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Research paper thumbnail of ARBI Toolkit: A resource for planning maternity services in rural and remote Australia

Research paper thumbnail of Additional file 3: Table S3. of The distribution of maternity services across rural and remote Australia: does it reflect population need?

Descriptive characteristics of the facilities as well as results of tests of association and tren... more Descriptive characteristics of the facilities as well as results of tests of association and trend for Stage 2: facilities offering birthing with or without C-section. (DOCX 35 kb)

Research paper thumbnail of Additional file 4: Table S4. of The distribution of maternity services across rural and remote Australia: does it reflect population need?

Summarised results of univariable logistic regression for Stage 2: facilities offering birthing w... more Summarised results of univariable logistic regression for Stage 2: facilities offering birthing with or without C-section. (DOCX 36 kb)

Research paper thumbnail of Additional file 5: Figure S1. of The distribution of maternity services across rural and remote Australia: does it reflect population need?

Annual birth numbers (5Â year average) of catchments for no birthing, no C-Section and C-Section ... more Annual birth numbers (5Â year average) of catchments for no birthing, no C-Section and C-Section birthing facilities. (DOCX 41 kb)

Research paper thumbnail of Additional file 2: Table S2. of The distribution of maternity services across rural and remote Australia: does it reflect population need?

Results of the univariable logistic models for Stage 1 Modelling - birthing facilities versus non... more Results of the univariable logistic models for Stage 1 Modelling - birthing facilities versus non-birthing facilities. (DOCX 37 kb)

Research paper thumbnail of Additional file 1: Table S1. of The distribution of maternity services across rural and remote Australia: does it reflect population need?

Descriptive statistics and the tests of association for Stage 1 Modelling - birthing facilities v... more Descriptive statistics and the tests of association for Stage 1 Modelling - birthing facilities versus non-birthing facilities. (DOCX 33 kb)

Research paper thumbnail of The networking of care in the newborn nurseries of Australia and New Zealand

Research paper thumbnail of The exclusive use of continuous positive airways pressure to ventilate babies of the Australian and New Zealand Neonatal Network during 1998

Research paper thumbnail of Report of the Australian and New Zealand Neonatal Network, 2000

Research paper thumbnail of Suicide /self-harm-risk reducing effects of an Aboriginal art program for Aboriginal prisoners

Advances in Mental Health

ABSTRACT Objective: Aboriginal art is an effective, culture-specific therapy for Aboriginal peopl... more ABSTRACT Objective: Aboriginal art is an effective, culture-specific therapy for Aboriginal people. This may have important implications for Aboriginal prisoners at risk of suicide/self-harm. This project aimed to evaluate the potential positive effects of Aboriginal art activities on the suicide/self-harm risk behaviours of Aboriginal prisoners. Method: A retrospective audit was undertaken of data related to the incidence of suicide/self-harm risk assessments for a cohort of male Aboriginal prisoners (N = 335) incarcerated in a single Australian prison between 11th December 2008 and 22nd December 2010. Results: Of the 335 Aboriginal prisoners, 108 (32.2%) attended the Aboriginal art program at least once and 227 did not. Univariate analyses of the sample characteristics showed that those who attended the Aboriginal art program were less likely to have a history of psychiatric illness (10.2% versus 19.8%), but more likely to have a history of violent offences (90.7% versus 67.4%) and more likely to have presented with grief/loss issues at receptions (24.1% versus 14.5%). Univariate analyses using binomial regression showed that both suicide/self-harm history and number of days attending Aboriginal art was associated with the incidence rate of suicide/self-harm risk assessments. Controlling for a history of suicide self-harm, we found that each day (and additional day) of attendance to the Aboriginal art program reduced the incidence rate of suicide/self-harm assessment by a factor of 0.81 (CI 95%: 0.70–0.95). Discussion: This study provides some evidence of the protective effect of engaging in Aboriginal art for reducing suicide or self-harm behaviours for Aboriginal prisoners. Clinical implications and recommendations for future studies are discussed.

Research paper thumbnail of Use of systematic reviews of randomised trials by Australian neonatologists and obstetricians

Medical Journal of Australia

To determine what proportion of Australian neonatologists and obstetricians report using systemat... more To determine what proportion of Australian neonatologists and obstetricians report using systematic reviews of randomised trials. Cross-sectional survey using structured telephone interviews. Australian clinical practice in 1995. 103 of the 104 neonatologists in Australia (defined as clinicians holding a position in a neonatal intensive care unit); a random sample of 145 members of the Royal Australian College of Obstetricians and Gynaecologists currently practising in Australia. Information sources used in clinical practice; reported awareness of, access to and use of systematic reviews, and consequent practice changes. Response rates were 95% (neonatologists) and 87% (obstetricians); 71 neonatologists (72%) and 55 obstetricians (44%) reported using systematic reviews, primarily for individual patient care. Databases of systematic reviews were used with a median frequency of once per month. Among neonatologists, systematic reviews were used more commonly by those who were familiar with computers, attended professional meetings, and had authored research papers. Among obstetricians, they were used more commonly by those who were familiar with computers, had less than 10 years' clinical experience, attended more deliveries, and were full-time staff specialists in public hospitals. Of neonatologists who reported using systematic reviews, 58% attributed some practice change to this use. For obstetricians, the corresponding figure was 80%. There is evidence that Australian neonatologists and obstetricians use systematic reviews and modify their practice accordingly. Dissemination efforts can benefit from knowledge of factors that predict use of systematic reviews.

Research paper thumbnail of Maternity services for rural and remote Australia: barriers to operationalising national policy

Health Policy

Highlights National policy intends woman-centred rural maternity services should continue A c... more Highlights National policy intends woman-centred rural maternity services should continue A considerable gap exists between this intent and services at local level Barriers to operationalising this intent include lack of leadership and workforce planning Barriers to operationalising policy intent may be eased by using a planning Toolkit

Research paper thumbnail of The distribution of maternity services across rural and remote Australia: does it reflect population need?

BMC Health Services Research, 2017

Background: Australia has a universal health care system and a comprehensive safety net. Despite ... more Background: Australia has a universal health care system and a comprehensive safety net. Despite this, outcomes for Australians living in rural and remote areas are worse than those living in cities. This study will examine the current state of equity of access to birthing services for women living in small communities in rural and remote Australia from a population perspective and investigates whether services are distributed according to need. Methods: Health facilities in Australia were identified and a service catchment was determined around each using a one-hour road travel time from that facility. Catchment exclusions: metropolitan areas, populations above 25,000 or below 1,000, and a non-birthing facility within the catchment of one with birthing. Catchments were attributed with population-based characteristics representing need: population size, births, demographic factors, socioeconomic status, and a proxy for isolation-the time to the nearest facility providing a caesarean section (C-section). Facilities were dichotomised by service levelthose providing birthing services (birthing) or not (no birthing). Birthing services were then divided by C-section provision (C-section vs no C-section birthing). Analysis used two-stage univariable and multivariable logistic regression. Results: There were 259 health facilities identified after exclusions. Comparing services with birthing to no birthing, a population is more likely to have a birthing service if they have more births, (adjusted Odds Ratio (aOR): 1.50 for every 10 births, 95% Confidence Interval (CI) [1.33-1.69]), and a service offering C-sections 1 to 2 h drive away (aOR: 28.7, 95% CI [5.59-148]). Comparing the birthing services categorised by C-section vs no C-section, the likelihood of a facility having a C-section was again positively associated with increasing catchment births and with travel time to another service offering C-sections. Both models demonstrated significant associations with jurisdiction but not socioeconomic status. Conclusions: Our investigation of current birthing services in rural and remote Australia identified disparities in their distribution. Population factors relating to vulnerability and isolation did not increase the likelihood of a local birthing facility, and very remote communities were less likely to have any service. In addition, services are influenced by jurisdictions.

Research paper thumbnail of Australian & New Zealand Neonatal Network 1999

Research paper thumbnail of Reconceptualising risk: perceptions of risk in rural and remote maternity service planning

Midwifery, 2016

Objective: to explore perceptions and examples of risk related to pregnancy and childbirth in rur... more Objective: to explore perceptions and examples of risk related to pregnancy and childbirth in rural and remote Australia and how these influence the planning of maternity services. Design: data collection in this qualitative component of a mixed methods study included 88 semistructured individual and group interviews (n ¼ 102), three focus groups (n ¼22) and one group information session (n ¼17). Researchers identified two categories of risk for exploration: health services risk (including clinical and corporate risks) and social risk (including cultural, emotional and financial risks). Data were aggregated and thematically analysed to identify perceptions and examples of risk related to each category. Setting: fieldwork was conducted in four jurisdictions at nine sites in rural (n ¼ 3) and remote (n ¼ 6) Australia. Participants: 117 health service employees and 24 consumers. Measurements and findings: examples and perceptions relating to each category of risk were identified from the data. Most medical practitioners and health service managers perceived clinical risks related to rural birthing services without access to caesarean section. Consumer participants were more likely to emphasise social risks arising from a lack of local birthing services. Key conclusions: our analysis demonstrated that the closure of services adds social risk, which exacerbates clinical risk. Analysis also highlighted that perceptions of clinical risk are privileged over social risk in decisions about rural and remote maternity service planning. Implications for practice: a comprehensive analysis of risk that identifies how social and other forms of risk contribute to adverse clinical outcomes would benefit rural and remote people and their health Contents lists available at ScienceDirect

Research paper thumbnail of Australian and New Zealand Neonatal Network, 1996-97

Research paper thumbnail of Neurologic assessment of the preterm infant in the intensive and special care nursery & the diagnostic significance of the ATNR

The Australian journal of physiotherapy

Research paper thumbnail of Australian and New Zealand Neonatal Network, 1994

Research paper thumbnail of Australian & New Zealand Neonatal Network, 2000

Research paper thumbnail of Identifying maternity services in public hospitals in rural and remote Australia

Australian Health Review, 2014

Objective This paper articulates the importance of accurately identifying maternity services. It ... more Objective This paper articulates the importance of accurately identifying maternity services. It describes the process and challenges of identifying the number, level and networks of rural and remote maternity services in public hospitals serving communities of between 1000 and 25 000 people across Australia, and presents the findings of this process. Methods Health departments and the national government’s websites, along with lists of public hospitals, were used to identify all rural and remote Australian public hospitals offering maternity services in small towns. State perinatal reports were reviewed to establish numbers of births by hospital. The level of maternity services and networks of hospitals within which services functioned were determined via discussion with senior jurisdictional representatives. Results In all, 198 rural and remote public hospitals offering maternity services were identified. There were challenges in sourcing information on maternity services to gener...

Research paper thumbnail of ARBI Toolkit: A resource for planning maternity services in rural and remote Australia

Research paper thumbnail of Additional file 3: Table S3. of The distribution of maternity services across rural and remote Australia: does it reflect population need?

Descriptive characteristics of the facilities as well as results of tests of association and tren... more Descriptive characteristics of the facilities as well as results of tests of association and trend for Stage 2: facilities offering birthing with or without C-section. (DOCX 35 kb)

Research paper thumbnail of Additional file 4: Table S4. of The distribution of maternity services across rural and remote Australia: does it reflect population need?

Summarised results of univariable logistic regression for Stage 2: facilities offering birthing w... more Summarised results of univariable logistic regression for Stage 2: facilities offering birthing with or without C-section. (DOCX 36 kb)

Research paper thumbnail of Additional file 5: Figure S1. of The distribution of maternity services across rural and remote Australia: does it reflect population need?

Annual birth numbers (5Â year average) of catchments for no birthing, no C-Section and C-Section ... more Annual birth numbers (5Â year average) of catchments for no birthing, no C-Section and C-Section birthing facilities. (DOCX 41 kb)

Research paper thumbnail of Additional file 2: Table S2. of The distribution of maternity services across rural and remote Australia: does it reflect population need?

Results of the univariable logistic models for Stage 1 Modelling - birthing facilities versus non... more Results of the univariable logistic models for Stage 1 Modelling - birthing facilities versus non-birthing facilities. (DOCX 37 kb)

Research paper thumbnail of Additional file 1: Table S1. of The distribution of maternity services across rural and remote Australia: does it reflect population need?

Descriptive statistics and the tests of association for Stage 1 Modelling - birthing facilities v... more Descriptive statistics and the tests of association for Stage 1 Modelling - birthing facilities versus non-birthing facilities. (DOCX 33 kb)

Research paper thumbnail of The networking of care in the newborn nurseries of Australia and New Zealand

Research paper thumbnail of The exclusive use of continuous positive airways pressure to ventilate babies of the Australian and New Zealand Neonatal Network during 1998

Research paper thumbnail of Report of the Australian and New Zealand Neonatal Network, 2000

Research paper thumbnail of Suicide /self-harm-risk reducing effects of an Aboriginal art program for Aboriginal prisoners

Advances in Mental Health

ABSTRACT Objective: Aboriginal art is an effective, culture-specific therapy for Aboriginal peopl... more ABSTRACT Objective: Aboriginal art is an effective, culture-specific therapy for Aboriginal people. This may have important implications for Aboriginal prisoners at risk of suicide/self-harm. This project aimed to evaluate the potential positive effects of Aboriginal art activities on the suicide/self-harm risk behaviours of Aboriginal prisoners. Method: A retrospective audit was undertaken of data related to the incidence of suicide/self-harm risk assessments for a cohort of male Aboriginal prisoners (N = 335) incarcerated in a single Australian prison between 11th December 2008 and 22nd December 2010. Results: Of the 335 Aboriginal prisoners, 108 (32.2%) attended the Aboriginal art program at least once and 227 did not. Univariate analyses of the sample characteristics showed that those who attended the Aboriginal art program were less likely to have a history of psychiatric illness (10.2% versus 19.8%), but more likely to have a history of violent offences (90.7% versus 67.4%) and more likely to have presented with grief/loss issues at receptions (24.1% versus 14.5%). Univariate analyses using binomial regression showed that both suicide/self-harm history and number of days attending Aboriginal art was associated with the incidence rate of suicide/self-harm risk assessments. Controlling for a history of suicide self-harm, we found that each day (and additional day) of attendance to the Aboriginal art program reduced the incidence rate of suicide/self-harm assessment by a factor of 0.81 (CI 95%: 0.70–0.95). Discussion: This study provides some evidence of the protective effect of engaging in Aboriginal art for reducing suicide or self-harm behaviours for Aboriginal prisoners. Clinical implications and recommendations for future studies are discussed.

Research paper thumbnail of Use of systematic reviews of randomised trials by Australian neonatologists and obstetricians

Medical Journal of Australia

To determine what proportion of Australian neonatologists and obstetricians report using systemat... more To determine what proportion of Australian neonatologists and obstetricians report using systematic reviews of randomised trials. Cross-sectional survey using structured telephone interviews. Australian clinical practice in 1995. 103 of the 104 neonatologists in Australia (defined as clinicians holding a position in a neonatal intensive care unit); a random sample of 145 members of the Royal Australian College of Obstetricians and Gynaecologists currently practising in Australia. Information sources used in clinical practice; reported awareness of, access to and use of systematic reviews, and consequent practice changes. Response rates were 95% (neonatologists) and 87% (obstetricians); 71 neonatologists (72%) and 55 obstetricians (44%) reported using systematic reviews, primarily for individual patient care. Databases of systematic reviews were used with a median frequency of once per month. Among neonatologists, systematic reviews were used more commonly by those who were familiar with computers, attended professional meetings, and had authored research papers. Among obstetricians, they were used more commonly by those who were familiar with computers, had less than 10 years' clinical experience, attended more deliveries, and were full-time staff specialists in public hospitals. Of neonatologists who reported using systematic reviews, 58% attributed some practice change to this use. For obstetricians, the corresponding figure was 80%. There is evidence that Australian neonatologists and obstetricians use systematic reviews and modify their practice accordingly. Dissemination efforts can benefit from knowledge of factors that predict use of systematic reviews.

Research paper thumbnail of Maternity services for rural and remote Australia: barriers to operationalising national policy

Health Policy

Highlights National policy intends woman-centred rural maternity services should continue A c... more Highlights National policy intends woman-centred rural maternity services should continue A considerable gap exists between this intent and services at local level Barriers to operationalising this intent include lack of leadership and workforce planning Barriers to operationalising policy intent may be eased by using a planning Toolkit

Research paper thumbnail of The distribution of maternity services across rural and remote Australia: does it reflect population need?

BMC Health Services Research, 2017

Background: Australia has a universal health care system and a comprehensive safety net. Despite ... more Background: Australia has a universal health care system and a comprehensive safety net. Despite this, outcomes for Australians living in rural and remote areas are worse than those living in cities. This study will examine the current state of equity of access to birthing services for women living in small communities in rural and remote Australia from a population perspective and investigates whether services are distributed according to need. Methods: Health facilities in Australia were identified and a service catchment was determined around each using a one-hour road travel time from that facility. Catchment exclusions: metropolitan areas, populations above 25,000 or below 1,000, and a non-birthing facility within the catchment of one with birthing. Catchments were attributed with population-based characteristics representing need: population size, births, demographic factors, socioeconomic status, and a proxy for isolation-the time to the nearest facility providing a caesarean section (C-section). Facilities were dichotomised by service levelthose providing birthing services (birthing) or not (no birthing). Birthing services were then divided by C-section provision (C-section vs no C-section birthing). Analysis used two-stage univariable and multivariable logistic regression. Results: There were 259 health facilities identified after exclusions. Comparing services with birthing to no birthing, a population is more likely to have a birthing service if they have more births, (adjusted Odds Ratio (aOR): 1.50 for every 10 births, 95% Confidence Interval (CI) [1.33-1.69]), and a service offering C-sections 1 to 2 h drive away (aOR: 28.7, 95% CI [5.59-148]). Comparing the birthing services categorised by C-section vs no C-section, the likelihood of a facility having a C-section was again positively associated with increasing catchment births and with travel time to another service offering C-sections. Both models demonstrated significant associations with jurisdiction but not socioeconomic status. Conclusions: Our investigation of current birthing services in rural and remote Australia identified disparities in their distribution. Population factors relating to vulnerability and isolation did not increase the likelihood of a local birthing facility, and very remote communities were less likely to have any service. In addition, services are influenced by jurisdictions.

Research paper thumbnail of Australian & New Zealand Neonatal Network 1999

Research paper thumbnail of Reconceptualising risk: perceptions of risk in rural and remote maternity service planning

Midwifery, 2016

Objective: to explore perceptions and examples of risk related to pregnancy and childbirth in rur... more Objective: to explore perceptions and examples of risk related to pregnancy and childbirth in rural and remote Australia and how these influence the planning of maternity services. Design: data collection in this qualitative component of a mixed methods study included 88 semistructured individual and group interviews (n ¼ 102), three focus groups (n ¼22) and one group information session (n ¼17). Researchers identified two categories of risk for exploration: health services risk (including clinical and corporate risks) and social risk (including cultural, emotional and financial risks). Data were aggregated and thematically analysed to identify perceptions and examples of risk related to each category. Setting: fieldwork was conducted in four jurisdictions at nine sites in rural (n ¼ 3) and remote (n ¼ 6) Australia. Participants: 117 health service employees and 24 consumers. Measurements and findings: examples and perceptions relating to each category of risk were identified from the data. Most medical practitioners and health service managers perceived clinical risks related to rural birthing services without access to caesarean section. Consumer participants were more likely to emphasise social risks arising from a lack of local birthing services. Key conclusions: our analysis demonstrated that the closure of services adds social risk, which exacerbates clinical risk. Analysis also highlighted that perceptions of clinical risk are privileged over social risk in decisions about rural and remote maternity service planning. Implications for practice: a comprehensive analysis of risk that identifies how social and other forms of risk contribute to adverse clinical outcomes would benefit rural and remote people and their health Contents lists available at ScienceDirect

Research paper thumbnail of Australian and New Zealand Neonatal Network, 1996-97

Research paper thumbnail of Neurologic assessment of the preterm infant in the intensive and special care nursery & the diagnostic significance of the ATNR

The Australian journal of physiotherapy

Research paper thumbnail of Australian and New Zealand Neonatal Network, 1994

Research paper thumbnail of Australian & New Zealand Neonatal Network, 2000

Research paper thumbnail of Identifying maternity services in public hospitals in rural and remote Australia

Australian Health Review, 2014

Objective This paper articulates the importance of accurately identifying maternity services. It ... more Objective This paper articulates the importance of accurately identifying maternity services. It describes the process and challenges of identifying the number, level and networks of rural and remote maternity services in public hospitals serving communities of between 1000 and 25 000 people across Australia, and presents the findings of this process. Methods Health departments and the national government’s websites, along with lists of public hospitals, were used to identify all rural and remote Australian public hospitals offering maternity services in small towns. State perinatal reports were reviewed to establish numbers of births by hospital. The level of maternity services and networks of hospitals within which services functioned were determined via discussion with senior jurisdictional representatives. Results In all, 198 rural and remote public hospitals offering maternity services were identified. There were challenges in sourcing information on maternity services to gener...