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

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.

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.

The Noongar people of the federal state of Western Australia have recently entered into what can be described as the most comprehensive settlement of a native title claim that spans an area of 200 000 square kilometres. The Settlement lays the foundation of a sui generis model for indigenous and minority self-determination in Australia and beyond. The Settlement sits between the spheres of public law and private law and provides for a form of non-territorial autonomy that is unique not only to Australia. The Noongar people are acknowledged as the traditional owners of the entire area, albeit that major other towns and cities are located in the area and the Noongar people only constitute very small minority. Whereas the topic of non-territorial self-government has been mainly explored in theory and in practice in the European domain, the Noongar Settlement shows how the principles that embody non-territorial autonomy may find root in other parts of the world. The potential relevance of the Noongar Settlement for non-territorial self-government of Aboriginal people or other minorities lies in four essential elements: firstly, creating for the Noongar people legal Corporations by statute for purposes of their self-government; secondly, decentralising powers and functions to the Corporations to enable them to perform the functions of a community government to its members; thirdly, to enable the elected Corporations to develop policies, make decisions and deliver pubic services on a personal rather than a geographical basis to the members of the community; and fourthly, to allow the Corporations to cooperate with and engage other levels of government within the system of intergovernmental relations in Australia. The Noongar Corporations, in effect, have the hallmarks of a fourth level government and represent a potential sui generis model for indigenous and minority non-territorial self-government.

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

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.

Introduction I think the Privacy Act is a huge edifice to protect the minority of things that could go wrong. I’ve got a good example for you, I’m just trying to think … yeah the worst one I’ve ever seen was the Balga Youth Program where we took these students on a reward excursion all the way to Fremantle and suddenly this very alienated kid started to jump under a bus, a moving bus so the kid had to be restrained. The cops from Fremantle arrived because all the very good people in Fremantle were alarmed at these grown-ups manhandling a kid and what had happened is that DCD [Department of Community Development] had dropped him into the program but hadn’t told us that this kid had suicide tendencies. No, it’s just chronically bad. And there were caseworkers involved and … there is some information that we have to have that doesn’t get handed down. Rather than a blanket rule that everything’s confidential coming from them to us, and that was a real live situation, and you imagine how we’re trying to handle it, we had taxis going from Balga to Fremantle to get staff involved and we only had to know what to watch out for and we probably could have … well what you would have done is not gone on the excursion I suppose (School Principal, quoted in Balnaves and Luca 49). These comments are from a school principal in Perth, Western Australia in a school that is concerned with “at-risk” students, and in a context where the Commonwealth Privacy Act 1988 has imposed limitations on their work. Under this Act it is illegal to pass health, personal or sensitive information concerning an individual on to other people. In the story cited above the Department of Community Development personnel were apparently protecting the student’s “negative right”, that is, “freedom from” interference by others. On the other hand, the principal’s assertion that such information should be shared is potentially a “positive right” because it could cause something to be done in that person’s or society’s interests. Balnaves and Luca noted that positive and negative rights have complex philosophical underpinnings, and they inform much of how we operate in everyday life and of the dilemmas that arise (49). For example, a ban on euthanasia or the “assisted suicide” of a terminally ill person can be a “positive right” because it is considered to be in the best interests of society in general. However, physicians who tacitly approve a patient’s right to end their lives with a lethal dose by legally prescribed dose of medication could be perceived as protecting the patient’s “negative right” as a “freedom from” interference by others. While acknowledging the merits of collaboration between people who are working to improve the wellbeing of students “at-risk”, this paper examines some of the barriers to collaboration. Based on both primary and secondary sources, and particularly on oral testimonies, the paper highlights the tension between privacy as a negative right and collaborative helping as a positive right. It also points to other difficulties and dilemmas within and between the institutions engaged in this joint undertaking. The authors acknowledge Michel Foucault’s contention that discourse is power. The discourse on privacy and the sharing of information in modern societies suggests that privacy is a negative right that gives freedom from bureaucratic interference and protects the individual. However, arguably, collaboration between agencies that are working to support individuals “at-risk” requires a measured relaxation of the requirements of this negative right. Children and young people “at-risk” are a case in point. Towards Collaboration From a series of interviews conducted in 2004, the school authorities at Balga Senior High School and Midvale Primary School, people working for the Western Australian departments of Community Development, Justice, and Education and Training in Western Australia, and academics at the Edith Cowan and Curtin universities, who are working to improve the wellbeing of students “at-risk” as part of an Australian Research Council (ARC) project called Smart Communities, have identified students “at-risk” as individuals who have behavioural problems and little motivation, who are alienated and possibly violent or angry, who under-perform in the classroom and have begun to truant. They noted also that students “at-risk” often suffer from poor health, lack of food and medication, are victims of unwanted pregnancies, and are engaged in antisocial and illegal behaviour such as stealing cars and substance abuse. These students are also often subject to domestic violence (parents on drugs or alcohol), family separation, and homelessness. Some are depressed or suicidal. Sometimes cultural factors contribute to students being regarded as “at-risk”. For example, a social worker in the Smart Communities project stated: Cultural factors sometimes come into that as well … like with some Muslim families … they can flog their daughter or their son, usually the daughter … so cultural factors can create a risk. Research elsewhere has revealed that those children between the ages of 11-17 who have been subjected to bullying at school or physical or sexual abuse at home and who have threatened and/or harmed another person or suicidal are “high-risk” youths (Farmer 4). In an attempt to bring about a positive change in these alienated or “at-risk” adolescents, Balga Senior High School has developed several programs such as the Youth Parents Program, Swan Nyunger Sports Education program, Intensive English Centre, and lower secondary mainstream program. The Midvale Primary School has provided services such as counsellors, Aboriginal child protection workers, and Aboriginal police liaison officers for these “at-risk” students. On the other hand, the Department of Community Development (DCD) has provided services to parents and caregivers for children up to 18 years. Academics from Edith Cowan and Curtin universities are engaged in gathering the life stories of these “at-risk” students. One aspect of this research entails the students writing their life stories in a secured web portal that the universities have developed. The researchers believe that by engaging the students in these self-exploration activities, they (the students) would develop a more hopeful outlook on life. Though all agencies and educational institutions involved in this collaborative project are working for the well-being of the children “at-risk”, the Privacy Act forbids the authorities from sharing information about them. A school psychologist expressed concern over the Privacy Act: When the Juvenile Justice Department want to reintroduce a student into a school, we can’t find out anything about this student so we can’t do any preplanning. They want to give the student a fresh start, so there’s always that tension … eventually everyone overcomes [this] because you realise that the student has to come to the school and has to be engaged. Of course, the manner and consequences of a student’s engagement in school cannot be predicted. In the scenario described above students may have been given a fair chance to reform themselves, which is their positive right but if they turn out to be at “high risk” it would appear that the Juvenile Department protected the negative right of the students by supporting “freedom from” interference by others. Likewise, a school health nurse in the project considered confidentiality or the Privacy Act an important factor in the security of the student “at-risk”: I was trying to think about this kid who’s one of the children who has been sexually abused, who’s a client of DCD, and I guess if police got involved there and wanted to know details and DCD didn’t want to give that information out then I’d guess I’d say to the police “Well no, you’ll have to talk to the parents about getting further information.” I guess that way, recognising these students are minor and that they are very vulnerable, their information … where it’s going, where is it leading? Who wants to know? Where will it be stored? What will be the outcomes in the future for this kid? As a 14 year old, if they’re reckless and get into things, you know, do they get a black record against them by the time they’re 19? What will that information be used for if it’s disclosed? So I guess I become an advocate for the student in that way? Thus the nurse considers a sexually abused child should not be identified. It is a positive right in the interest of the person. Once again, though, if the student turns out to be at “high risk” or suicidal, then it would appear that the nurse was protecting the youth’s negative right—“freedom from” interference by others. Since collaboration is a positive right and aims at the students’ welfare, the workable solution to prevent the students from suicide would be to develop inter-agency trust and to share vital information about “high-risk” students. Dilemmas of Collaboration Some recent cases of the deaths of young non-Caucasian girls in Western countries, either because of the implications of the Privacy Act or due to a lack of efficient and effective communication and coordination amongst agencies, have raised debates on effective child protection. For example, the British Laming report (2003) found that Victoria Climbié, a young African girl, was sent by her parents to her aunt in Britain in order to obtain a good education and was murdered by her aunt and aunt’s boyfriend. However, the risk that she could be harmed was widely known. The girl’s problems were known to 6 local authorities, 3 housing authorities, 4 social services, 2 child protection teams, and the police, the local church, and the hospital, but not to the education authorities. According to the Laming Report, her death could have been prevented if there had been inter-agency sharing of information and appropriate evaluation (Balnaves and Luca 49). The agencies had supported the negative rights of the young girl’s “freedom from” interference by others, but at the cost of her life. Perhaps Victoria’s racial background may have contributed to the concealment of information and added to her disadvantaged position. Similarly, in Western Australia, the Gordon Inquiry into the death of Susan Taylor, a 15 year old girl Aboriginal girl at the Swan Nyungah Community, found that in her short life this girl had encountered sexual violation, violence, and the ravages of alcohol and substance abuse. The Gordon Inquiry reported: Although up to thirteen different agencies were involved in providing services to Susan Taylor and her family, the D[epartment] of C[ommunity] D[evelopment] stated they were unaware of “all the services being provided by each agency” and there was a lack of clarity as to a “lead coordinating agency” (Gordon et al. quoted in Scott 45). In this case too, multiple factors—domestic, racial, and the Privacy Act—may have led to Susan Taylor’s tragic end. In the United Kingdom, Harry Ferguson noted that when a child is reported to be “at-risk” from domestic incidents, they can suffer further harm because of their family’s concealment (204). Ferguson’s study showed that in 11 per cent of the 319 case sample, children were known to be re-harmed within a year of initial referral. Sometimes, the parents apply a veil of secrecy around themselves and their children by resisting or avoiding services. In such cases the collaborative efforts of the agencies and education may be thwarted. Lack of cultural education among teachers, youth workers, and agencies could also put the “at-risk” cultural minorities into a high risk category. For example, an “at-risk” Muslim student may not be willing to share personal experiences with the school or agencies because of religious sensitivities. This happened in the UK when Khadji Rouf was abused by her father, a Bangladeshi. Rouf’s mother, a white woman, and her female cousin from Bangladesh, both supported Rouf when she finally disclosed that she had been sexually abused for over eight years. After group therapy, Rouf stated that she was able to accept her identity and to call herself proudly “mixed race”, whereas she rejected the Asian part of herself because it represented her father. Other Asian girls and young women in this study reported that they could not disclose their abuse to white teachers or social workers because of the feeling that they would be “letting down their race or their Muslim culture” (Rouf 113). The marginalisation of many Muslim Australians both in the job market and in society is long standing. For example, in 1996 and again in 2001 the Muslim unemployment rate was three times higher than the national total (Australian Bureau of Statistics). But since the 9/11 tragedy and Bali bombings visible Muslims, such as women wearing hijabs (headscarves), have sometimes been verbally and physically abused and called ‘terrorists’ by some members of the wider community (Dreher 13). The Howard government’s new anti-terrorism legislation and the surveillance hotline ‘Be alert not alarmed’ has further marginalised some Muslims. Some politicians have also linked Muslim asylum seekers with terrorists (Kabir 303), which inevitably has led Muslim “at-risk” refugee students to withdraw from school support such as counselling. Under these circumstances, Muslim “at-risk” students and their parents may prefer to maintain a low profile rather than engage with agencies. In this case, arguably, federal government politics have exacerbated the barriers to collaboration. It appears that unfamiliarity with Muslim culture is not confined to mainstream Australians. For example, an Aboriginal liaison police officer engaged in the Smart Communities project in Western Australia had this to say about Muslim youths “at-risk”: Different laws and stuff from different countries and they’re coming in and sort of thinking that they can bring their own laws and religions and stuff … and when I say religions there’s laws within their religions as well that they don’t seem to understand that with Australia and our laws. Such generalised misperceptions of Muslim youths “at-risk” would further alienate them, thus causing a major hindrance to collaboration. The “at-risk” factors associated with Aboriginal youths have historical connections. Research findings have revealed that indigenous youths aged between 10-16 years constitute a vast majority in all Australian States’ juvenile detention centres. This over-representation is widely recognised as associated with the nature of European colonisation, and is inter-related with poverty, marginalisation and racial discrimination (Watson et al. 404). Like the Muslims, their unemployment rate was three times higher than the national total in 2001 (ABS). However, in 1998 it was estimated that suicide rates among Indigenous peoples were at least 40 per cent higher than national average (National Advisory Council for Youth Suicide Prevention, quoted in Elliot-Farrelly 2). Although the wider community’s unemployment rate is much lower than the Aboriginals and the Muslims, the “at-risk” factors of mainstream Australian youths are often associated with dysfunctional families, high conflict, low-cohesive families, high levels of harsh parental discipline, high levels of victimisation by peers, and high behavioural inhibition (Watson et al. 404). The Macquarie Fields riots in 2005 revealed the existence of “White” underclass and “at-risk” people in Sydney. Macquarie Fields’ unemployment rate was more than twice the national average. Children growing up in this suburb are at greater risk of being involved in crime (The Age). Thus small pockets of mainstream underclass youngsters also require collaborative attention. In Western Australia people working on the Smart Communities project identified that lack of resources can be a hindrance to collaboration for all sectors. As one social worker commented: “government agencies are hierarchical systems and lack resources”. They went on to say that in their department they can not give “at-risk” youngsters financial assistance in times of crisis: We had a petty cash box which has got about 40 bucks in it and sometimes in an emergency we might give a customer a couple of dollars but that’s all we can do, we can’t give them any larger amount. We have bus/metro rail passes, that’s the only thing that we’ve actually got. A youth worker in Smart Communities commented that a lot of uncertainty is involved with young people “at-risk”. They said that there are only a few paid workers in their field who are supported and assisted by “a pool of volunteers”. Because the latter give their time voluntarily they are under no obligation to be constant in their attendance, so the number of available helpers can easily fluctuate. Another youth worker identified a particularly important barrier to collaboration: because of workers’ relatively low remuneration and high levels of work stress, the turnover rates are high. The consequence of this is as follows: The other barrier from my point is that you’re talking to somebody about a student “at-risk”, and within 14 months or 18 months a new person comes in [to that position] then you’ve got to start again. This way you miss a lot of information [which could be beneficial for the youth]. Conclusion The Privacy Act creates a dilemma in that it can be either beneficial or counter-productive for a student’s security. To be blunt, a youth who has suicided might have had their privacy protected, but not their life. Lack of funding can also be a constraint on collaboration by undermining stability and autonomy in the workforce, and blocking inter-agency initiatives. Lack of awareness about cultural differences can also affect unity of action. The deepening inequality between the “haves” and “have-nots” in the Australian society, and the Howard government’s harshness on national security issues, can also pose barriers to collaboration on youth issues. Despite these exigencies and dilemmas, it would seem that collaboration is “the only game” when it comes to helping students “at-risk”. To enhance this collaboration, there needs to be a sensible modification of legal restrictions to information sharing, an increase in government funding and support for inter-agency cooperation and informal information sharing, and an increased awareness about the cultural needs of minority groups and knowledge of the mainstream underclass. Acknowledgments The research is part of a major Australian Research Council (ARC) funded project, Smart Communities. The authors very gratefully acknowledge the contribution of the interviewees, and thank *Donald E. Scott for conducting the interviews. References Australian Bureau of Statistics. 1996 and 2001. Balnaves, Mark, and Joe Luca. “The Impact of Digital Persona on the Future of Learning: A Case Study on Digital Repositories and the Sharing of Information about Children At-Risk in Western Australia”, paper presented at Ascilite, Brisbane (2005): 49-56. 10 April 2006. http://www.ascilite.org.au/conferences/brisbane05/blogs/proceedings/ 06_Balnaves.pdf>. Dreher, Tanya. ‘Targeted’: Experiences of Racism in NSW after September 11, 2001. Sydney: University of Technology, 2005. Elliot-Farrelly, Terri. “Australian Aboriginal Suicide: The Need for an Aboriginal Suicidology”? Australian e-Journal for the Advancement of Mental Health, 3.3 (2004): 1-8. 15 April 2006 http://www.auseinet.com/journal/vol3iss3/elliottfarrelly.pdf>. Farmer, James. A. High-Risk Teenagers: Real Cases and Interception Strategies with Resistant Adolescents. Springfield, Ill.: C.C. Thomas, 1990. Ferguson, Harry. Protecting Children in Time: Child Abuse, Child Protection and the Consequences of Modernity. London: Palgrave Macmillan, 2004. Foucault, Michel. Power/Knowledge: Selected Interviews and Other Writings, 1972-1977. Ed. Colin Gordon, trans. Colin Gordon et al. New York: Pantheon, 1980. Kabir, Nahid. Muslims in Australia: Immigration, Race Relations and Cultural History. London: Kegan Paul, 2005. Rouf, Khadji. “Myself in Echoes. My Voice in Song.” Ed. A. Bannister, et al. Listening to Children. London: Longman, 1990. Scott E. Donald. “Exploring Communication Patterns within and across a School and Associated Agencies to Increase the Effectiveness of Service to At-Risk Individuals.” MS Thesis, Curtin University of Technology, August 2005. The Age. “Investing in People Means Investing in the Future.” The Age 5 March, 2005. 15 April 2006 http://www.theage.com.au>. Watson, Malcolm, et al. “Pathways to Aggression in Children and Adolescents.” Harvard Educational Review, 74.4 (Winter 2004): 404-428. Citation reference for this article MLA Style Kabir, Nahid, and Mark Balnaves. "Students “at Risk”: Dilemmas of Collaboration." M/C Journal 9.2 (2006). echo date('d M. Y'); ?> <http://journal.media-culture.org.au/0605/04-kabirbalnaves.php>. APA Style Kabir, N., and M. Balnaves. (May 2006) "Students “at Risk”: Dilemmas of Collaboration," M/C Journal, 9(2). Retrieved echo date('d M. Y'); ?> from <http://journal.media-culture.org.au/0605/04-kabirbalnaves.php>.

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.

Introduction During emergency ambulance calls, one of the key issues assessed is the patient’s level of consciousness. An altered conscious state can be indicative of a need for a high priority response; however, the reliability of the resulting triage depends on how accurately alertness can be ascertained over the phone. This study investigated the accuracy of emergency medical dispatcher (EMD) determination of conscious state in emergency ambulance calls in Perth, Western Australia. Methods The study compared EMD determination of patient alertness based on the Medical Priority Dispatch System (MPDS), with conscious state as recorded by paramedics on arrival, for all emergency ambulance calls in a 1-year period in metropolitan Perth. Diagnostic accuracy was reported across the whole system and stratified by MPDS chief complaint. Results There were 109,678 calls included for analysis. In terms of identifying patients as not alert, the overall positive predictive value was 6.62% and negative predictive value was 99.93%, with 10 times as many patients dispatched as not alert than found to be not alert at scene. Sensitivity was only 69.94%. There was significant variation in accuracy between chief complaints. Conclusion The study found high levels of inaccuracy between dispatch identification of not-alert patients, and what paramedics found on scene. While not-alert dispatch was 10 times more common than patients being determined not-alert on scene, only 70% of not-alert patients on scene were classified as such during dispatch. Further research is suggested into the factors that affect the accuracy of EMD determination of patient conscious state.

Urban development and land release policies in the city fringes are criticised because they often fail to achieve their objectives such as providing affordable housing for low to moderate-income groups as well as provision of infrastructure and transportation. From a Marxian point of view, urban development plans fail because of the inherent contradictions of capital, and consequently, maximisation of surplus-value becomes the main objectives of land supply policies. In this paper, I draw on the Lacanian concept of drive and use the homology between Marxian surplus-value and Lacanian surplus-enjoyment to explain how the market rationality of neoliberalism (late-capitalism) deflects the desired objectives of urban development plans (UDPs); that is, the desire to provide affordable housing and urban services and infrastructure instead facilitates speculative activities on land in the suburban areas of a metropolis, such as Perth, Western Australia. In particular, the paper focuses on the neoliberal intuitional and financial dimensions of UDPs. In conclusion, I suggest how planners may deal with the pressure of the lack in the hegemonic discourse of neoliberalism in order to avoid the stuckness of the logic of drive materialised in the operation of planning institutions.