioral disturbances among older adults living in residential care facilities is high, and it has been shown previously that people with such symptoms have poorer health outcomes. This study was designed to assess the efficacy of an early psychiatric intervention on the 12-month health outcomes of older adults admitted to residential care facilities in Perth, Western Australia. We hypothesized that subjects in the intervention group would have better mental and physical health outcomes than controls.Methods: The study was designed as a randomized, single-blinded, controlled trial. All subjects aged 65 years or over admitted to one of the 22/26 participating residential care facilities of the Inner City area of Perth were approached to join the study and were allocated randomly to the intervention or usual care group. Demographic and clinical information (including medications and use of physical restraint) was gathered systematically from all participants at baseline, and at 6 and 12 months. At each assessment, the Geriatric Depression Scale (GDS), the Health of the Nation Outcome Scales for older adults (HoNOS 65+), the Mini-mental State Examination (MMSE) and the Neuropsychiatric Inventory (NPI) were administered. Subjects in the intervention group who screened positive at the baseline assessment for psychiatric morbidity were reviewed within a 2-week period by the Inner City Mental Health Service of Older Adults (ICMHSOA). If clinically appropriate, mental health services were introduced without the involvement of the research team.Results: One hundred and six subjects and their next of kin consented to participate in the study (53 in each group). Mental health screening and early referral to a psychogeriatric service did not significantly change the average number of medical contacts, self-rated health, use of psychotropic or PRN medication, use of physical restraint, 12-month mortality, or mental health outcomes, as measured by the GDS-15, HoNOS 65+ and NPI (p>0.05 for all relevant outcomes).Conclusion: Systematic mental health screening of older adults admitted to residential care facilities and early clinical intervention does not change 12-month health outcomes. More effective interventions to improve the health outcomes of older adults with psychological and behavioral disturbances admitted to residential care facilities are needed.

Despite dedicated government funding, Aboriginal Australians, including children, experience more dental disease than other Australians, despite it being seen as mostly preventable. The ongoing legacy of colonization and discrimination against Aboriginal Australians persists, even in health services. Current neoliberal discourse often holds individuals responsible for the state of their health, rather than the structural factors beyond individual control. While presenting a balanced view of Aboriginal health is important and attests to Indigenous peoples’ resilience when faced with persistent adversity, calling to account those structural factors affecting the ability of Aboriginal people to make favorable oral health choices is also important. A decolonizing approach informed by Indigenous methodologies and whiteness studies guides this article to explore the perceptions and experiences of Aboriginal parents ( N = 52) of young children, mainly mothers, in Perth, Western Australia, as they relate to the oral health. Two researchers, 1 Aboriginal and 1 non-Aboriginal, conducted 9 focus group discussions with 51 Aboriginal participants, as well as 1 interview with the remaining individual, and independently analyzed responses to identify themes underpinning barriers and enablers to oral health. These were compared, discussed, and revised under key themes and interpreted for meanings attributed to participants’ perspectives. Findings indicated that oral health is important yet often compromised by structural factors, including policy and organizational practices that adversely preclude participants from making optimal oral health choices: limited education about prevention, prohibitive cost of services, intensive marketing of sugary products, and discrimination from health providers resulting in reluctance to attend services. Current government intentions center on Aboriginal–non-Aboriginal partnerships, access to flexible services, and health care that is free of racism and proactively seeks and welcomes Aboriginal people. The challenge is whether these good intentions are matched by policies and practices that translate into sustained improvements to oral health for Aboriginal Australians. Knowledge Transfer Statement: Slow progress in reducing persistent oral health disparities between Aboriginal and non-Aboriginal Australians calls for a new approach to this seemingly intractable problem. Findings from our qualitative research identified that structural factors—such as cost of services, little or no education on preventing oral disease, and discrimination by health providers—compromised Aboriginal people’s optimum oral health choices and access to services. The results from this study can be used to recommend changes to policies and practices that promote rather than undermine Aboriginal health and well-being and involve Aboriginal people in decisions about their health care.

IntroductionCaesarean delivery is steadily becoming one of the more common surgical procedures in Australia with over 100 000 caesarean sections performed each year. Over the last 10 years in Australia, the caesarean section rate has increased from 28% in 2003 to 33% in 2013. On the international stage, the Australian caesarean delivery rates are higher than the average for the Organisation for Economic Co-operation and Development, Australia ranked as 8 out of 33 and is second to the USA. Postoperative surgical site infections (SSIs) and wound complications are the most common and costly event following a caesarean section. Globally, complication rates following a caesarean delivery vary from 4.9% to 9.8%. Complications such as infection and wound breakdown affect the postpartum mother’s health and well-being, and contribute to healthcare costs for clinical management that often spans the acute, community and primary healthcare settings. Published level one studies using advanced wound dressings in the identified ‘at-risk’ population prior to surgery for prophylactic intervention are yet to be forthcoming.Methods and analysisA parallel group randomised control trial of 448 patients will be conducted across two metropolitan hospitals in Perth, Western Australia, which provide obstetric and midwifery services. We will recruit pregnant women in the last trimester, prior to their admission into the healthcare facility for delivery of their child. We will use a computer-generated block sequence to randomise the 448 participants to either the interventional (negative pressure wound therapy (NPWT) dressing, n=224) or comparator arm (non-NPWT dressing, n=224). The primary outcome measure is the occurrence of surgical wound dehiscence (SSWD) or SSI. The Centres for Disease Control reporting definition of either superficial or deep infection at 30 days will be used as the outcome measure definition. SWD will be classified as per the World Union of Wound Healing Societies grading system (grade I–IV). We will assess recruitment rate, and adherence to intervention and follow-up. We will assess the potential effectiveness of NPWT in the prevention of postpartum surgical wound complications at three time points during the study; postoperative days 5, 14 and 30, after which the participant will be closed out of the trial. We will use statistical methods to determine efficacy, and risk stratification will be conducted to determine the SWD risk profile of the participant. Follow-up at day 30 will assess superficial and deep infection, and wound dehiscence (grade I–IV) and the core outcome data set for wound complications. This study will collect health-related quality of life (European Quality of Life 5-Dimensions 5-Level Scale), mortality and late complications such as further surgery with a cost analysis conducted. The primary analysis will be by intention-to-treat. This clinical trial protocol follows the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) and the Consolidated Standards of Reporting Trials guidelines.Ethics and disseminationEthics approval was obtained through St John of God Health Care (HREC1409), Western Australia Department of Health King Edward Memorial Hospital (HREC3111). Study findings will be published in peer-reviewed journals and presented at international conferences. We used the SPIRIT checklist when writing our study protocol.Trial registration numberAustralian and New Zealand Clinical Trials Registry (ACTRN12618002006224p).

Purpose The purpose of this paper is to consider the monetary valuation implications arising from local government tree trimming, by calculating the loss of local government authority’ monetary tree value arising from trimming trees under power lines. Design/methodology/approach A city council model of estimation of the monetary value of city trees in a sample of three streets in a suburb of the Perth Metropolitan Area in Western Australia is applied to ascertain the loss of monetary value to the local government authority arising from tree trimming. Findings Using a sample of 274 city trees, the results of the study show that 156 city trees did not get trimmed thus incurring no monetary loss. However, the average loss of monetary value from 118 city trees that were trimmed was AU$2,816 per tree, suggesting a substantial loss of value to the council. Research limitations/implications The use of monetary tree valuation should be treated with caution as there is a focus on monetary calculations rather than non-monetary evaluations of trees. Further, the analysis does not take into account increases in value of city trees resulting from their growth. Practical implications In trimming trees, monetary value and canopy cover of trees may be reduced. In terms of property management, it may be helpful for the city council to take into account loss of city tree value from tree trimming when considering a cost-benefit analysis of the above ground/underground trade-off of power line installation. Social implications With increasing populations and demand on services, local government authorities may use monetary valuation techniques of trees to provide an accountability to ratepayers. Originality/value The results highlight the value loss of trimming a tree. The study’s originality rests in providing local government authority a valuation.

Early survivorship is a time of critical transition for women survivors of breast cancer as they attempt to resume functional activities and important life roles. This study aimed to explore the challenges of women and their partners as they attempted to resume activities and roles, identify unmet needs and make recommendations regarding a suitable framework to support women and partners to recommence valued activities and important roles during early survivorship. Qualitative methods utilising in-depth interviews of women (n = 18) and their partners (n = 8), and two focus groups (n = 10) were completed in Perth, Western Australia, between June 2014 and April 2015. These methods were used to facilitate women and partners’ views regarding the resumption of previously meaningful activities and important life roles during early survivorship. Questions addressed their individual and shared experiences concerning self-care, leisure, social and productive activities and important roles. Thematic analysis was employed to determine themes. Women and partners reported significant impact on their ability to engage in valued activities, resulting in changes to participation in meaningful roles. Three themes were determined: (1) ambiguity regarding survivorship prevents resumption of activities and previous roles, (2) breast cancer continues to impact a couples’ relationship during survivorship, and (3) support is needed to assist women and partners to resume activities and important roles. This research provides evidence suggesting that the ongoing symptoms of breast cancer treatment continue to impact many women and their partners, as they attempt to resume functional activities and important life roles during early survivorship. Disruption to these valued activities and roles may influence women and their partner’s health and well-being during early survivorship and extend beyond this period. Rehabilitation following cessation of treatment could be offered as required to facilitate access to multi-disciplinary services and supports for both individuals and couples.

These are the conferences abstracts for oral and poster presentations at the Australian College of Ambulance Professionals Conference, Perth, Western Australia, Australia, on the 15th and 16th of October 2010

“Human beings are not born once and for all on the day their mothers give birth to them [...] life obliges them over and over again to give birth to themselves.” (Garcia Marquez 165) Introduction The refugee experience is, at heart, one of rebirth. Just as becoming a new, distinctive being—biological birth—necessarily involves the physical separation of mother and infant, so becoming a refugee entails separation from a "mother country." This mother country may or may not be a recognised nation state; the point is that the refugee transitions from physical connectedness to separation, from insider to outsider, from endemic to alien. Like babies, refugees may have little control over the timing and conditions of their expulsion. Successful resettlement requires not one rebirth but multiple rebirths—resettlement is a lifelong process (Layton)—which in turn require hope, imagination, and energy. In rebirthing themselves over and over again, people who have fled or been forced from their homelands become both mother and child. They do not go through this rebirthing alone. A range of agencies and individuals may be there to assist, including immigration officials, settlement services, schools and teachers, employment agencies and employers, English as a Second Language (ESL) resources and instructors, health-care providers, counsellors, diasporic networks, neighbours, church groups, and other community organisations. The nature, intensity, and duration of these “midwives’” interventions—and when they occur and in what combinations—vary hugely from place to place and from person to person, but there is clear evidence that post-migration experiences have a significant impact on settlement outcomes (Fozdar and Hartley). This paper draws on qualitative research I did in 2012 in a regional town in New South Wales to illuminate some of the ways in which settlement aides ease, or impede, refugees’ rebirth as fully recognised and participating Australians. I begin by considering what it means to be resilient before tracing some of the dimensions of the resettlement process. In doing so, I draw on data from interviews and focus groups with former refugees, service providers, and other residents of the town I shall call Easthaven. First, though, a word about Easthaven. As is the case in many rural and regional parts of Australia, Easthaven’s population is strongly dominated by Anglo Celtic and Saxon ancestries: 2011 Census data show that more than 80 per cent of residents were born in Australia (compared with a national figure of 69.8 per cent) and about 90 per cent speak only English at home (76.8 per cent). Almost twice as many people identify as Aboriginal or Torres Strait Islander as the national figure of 2.5 per cent (Australian Bureau of Statistics). For several years Easthaven has been an official “Refugee Welcome Zone”, welcoming hundreds of refugees from diverse countries in Africa and the Middle East as well as from Myanmar. This reflects the Department of Immigration and Citizenship’s drive to settle a fifth of Australia’s 13,750 humanitarian entrants a year directly in regional areas. In Easthaven’s schools—which is where I focused my research—almost all of the ESL students are from refugee backgrounds. Defining Resilience Much of the research on human resilience is grounded in psychology, with a capacity to “bounce back” from adverse experiences cited in many definitions of resilience (e.g. American Psychological Association). Bouncing back implies a relatively quick process, and a return to a state or form similar to that which existed before the encounter with adversity. Yet resilience often requires sustained effort and significant changes in identity. As Jerome Rugaruza, a former UNHCR refugee, says of his journey from the Democratic Republic of Congo to Australia: All the steps begin in the burning village: you run with nothing to eat, no clothes. You just go. Then you get to the refugee camp […] You have a little bread and you thank god you are safe. Then after a few years in the camp, you think about a future for your children. You arrive in Australia and then you learn a new language, you learn to drive. There are so many steps and not everyone can do it. (Milsom) Not everyone can do it, but a large majority do. Research by Graeme Hugo, for example, shows that although humanitarian settlers in Australia face substantial barriers to employment and initially have much higher unemployment rates than other immigrants, for most nationality groups this difference has disappeared by the second generation: “This is consistent with the sacrifice (or investment) of the first generation and the efforts extended to attain higher levels of education and English proficiency, thereby reducing the barriers over time.” (Hugo 35). Ingrid Poulson writes that “resilience is not just about bouncing. Bouncing […] is only a reaction. Resilience is about rising—you rise above it, you rise to the occasion, you rise to the challenge. Rising is an active choice” (47; my emphasis) I see resilience as involving mental and physical grit, coupled with creativity, aspiration and, crucially, agency. Dimensions of Resettlement To return to the story of 41-year-old Jerome Rugaruza, as related in a recent newspaper article: He [Mr Rugaruza] describes the experience of being a newly arrived refugee as being like that of a newborn baby. “You need special care; you have to learn to speak [English], eat the different food, create relationships, connections”. (Milsom) This is a key dimension of resettlement: the adult becomes like an infant again, shifting from someone who knows how things work and how to get by to someone who is likely to be, for a while, dependent on others for even the most basic things—communication, food, shelter, clothing, and social contact. The “special care” that most refugee arrivals need initially (and sometimes for a long time) often results in their being seen as deficient—in knowledge, skills, dispositions, and capacities as well as material goods (Keddie; Uptin, Wright and Harwood). As Fozdar and Hartley note: “The tendency to use a deficit model in refugee resettlement devalues people and reinforces the view of the mainstream population that refugees are a liability” (27). Yet unlike newborns, humanitarian settlers come to their new countries with rich social networks and extensive histories of experience and learning—resources that are in fact vital to their rebirth. Sisay (all names are pseudonyms), a year 11 student of Ethiopian heritage who was born in Kenya, told me with feeling: I had a life back in Africa [her emphasis]. It was good. Well, I would go back there if there’s no problems, which—is a fact. And I came here for a better life—yeah, I have a better life, there’s good health care, free school, and good environment and all that. But what’s that without friends? A fellow student, Celine, who came to Australia five years ago from Burundi via Uganda, told me in a focus group: Some teachers are really good but I think some other teachers could be a little bit more encouraging and understanding of what we’ve gone through, because [they] just look at you like “You’re year 11 now, you should know this” […] It’s really discouraging when [the teachers say] in front of the class, “Oh, you shouldn’t do this subject because you haven’t done this this this this” […] It’s like they’re on purpose to tell you “you don’t have what it takes; just give up and do something else.” As Uptin, Wright and Harwood note, “schools not only have the power to position who is included in schooling (in culture and pedagogy) but also have the power to determine whether there is room and appreciation for diversity” (126). Both Sisay and Celine were disheartened by the fact they felt some of their teachers, and many of their peers, had little interest in or understanding of their lives before they came to Australia. The teachers’ low expectations of refugee-background students (Keddie, Uptin, Wright and Harwood) contrasted with the students’ and their families’ high expectations of themselves (Brown, Miller and Mitchell; Harris and Marlowe). When I asked Sisay about her post-school ambitions, she said: “I have a good idea of my future […] write a documentary. And I’m working on it.” Celine’s response was: “I know I’m gonna do medicine, be a doctor.” A third girl, Lily, who came to Australia from Myanmar three years ago, told me she wanted to be an accountant and had studied accounting at the local TAFE last year. Joseph, a father of three who resettled from South Sudan seven years ago, stressed how important getting a job was to successful settlement: [But] you have to get a certificate first to get a job. Even the job of cleaning—when I came here I was told that somebody has to go to have training in cleaning, to use the different chemicals to clean the ground and all that. But that is just sweeping and cleaning with water—you don’t need the [higher-level] skills. Simple jobs like this, we are not able to get them. In regional Australia, employment opportunities tend to be limited (Fozdar and Hartley); the unemployment rate in Easthaven is twice the national average. Opportunities to study are also more limited than in urban centres, and would-be students are not always eligible for financial assistance to gain or upgrade qualifications. Even when people do have appropriate qualifications, work experience, and language proficiency, the colour of their skin may still mean they miss out on a job. Tilbury and Colic-Peisker have documented the various ways in which employers deflect responsibility for racial discrimination, including the “common” strategy (658) of arguing that while the employer or organisation is not prejudiced, they have to discriminate because of their clients’ needs or expectations. I heard this strategy deployed in an interview with a local businesswoman, Catriona: We were advertising for a new technician. And one of the African refugees came to us and he’d had a lot of IT experience. And this is awful, but we felt we couldn't give him the job, because we send our technicians into people's houses, and we knew that if a black African guy rocked up at someone’s house to try and fix their computer, they would not always be welcomed in all—look, it would not be something that [Easthaven] was ready for yet. Colic-Peisker and Tilbury (Refugees and Employment) note that while Australia has strict anti-discrimination legislation, this legislation may be of little use to the people who, because of the way they look and sound (skin colour, dress, accent), are most likely to face prejudice and discrimination. The researchers found that perceived discrimination in the labour market affected humanitarian settlers’ sense of satisfaction with their new lives far more than, for example, racist remarks, which were generally shrugged off; the students I interviewed spoke of racism as “expected,” but “quite rare.” Most of the people Colic-Peisker and Tilbury surveyed reported finding Australians “friendly and accepting” (33). Even if there is no active discrimination on the basis of skin colour in employment, education, or housing, or overt racism in social situations, visible difference can still affect a person’s sense of belonging, as Joseph recounts: I think of myself as Australian, but my colour doesn’t [laughs] […] Unfortunately many, many Australians are expecting that Australia is a country of Europeans … There is no need for somebody to ask “Where do you come from?” and “Do you find Australia here safe?” and “Do you enjoy it?” Those kind of questions doesn’t encourage that we are together. This highlights another dimension of resettlement: the journey from feeling “at home” to feeling “foreign” to, eventually, feeling at home again in the host country (Colic-Peisker and Tilbury, Refugees and Employment). In the case of visibly different settlers, however, this last stage may never be completed. Whether the questions asked of Joseph are well intentioned or not, their effect may be the same: they position him as a “forever foreigner” (Park). A further dimension of resettlement—one already touched on—is the degree to which humanitarian settlers actively manage their “rebirth,” and are allowed and encouraged to do so. A key factor will be their mastery of English, and Easthaven’s ESL teachers are thus pivotal in the resettlement process. There is little doubt that many of these teachers have gone to great lengths to help this cohort of students, not only in terms of language acquisition but also social inclusion. However, in some cases what is initially supportive can, with time, begin to undermine refugees’ maturity into independent citizens. Sharon, an ESL teacher at one of the schools, told me how she and her colleagues would give their refugee-background students lifts to social events: But then maybe three years down the track they have a car and their dad can drive, but they still won’t take them […] We arrive to pick them up and they’re not ready, or there’s five fantastic cars in the driveway, and you pick up the student and they say “My dad’s car’s much bigger and better than yours” [laughs]. So there’s an expectation that we’ll do stuff for them, but we’ve created that [my emphasis]. Other support services may have more complex interests in keeping refugee settlers dependent. The more clients an agency has, the more services it provides, and the longer clients stay on its books, the more lucrative the contract for the agency. Thus financial and employment imperatives promote competition rather than collaboration between service providers (Fozdar and Hartley; Sidhu and Taylor) and may encourage assumptions about what sorts of services different individuals and groups want and need. Colic-Peisker and Tilbury (“‘Active’ and ‘Passive’ Resettlement”) have developed a typology of resettlement styles—“achievers,” “consumers,” “endurers,” and “victims”—but stress that a person’s style, while influenced by personality and pre-migration factors, is also shaped by the institutions and individuals they come into contact with: “The structure of settlement and welfare services may produce a victim mentality, leaving members of refugee communities inert and unable to see themselves as agents of change” (76). The prevailing narrative of “the traumatised refugee” is a key aspect of this dynamic (Colic-Peisker and Tilbury, “‘Active’ and ‘Passive’ Resettlement”; Fozdar and Hartley; Keddie). Service providers may make assumptions about what humanitarian settlers have gone through before arriving in Australia, how they have been affected by their experiences, and what must be done to “fix” them. Norah, a long-time caseworker, told me: I think you get some [providers] who go, “How could you have gone through something like that and not suffered? There must be—you must have to talk about this stuff” […] Where some [refugees] just come with the [attitude] “We’re all born into a situation; that was my situation, but I’m here now and now my focus is this.” She cited failure to consider cultural sensitivities around mental illness and to recognise that stress and anxiety during early resettlement are normal (Tilbury) as other problems in the sector: [Newly arrived refugees] go through the “happy to be here” [phase] and now “hang on, I’ve thumped to the bottom and I’m missing my own foods and smells and cultures and experiences”. I think sometimes we’re just too quick to try and slot people into a box. One factor that appears to be vital in fostering and sustaining resilience is social connection. Norah said her clients were “very good on the mobile phone” and had links “everywhere,” including to family and friends in their countries of birth, transition countries, and other parts of Australia. A 2011 report for DIAC, Settlement Outcomes of New Arrivals, found that humanitarian entrants to Australia were significantly more likely to be members of cultural and/or religious groups than other categories of immigrants (Australian Survey Research). I found many examples of efforts to build both bonding and bridging capital (Putnam) in Easthaven, and I offer two examples below. Several people told me about a dinner-dance that had been held a few weeks before one of my visits. The event was organised by an African women’s group, which had been formed—with funding assistance—several years before. The dinner-dance was advertised in the local newspaper and attracted strong interest from a broad cross-section of Easthaveners. To Debbie, a counsellor, the response signified a “real turnaround” in community relations and was a big boon to the women’s sense of belonging. Erica, a teacher, told me about a cultural exchange day she had organised between her bush school—where almost all of the children are Anglo Australian—and ESL students from one of the town schools: At the start of the day, my kids were looking at [the refugee-background students] and they were scared, they were saying to me, "I feel scared." And we shoved them all into this tiny little room […] and they had no choice but to sit practically on top of each other. And by the end of the day, they were hugging each other and braiding their hair and jumping and playing together. Like Uptin, Wright and Harwood, I found that the refugee-background students placed great importance on the social aspects of school. Sisay, the girl I introduced earlier in this paper, said: “It’s just all about friendship and someone to be there for you […] We try to be friends with them [the non-refugee students] sometimes but sometimes it just seems they don’t want it.” Conclusion A 2012 report on refugee settlement services in NSW concludes that the state “is not meeting its responsibility to humanitarian entrants as well as it could” (Audit Office of New South Wales 2); moreover, humanitarian settlers in NSW are doing less well on indicators such as housing and health than humanitarian settlers in other states (3). Evaluating the effectiveness of formal refugee-centred programs was not part of my research and is beyond the scope of this paper. Rather, I have sought to reveal some of the ways in which the attitudes, assumptions, and everyday practices of service providers and members of the broader community impact on refugees' settlement experience. What I heard repeatedly in the interviews I conducted was that it was emotional and practical support (Matthews; Tilbury), and being asked as well as told (about their hopes, needs, desires), that helped Easthaven’s refugee settlers bear themselves into fulfilling new lives. References Audit Office of New South Wales. Settling Humanitarian Entrants in New South Wales—Executive Summary. May 2012. 15 Aug. 2013 ‹http://www.audit.nsw.gov.au/ArticleDocuments/245/02_Humanitarian_Entrants_2012_Executive_Summary.pdf.aspx?Embed=Y>. Australian Bureau of Statistics. 2011 Census QuickStats. Mar. 2013. 11 Aug. 2013 ‹http://www.censusdata.abs.gov.au/census_services/getproduct/census/2011/quickstat/0>. Australian Survey Research. Settlement Outcomes of New Arrivals—Report of Findings. Apr. 2011. 15 Aug. 2013 ‹http://www.immi.gov.au/media/publications/research/_pdf/settlement-outcomes-new-arrivals.pdf>. Brown, Jill, Jenny Miller, and Jane Mitchell. “Interrupted Schooling and the Acquisition of Literacy: Experiences of Sudanese Refugees in Victorian Secondary Schools.” Australian Journal of Language and Literacy 29.2 (2006): 150-62. Colic-Peisker, Val, and Farida Tilbury. “‘Active’ and ‘Passive’ Resettlement: The Influence of Supporting Services and Refugees’ Own Resources on Resettlement Style.” International Migration 41.5 (2004): 61-91. ———. Refugees and Employment: The Effect of Visible Difference on Discrimination—Final Report. Perth: Centre for Social and Community Research, Murdoch University, 2007. Fozdar, Farida, and Lisa Hartley. “Refugee Resettlement in Australia: What We Know and Need To Know.” Refugee Survey Quarterly 4 Jun. 2013. 12 Aug. 2013 ‹http://rsq.oxfordjournals.org/search?fulltext=fozdar&submit=yes&x=0&y=0>. Garcia Marquez, Gabriel. Love in the Time of Cholera. London: Penguin Books, 1989. Harris, Vandra, and Jay Marlowe. “Hard Yards and High Hopes: The Educational Challenges of African Refugee University Students in Australia.” International Journal of Teaching and Learning in Higher Education 23.2 (2011): 186-96. Hugo, Graeme. A Significant Contribution: The Economic, Social and Civic Contributions of First and Second Generation Humanitarian Entrants—Summary of Findings. Canberra: Department of Immigration and Citizenship, 2011. Keddie, Amanda. “Pursuing Justice for Refugee Students: Addressing Issues of Cultural (Mis)recognition.” International Journal of Inclusive Education 16.12 (2012): 1295-1310. Layton, Robyn. "Building Capacity to Ensure the Inclusion of Vulnerable Groups." Creating Our Future conference, Adelaide, 28 Jul. 2012. Milsom, Rosemarie. “From Hard Luck Life to the Lucky Country.” Sydney Morning Herald 20 Jun. 2013. 12 Aug. 2013 ‹http://www.smh.com.au/national/from-hard-luck-life-to-the-lucky-country-20130619-2oixl.html>. Park, Gilbert C. “’Are We Real Americans?’: Cultural Production of Forever Foreigners at a Diversity Event.” Education and Urban Society 43.4 (2011): 451-67. Poulson, Ingrid. Rise. Sydney: Pan Macmillan Australia, 2008. Putnam, Robert D. Bowling Alone: The Collapse and Revival of American Community. New York: Simon & Schuster, 2000. Sidhu, Ravinder K., and Sandra Taylor. “The Trials and Tribulations of Partnerships in Refugee Settlement Services in Australia.” Journal of Education Policy 24.6 (2009): 655-72. Tilbury, Farida. “‘I Feel I Am a Bird without Wings’: Discourses of Sadness and Loss among East Africans in Western Australia.” Identities: Global Studies in Culture and Power 14.4 (2007): 433-58. ———, and Val Colic-Peisker. “Deflecting Responsibility in Employer Talk about Race Discrimination.” Discourse & Society 17.5 (2006): 651-76. Uptin, Jonnell, Jan Wright, and Valerie Harwood. “It Felt Like I Was a Black Dot on White Paper: Examining Young Former Refugees’ Experience of Entering Australian High Schools.” The Australian Educational Researcher 40.1 (2013): 125-37.

This paper evaluates the functions and service delivery of NGOs for immigrants in Australia. It argues that the radical economic restructuring in Western nations has been characterised by massive processes of deinstitutionalisation and decentralisation, with an associated move towards privatisation and the targeting of disadvantaged groups. This has led to a significant reliance on the voluntary sector to assist in the provision of settlement services for immigrant groups. As result in most immigrant receiving nations the use of NGOs as an extension of the state is common.

The term “coffee palace” was primarily used in Australia to describe the temperance hotels that were built in the last decades of the 19th century, although there are references to the term also being used to a lesser extent in the United Kingdom (Denby 174). Built in response to the worldwide temperance movement, which reached its pinnacle in the 1880s in Australia, coffee palaces were hotels that did not serve alcohol. This was a unique time in Australia’s architectural development as the economic boom fuelled by the gold rush in the 1850s, and the demand for ostentatious display that gathered momentum during the following years, afforded the use of richly ornamental High Victorian architecture and resulted in very majestic structures; hence the term “palace” (Freeland 121). The often multi-storied coffee palaces were found in every capital city as well as regional areas such as Geelong and Broken Hill, and locales as remote as Maria Island on the east coast of Tasmania. Presented as upholding family values and discouraging drunkenness, the coffee palaces were most popular in seaside resorts such as Barwon Heads in Victoria, where they catered to families. Coffee palaces were also constructed on a grand scale to provide accommodation for international and interstate visitors attending the international exhibitions held in Sydney (1879) and Melbourne (1880 and 1888). While the temperance movement lasted well over 100 years, the life of coffee palaces was relatively short-lived. Nevertheless, coffee palaces were very much part of Australia’s cultural landscape. In this article, I examine the rise and demise of coffee palaces associated with the temperance movement and argue that coffee palaces established in the name of abstinence were modelled on the coffee houses that spread throughout Europe and North America in the 17th and 18th centuries during the Enlightenment—a time when the human mind could be said to have been liberated from inebriation and the dogmatic state of ignorance. The Temperance Movement At a time when newspapers are full of lurid stories about binge-drinking and the alleged ill-effects of the liberalisation of licensing laws, as well as concerns over the growing trend of marketing easy-to-drink products (such as the so-called “alcopops”) to teenagers, it is difficult to think of a period when the total suppression of the alcohol trade was seriously debated in Australia. The cause of temperance has almost completely vanished from view, yet for well over a century—from 1830 to the outbreak of the Second World War—the control or even total abolition of the liquor trade was a major political issue—one that split the country, brought thousands onto the streets in demonstrations, and influenced the outcome of elections. Between 1911 and 1925 referenda to either limit or prohibit the sale of alcohol were held in most States. While moves to bring about abolition failed, Fitzgerald notes that almost one in three Australian voters expressed their support for prohibition of alcohol in their State (145). Today, the temperance movement’s platform has largely been forgotten, killed off by the practical example of the United States, where prohibition of the legal sale of alcohol served only to hand control of the liquor traffic to organised crime. Coffee Houses and the Enlightenment Although tea has long been considered the beverage of sobriety, it was coffee that came to be regarded as the very antithesis of alcohol. When the first coffee house opened in London in the early 1650s, customers were bewildered by this strange new drink from the Middle East—hot, bitter, and black as soot. But those who tried coffee were, reports Ellis, soon won over, and coffee houses were opened across London, Oxford, and Cambridge and, in the following decades, Europe and North America. Tea, equally exotic, entered the English market slightly later than coffee (in 1664), but was more expensive and remained a rarity long after coffee had become ubiquitous in London (Ellis 123-24). The impact of the introduction of coffee into Europe during the seventeenth century was particularly noticeable since the most common beverages of the time, even at breakfast, were weak “small beer” and wine. Both were safer to drink than water, which was liable to be contaminated. Coffee, like beer, was made using boiled water and, therefore, provided a new and safe alternative to alcoholic drinks. There was also the added benefit that those who drank coffee instead of alcohol began the day alert rather than mildly inebriated (Standage 135). It was also thought that coffee had a stimulating effect upon the “nervous system,” so much so that the French called coffee une boisson intellectuelle (an intellectual beverage), because of its stimulating effect on the brain (Muskett 71). In Oxford, the British called their coffee houses “penny universities,” a penny then being the price of a cup of coffee (Standage 158). Coffee houses were, moreover, more than places that sold coffee. Unlike other institutions of the period, rank and birth had no place (Ellis 59). The coffee house became the centre of urban life, creating a distinctive social culture by treating all customers as equals. Egalitarianism, however, did not extend to women—at least not in London. Around its egalitarian (but male) tables, merchants discussed and conducted business, writers and poets held discussions, scientists demonstrated experiments, and philosophers deliberated ideas and reforms. For the price of a cup (or “dish” as it was then known) of coffee, a man could read the latest pamphlets and newsletters, chat with other patrons, strike business deals, keep up with the latest political gossip, find out what other people thought of a new book, or take part in literary or philosophical discussions. Like today’s Internet, Twitter, and Facebook, Europe’s coffee houses functioned as an information network where ideas circulated and spread from coffee house to coffee house. In this way, drinking coffee in the coffee house became a metaphor for people getting together to share ideas in a sober environment, a concept that remains today. According to Standage, this information network fuelled the Enlightenment (133), prompting an explosion of creativity. Coffee houses provided an entirely new environment for political, financial, scientific, and literary change, as people gathered, discussed, and debated issues within their walls. Entrepreneurs and scientists teamed up to form companies to exploit new inventions and discoveries in manufacturing and mining, paving the way for the Industrial Revolution (Standage 163). The stock market and insurance companies also had their birth in the coffee house. As a result, coffee was seen to be the epitome of modernity and progress and, as such, was the ideal beverage for the Age of Reason. By the 19th century, however, the era of coffee houses had passed. Most of them had evolved into exclusive men’s clubs, each geared towards a certain segment of society. Tea was now more affordable and fashionable, and teahouses, which drew clientele from both sexes, began to grow in popularity. Tea, however, had always been Australia’s most popular non-alcoholic drink. Tea (and coffee) along with other alien plants had been part of the cargo unloaded onto Australian shores with the First Fleet in 1788. Coffee, mainly from Brazil and Jamaica, remained a constant import but was taxed more heavily than tea and was, therefore, more expensive. Furthermore, tea was much easier to make than coffee. To brew tea, all that is needed is to add boiling water, coffee, in contrast, required roasting, grinding and brewing. According to Symons, until the 1930s, Australians were the largest consumers of tea in the world (19). In spite of this, and as coffee, since its introduction into Europe, was regarded as the antidote to alcohol, the temperance movement established coffee palaces. In the early 1870s in Britain, the temperance movement had revived the coffee house to provide an alternative to the gin taverns that were so attractive to the working classes of the Industrial Age (Clarke 5). Unlike the earlier coffee house, this revived incarnation provided accommodation and was open to men, women and children. “Cheap and wholesome food,” was available as well as reading rooms supplied with newspapers and periodicals, and games and smoking rooms (Clarke 20). In Australia, coffee palaces did not seek the working classes, as clientele: at least in the cities they were largely for the nouveau riche. Coffee Palaces The discovery of gold in 1851 changed the direction of the Australian economy. An investment boom followed, with an influx of foreign funds and English banks lending freely to colonial speculators. By the 1880s, the manufacturing and construction sectors of the economy boomed and land prices were highly inflated. Governments shared in the wealth and ploughed money into urban infrastructure, particularly railways. Spurred on by these positive economic conditions and the newly extended inter-colonial rail network, international exhibitions were held in both Sydney and Melbourne. To celebrate modern technology and design in an industrial age, international exhibitions were phenomena that had spread throughout Europe and much of the world from the mid-19th century. According to Davison, exhibitions were “integral to the culture of nineteenth century industrialising societies” (158). In particular, these exhibitions provided the colonies with an opportunity to demonstrate to the world their economic power and achievements in the sciences, the arts and education, as well as to promote their commerce and industry. Massive purpose-built buildings were constructed to house the exhibition halls. In Sydney, the Garden Palace was erected in the Botanic Gardens for the 1879 Exhibition (it burnt down in 1882). In Melbourne, the Royal Exhibition Building, now a World Heritage site, was built in the Carlton Gardens for the 1880 Exhibition and extended for the 1888 Centennial Exhibition. Accommodation was required for the some one million interstate and international visitors who were to pass through the gates of the Garden Palace in Sydney. To meet this need, the temperance movement, keen to provide alternative accommodation to licensed hotels, backed the establishment of Sydney’s coffee palaces. The Sydney Coffee Palace Hotel Company was formed in 1878 to operate and manage a number of coffee palaces constructed during the 1870s. These were designed to compete with hotels by “offering all the ordinary advantages of those establishments without the allurements of the drink” (Murdoch). Coffee palaces were much more than ordinary hotels—they were often multi-purpose or mixed-use buildings that included a large number of rooms for accommodation as well as ballrooms and other leisure facilities to attract people away from pubs. As the Australian Town and Country Journal reveals, their services included the supply of affordable, wholesome food, either in the form of regular meals or occasional refreshments, cooked in kitchens fitted with the latest in culinary accoutrements. These “culinary temples” also provided smoking rooms, chess and billiard rooms, and rooms where people could read books, periodicals and all the local and national papers for free (121). Similar to the coffee houses of the Enlightenment, the coffee palaces brought businessmen, artists, writers, engineers, and scientists attending the exhibitions together to eat and drink (non-alcoholic), socialise and conduct business. The Johnson’s Temperance Coffee Palace located in York Street in Sydney produced a practical guide for potential investors and businessmen titled International Exhibition Visitors Pocket Guide to Sydney. It included information on the location of government departments, educational institutions, hospitals, charitable organisations, and embassies, as well as a list of the tariffs on goods from food to opium (1–17). Women, particularly the Woman’s Christian Temperance Union (WCTU) were a formidable force in the temperance movement (intemperance was generally regarded as a male problem and, more specifically, a husband problem). Murdoch argues, however, that much of the success of the push to establish coffee palaces was due to male politicians with business interests, such as the one-time Victorian premiere James Munro. Considered a stern, moral church-going leader, Munro expanded the temperance movement into a fanatical force with extraordinary power, which is perhaps why the temperance movement had its greatest following in Victoria (Murdoch). Several prestigious hotels were constructed to provide accommodation for visitors to the international exhibitions in Melbourne. Munro was responsible for building many of the city’s coffee palaces, including the Victoria (1880) and the Federal Coffee Palace (1888) in Collins Street. After establishing the Grand Coffee Palace Company, Munro took over the Grand Hotel (now the Windsor) in 1886. Munro expanded the hotel to accommodate some of the two million visitors who were to attend the Centenary Exhibition, renamed it the Grand Coffee Palace, and ceremoniously burnt its liquor licence at the official opening (Murdoch). By 1888 there were more than 50 coffee palaces in the city of Melbourne alone and Munro held thousands of shares in coffee palaces, including those in Geelong and Broken Hill. With its opening planned to commemorate the centenary of the founding of Australia and the 1888 International Exhibition, the construction of the Federal Coffee Palace, one of the largest hotels in Australia, was perhaps the greatest monument to the temperance movement. Designed in the French Renaissance style, the façade was embellished with statues, griffins and Venus in a chariot drawn by four seahorses. The building was crowned with an iron-framed domed tower. New passenger elevators—first demonstrated at the Sydney Exhibition—allowed the building to soar to seven storeys. According to the Federal Coffee Palace Visitor’s Guide, which was presented to every visitor, there were three lifts for passengers and others for luggage. Bedrooms were located on the top five floors, while the stately ground and first floors contained majestic dining, lounge, sitting, smoking, writing, and billiard rooms. There were electric service bells, gaslights, and kitchens “fitted with the most approved inventions for aiding proficients [sic] in the culinary arts,” while the luxury brand Pears soap was used in the lavatories and bathrooms (16–17). In 1891, a spectacular financial crash brought the economic boom to an abrupt end. The British economy was in crisis and to meet the predicament, English banks withdrew their funds in Australia. There was a wholesale collapse of building companies, mortgage banks and other financial institutions during 1891 and 1892 and much of the banking system was halted during 1893 (Attard). Meanwhile, however, while the eastern States were in the economic doldrums, gold was discovered in 1892 at Coolgardie and Kalgoorlie in Western Australia and, within two years, the west of the continent was transformed. As gold poured back to the capital city of Perth, the long dormant settlement hurriedly caught up and began to emulate the rest of Australia, including the construction of ornately detailed coffee palaces (Freeman 130). By 1904, Perth had 20 coffee palaces. When the No. 2 Coffee Palace opened in Pitt Street, Sydney, in 1880, the Australian Town and Country Journal reported that coffee palaces were “not only fashionable, but appear to have acquired a permanent footing in Sydney” (121). The coffee palace era, however, was relatively short-lived. Driven more by reformist and economic zeal than by good business sense, many were in financial trouble when the 1890’s Depression hit. Leading figures in the temperance movement were also involved in land speculation and building societies and when these schemes collapsed, many, including Munro, were financially ruined. Many of the palaces closed or were forced to apply for liquor licences in order to stay afloat. Others developed another life after the temperance movement’s influence waned and the coffee palace fad faded, and many were later demolished to make way for more modern buildings. The Federal was licensed in 1923 and traded as the Federal Hotel until its demolition in 1973. The Victoria, however, did not succumb to a liquor licence until 1967. The Sydney Coffee Palace in Woolloomooloo became the Sydney Eye Hospital and, more recently, smart apartments. Some fine examples still survive as reminders of Australia’s social and cultural heritage. The Windsor in Melbourne’s Spring Street and the Broken Hill Hotel, a massive three-story iconic pub in the outback now called simply “The Palace,” are some examples. Tea remained the beverage of choice in Australia until the 1950s when the lifting of government controls on the importation of coffee and the influence of American foodways coincided with the arrival of espresso-loving immigrants. As Australians were introduced to the espresso machine, the short black, the cappuccino, and the café latte and (reminiscent of the Enlightenment), the post-war malaise was shed in favour of the energy and vigour of modernist thought and creativity, fuelled in at least a small part by caffeine and the emergent café culture (Teffer). Although the temperance movement’s attempt to provide an alternative to the ubiquitous pubs failed, coffee has now outstripped the consumption of tea and today’s café culture ensures that wherever coffee is consumed, there is the possibility of a continuation of the Enlightenment’s lively discussions, exchange of news, and dissemination of ideas and information in a sober environment. References Attard, Bernard. “The Economic History of Australia from 1788: An Introduction.” EH.net Encyclopedia. 5 Feb. (2012) ‹http://eh.net/encyclopedia/article/attard.australia›. Blainey, Anna. “The Prohibition and Total Abstinence Movement in Australia 1880–1910.” Food, Power and Community: Essays in the History of Food and Drink. Ed. Robert Dare. Adelaide: Wakefield Press, 1999. 142–52. Boyce, Francis Bertie. “Shall I Vote for No License?” An address delivered at the Convention of the Parramatta Branch of New South Wales Alliance, 3 September 1906. 3rd ed. Parramatta: New South Wales Alliance, 1907. Clarke, James Freeman. Coffee Houses and Coffee Palaces in England. Boston: George H. Ellis, 1882. “Coffee Palace, No. 2.” Australian Town and Country Journal. 17 Jul. 1880: 121. Davison, Graeme. “Festivals of Nationhood: The International Exhibitions.” Australian Cultural History. Eds. S. L. Goldberg and F. B. Smith. Cambridge: Cambridge UP, 1989. 158–77. Denby, Elaine. Grand Hotels: Reality and Illusion. London: Reaktion Books, 2002. Ellis, Markman. The Coffee House: A Cultural History. London: Weidenfeld & Nicolson, 2004. Federal Coffee Palace. The Federal Coffee Palace Visitors’ Guide to Melbourne, Its Suburbs, and Other Parts of the Colony of Victoria: Views of the Principal Public and Commercial Buildings in Melbourne, With a Bird’s Eye View of the City; and History of the Melbourne International Exhibition of 1880, etc. Melbourne: Federal Coffee House Company, 1888. Fitzgerald, Ross, and Trevor Jordan. Under the Influence: A History of Alcohol in Australia. Sydney: Harper Collins, 2009. Freeland, John. The Australian Pub. Melbourne: Sun Books, 1977. Johnson’s Temperance Coffee Palace. International Exhibition Visitors Pocket Guide to Sydney, Restaurant and Temperance Hotel. Sydney: Johnson’s Temperance Coffee Palace, 1879. Mitchell, Ann M. “Munro, James (1832–1908).” Australian Dictionary of Biography. Canberra: National Centre of Biography, Australian National U, 2006-12. 5 Feb. 2012 ‹http://adb.anu.edu.au/biography/munro-james-4271/text6905›. Murdoch, Sally. “Coffee Palaces.” Encyclopaedia of Melbourne. Eds. Andrew Brown-May and Shurlee Swain. 5 Feb. 2012 ‹http://www.emelbourne.net.au/biogs/EM00371b.htm›. Muskett, Philip E. The Art of Living in Australia. New South Wales: Kangaroo Press, 1987. Standage, Tom. A History of the World in 6 Glasses. New York: Walker & Company, 2005. Sydney Coffee Palace Hotel Company Limited. Memorandum of Association of the Sydney Coffee Palace Hotel Company, Ltd. Sydney: Samuel Edward Lees, 1879. Symons, Michael. One Continuous Picnic: A Gastronomic History of Australia. Melbourne: Melbourne UP, 2007. Teffer, Nicola. Coffee Customs. Exhibition Catalogue. Sydney: Customs House, 2005.

Introduction This study describes the relationship between falls from standing height, or greater, and mortality in ambulance-transported patients with major trauma from falls. Methods Road ambulance records from 1 January 2013 to 31 December 2016 were linked with WA State Trauma Registry records to identify ambulance-transported falls patients with major trauma. Results Of the patients who fell from standing level, 114/460 (25%) died within 30 days, compared with 47/222 (21%) who fell from height (p=0.64). Conclusion Mortality is relatively high, and fall height is not associated with 30-day survival, among ambulance-transported patients with major trauma in metropolitan Perth, Western Australia.

Background People with dementia usually prefer to live in the community. Research is needed to identify the ‘tipping point’ for residential care entry and to highlight how people with dementia can be supported to remain at home as long as possible. Few previous studies have examined caregivers’ perceptions and explanations for the reasons people with dementia need to enter residential care in Australia. Aim To explore the factors contributing to people with dementia entering residential care in Perth, Western Australia, from the perspectives of informal carers and care staff. Method This phenomenological study used purposive sampling to recruit informal and formal caregivers of people with dementia. Semi-structured in-depth interviews were conducted with 13 family carers and 11 home care staff. Data were thematically analysed to identify individual, carer and contextual factors that impact on residential care entry. Findings The majority of participants identified a combination of factors as the ‘tipping point’ to residential care entry; a few also identified the cause as a sudden event or specific issue. Factors identified included deterioration related to worsening cognition, changed behaviours and a decline in the performance of activities of daily living; co-occurring health conditions; safety concerns; carer no longer able to meet care needs; impact of providing support becoming too much for the informal carer; lack of family or social support and needing assistance from services that were unavailable or inaccessible. Factors assisting people with dementia to remain living at home longer were family and social support, formal services and dog ownership. Conclusion This study identified individual, carer and contextual factors that contribute to people with dementia entering residential care in Australia. The ‘tipping point’ was recognised as when the needs of a person with dementia outweigh the capacity of their informal and formal carers, services and supports to care for them.

Abstract Background Evidence suggests that Aboriginal babies in Western Australia are not receiving adequate primary health care in their first 3 months of life, leading to questions about enablers and constraints to delivering such care. This paper presents findings from a qualitative research project investigating health providers’ perceptions and experiences of best and current practice in discharge planning, postnatal care and health education for Aboriginal mothers and their newborn babies. Methods Constructivist grounded theory guided this research involving 58 semi-structured interviews conducted with health providers who deliver care to Aboriginal mothers and infants. Participants were recruited from hospital-based and primary health sites in metropolitan Perth, and regional and remote locations in Western Australia. Results Structural factors enabling best practice in discharge planning, postnatal care, and health education for mothers included health providers following best practice guidelines and adequate staffing levels. Organisational enablers included continuity of care throughout pregnancy, birth and postnatally. In particular, good communication between services around discharge planning, birth notifications, and training in culturally respectful care. Structural and organisational constraints to delivering best practice and compromising continuity of care were identified as beyond individual control. These included poor communication between different health and social services, insufficient hospital staffing levels leading to early discharge, inadequate cultural training, delayed receipt of birth notifications and discharge summaries received by Aboriginal primary health services. Conclusion Findings highlight the importance of examining current policies and practices to promote best practice in postnatal care to improve health outcomes for mothers and their Aboriginal babies.