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A rapid semi-quantitative ecological risk assessment method (productivity and susceptibility analysis) indicated that, despite its low biological productivity, the Port Jackson shark Heterodontus portusjacksoni is at low risk to all fishing methods in far-eastern Victoria, Australia, under the present fishing practices, because of its low catch susceptibility. The risk to this population, however, would increase if the shark gillnet fishery operating in the region were to retain the species as a by-product. Demographic analysis indicated that the species has medium intrinsic population growth rate and potential rebound in comparison with other chondrichthyan species, juveniles have higher elasticity than mature females and both juvenile and mature females have higher elasticities than hatchlings. Because of its low biological productivity and moderate resilience to the effects of fishing, cautious management measures will be necessary to ensure the sustainable use of H. portusjacksoni if its marketing increases in the future. Information on the dynamics of a population that is valuable to provide management advice can be obtained through demographic methods, but rapid assessment methods can also provide complementary information on the effects of fishing by considering the catch susceptibility of the population to each fishing method. [ABSTRACT FROM AUTHOR]

Abstract: Background: Previous studies of paediatric cardiac arrest have reported a low survival rate but there is limited data from Australia. We sought to determine the characteristics and outcomes of paediatric out-of-hospital cardiac arrest in Melbourne, Australia. Methods: Between October 1999 and June 2007, all cases of out-of-hospital cardiac arrest attended by emergency medical services in Melbourne, Australia were entered into a database (the Victorian Ambulance Cardiac Arrest Registry). Data on patients aged less than 16 years in cardiac arrest on arrival of ambulance paramedics was analysed. Results: There were 209 children in cardiac arrest on arrival of paramedics during the study period. Of these, resuscitation was not attempted in 16 children due to signs of definite death. Of the 193 children who had attempted resuscitation, 143 (74%) had an initial cardiac rhythm of asystole, 36 (18%) were in pulseless electrical activity and 14 (7%) were in ventricular fibrillation. There were 49 patients (25%) with return of spontaneous circulation at arrival to hospital of whom 14 (7%) survived to hospital discharge. Of 138 patients without return of a circulation, 120 were transported to hospital with continuing resuscitation and one survived (0.9%). Survival was higher in patients with an initial cardiac rhythm of ventricular fibrillation (5/14; 35%) compared with other rhythms (10/179; 4%), OR 9.38, 95% CI 2.64–33.2. Conclusions: Overall, 7.7% of paediatric patients with out-of-hospital cardiac arrest survive to leave hospital. Increased survival was seen if the initial cardiac rhythm was ventricular fibrillation. Survival was very rare (<1%) unless there was return of spontaneous circulation prior to hospital arrival. [ABSTRACT FROM AUTHOR]

Background: The commercial determinants of health is a rapidly expanding field of research; however Indigenous perspectives remain notably underrepresented. For Indigenous peoples the intersection of globalisation, colonialism and capitalism may amplify commercially-driven health inequities. This study aimed to explore the perspectives of Aboriginal leaders regarding the influence of commercial activities on Aboriginal health and wellbeing in Victoria, Australia., Methods: Semi-structured interviews with 23 Aboriginal leaders from across five sectors (n = 15 urban, n = 8 rural/regional) were analysed through reflexive thematic analysis., Results: Three overarching themes were identified encompassing (i) harmful commercial practices and processes, (ii) improving corporate engagement and (iii) opportunities for self-determination through business. Participants expressed concern over aggressive marketing by the gambling industry, commercial exploitation of Aboriginal culture, the privatisation of public services, and lack of oversignt of corporate social responsibility strategies. Simultaneously, Aboriginal-led businesses were viewed as opportunities for cultural connection, and financial empowerment and self-determination., Conclusion: Numerous commercial entities and activities are perceived to influence Aboriginal health and wellbeing. This study highlights the need for stronger policy and regulation to mitigate harmful industry practices while incentivising the potential positive impacts of the commercial activities on Aboriginal health and wellbeing., (© 2024. The Author(s).)

Objectives: Aboriginal and Torres Strait Islander Australians have a substantially greater fracture risk, where men are 50% and women are 26% more likely to experience a hip fracture compared with non-Indigenous Australians. Fall-related injuries in this population have also increased by 10%/year compared with 4.3%/year in non-Indigenous Australians. This study aims to determine why falls and fracture risk are higher in Aboriginal and Torres Strait Islander Australians., Setting: All clinical assessments will be performed at one centre in Melbourne, Australia. At baseline, participants will have clinical assessments, including questionnaires, anthropometry, bone structure, body composition and physical performance tests. These assessments will be repeated at follow-up 1 and follow-up 2, with an interval of 12 months between each clinical visit., Participants: This codesigned prospective observational study aims to recruit a total of 298 adults who identify as Aboriginal and Torres Strait Islander and reside within Victoria, Australia. Stratified sampling by age and sex will be used to ensure equitable distribution of men and women across four age-bands (35-44, 45-54, 55-64 and 65+ years)., Primary and Secondary Outcome Measures: The primary outcome is within-individual yearly change in areal bone mineral density at the total hip, femoral neck and lumbar spine assessed by dual energy X-ray absorptiometry. Within-individual change in cortical and trabecular volumetric bone mineral density at the radius and tibia using high-resolution peripheral quantitative computed tomography will be determined. Secondary outcomes include yearly differences in physical performance and body composition., Ethical Approval: Ethics approval for this study has been granted by the Monash Health Human Research Ethics Committee (project number: RES-19-0000374A)., Trial Registration Number: ACTRN12620000161921., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: A major review of Victoria's ambulance services identified the need to improve public awareness of the role of ambulances as an emergency service. A communications campaign was developed to address this challenge. This research paper expands on an initial evaluation of the campaign by focusing on the long-term behavioural outcomes., Methods: The behavioural evaluation involved two types of data collection - administrative data (routine collection from various health services) and survey data (cross-sectional community-wide surveys to measure behavioural intentions)., Results: Behavioural intentions for accessing two of the targeted non-emergency services increased after the second phase of the campaign commenced. There was also a significant change in the slope of call trends for emergency ambulances. This decrease is also likely attributed to the second phase of the campaign as significant level effects were identified 3 and 9 months after it commenced., Conclusions: A long-term campaign developed through evidence review, stakeholder consultation and behavioural theory was successful in reducing the number of daily calls requesting an emergency ambulance in Victoria and in increasing intentions to use alternative services. This research highlights the importance of collaborative intervention design along with the importance of implementing a robust monitoring and evaluation framework.

Objective: In Victoria, Australia, Emergency Medical Service (EMS) demand has increased almost 5% per annum over the past 5 years. This may adversely affect response times to time-critical patients. Additionally, >55% of cases have received Code 1 (lights/sirens) responses. Primary telephone triage occurs using the Medical Priority Dispatch System (MPDS); however, MPDS is reported to be highly sensitive, with common over-triage. The present study describes the methodology applied to better align the response allocated to MPDS determinant codes with patient acuity., Methods: Data between October 2013 and August 2014 were extracted from the Ambulance Victoria data warehouse. The decision to allocate MPDS determinant codes to a lower response priority and/or secondary triage was based on epidemiological profiling and, in some cases, expert panel review., Results: The review identified 105 MPDS codes receiving a Code 1 response as suitable for a Code 2 (urgent) response, and 221 Code 1 or 2 codes as suitable for secondary triage. Data analysis estimated a reduction in Code 1 responses by 28%, and an increase in the secondary triage caseload by 120%. Modelling also predicted a 2.6 percentage point improvement in the proportion of Code 1 cases attended within 15 min., Conclusion: Analysis of a large EMS dataset supported changes to the EMS response priority for a number of MPDS determinant codes. Such changes should improve the alignment between EMS response and patient acuity, and improve response times to time-critical patients. Other EMS with electronic data could consider testing this methodology., (© 2018 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.)

Background: In Victoria, Australia, emergency calls requesting an ambulance have been increasing at a rate higher than population growth. While most of these calls are for genuine emergencies, many do not require an immediate ambulance response. A collaborative research approach was undertaken to address this issue. The aim of this paper was to evaluate the effectiveness of applying a behaviour change approach to this challenge by first addressing antecedents of behaviour (attitudes, awareness and knowledge)., Methods: The project included a formative research phase to inform the design of a mass media campaign and subsequent evaluation of the campaign., Results: Results indicated that the campaign was successful in increasing community attitudes towards ambulances as being for emergencies only, particularly among those familiar with the campaign material and with other health service options (such as telephone advice lines)., Conclusions: These findings provide support for adopting the Forum approach to increase the chances that a mass media campaign will achieve its stated objectives. Recommendations for future campaign activities are discussed.

Background: Effective cardiopulmonary resuscitation and increased coronary perfusion pressures have been linked to improved survival from cardiac arrest. This study aimed to compare the rates of survival between conventional cardiopulmonary resuscitation (C-CPR) and automated CPR (A-CPR) using AutoPulse™ in adults following out-of-hospital cardiac arrest (OHCA)., Methods: This was a retrospective study using a matched case-control design across three regional study sites in Victoria, Australia. Each case was matched to at least two (maximum four) controls using age, gender, response time, presenting cardiac rhythm and bystander CPR, and analysed using conditional fixed-effects logistic regression., Results: During the period 1 October 2006 to 30 April 2010 there were 66 OHCA cases using A-CPR. These were matched to 220 cases of OHCA involving the administration of C-CPR only (controls). Survival to hospital was achieved in 26% (17/66) of cases receiving A-CPR compared with 20% (43/220) of controls receiving C-CPR and the propensity score adjusted odds ratio [AOR (95% CI)] was 1.69 (0.79, 3.63). Results were similar using only bystander witnessed OHCA cases with presumed cardiac aetiology. Survival to hospital was achieved for 29% (14/48) of cases receiving A-CPR compared with 18% (21/116) of those receiving C-CPR [AOR =1.80 (0.78, 4.11)]., Conclusions: The use of A-CPR resulted in a higher rate of survival to hospital compared with C-CPR, yet a tendency for a lower rate of survival to hospital discharge, however these associations did not reach statistical significance. Further research is warranted which is prospective in nature, involves randomisation and larger number of cases to investigate potential sub-group benefits of A-CPR including survival to hospital discharge.

Objective: To determine whether the statewide system of trauma care introduced in 2000 has resulted in improved survival for all major trauma patients in Victoria., Design, Setting and Participants: Population-based cohort study using data from the Victorian State Trauma Registry (VSTR), a registry of all hospitalised major trauma patients in Victoria. The study included major trauma patients with an Injury Severity Score > 15 captured by the VSTR between July 2001 and June 2006., Main Outcome Measure: In-hospital mortality., Results: The number of major trauma cases captured by the registry rose from 1153 in 2001-02 to 1737 in 2005-06. Adjusting for key predictors of mortality, there was a significant overall reduction between 2001-02 and 2005-06 in the risk of death for patients treated in the trauma system (adjusted odds ratio [AOR], 0.62 [95% CI, 0.48-0.80]). The reduced risk of death was also significant when road trauma cases (AOR, 0.56 [95% CI, 0.39-0.80]) and serious head injury cases (AOR, 0.62 [95% CI, 0.46-0.83]) were analysed separately. The proportion of road trauma patients definitively treated at one of the three major trauma service (MTS) hospitals in Victoria rose by 7% over the 5-year period. Direct transfers from the scene of injury to MTS hospitals rose by 8% for all cases and 13% for road trauma cases over the same period., Conclusions: Introduction of a statewide trauma system was associated with a significant reduction in risk-adjusted mortality. Such inclusive systems of trauma care should be regarded as a minimum standard for health jurisdictions.

Objective: To use the Pap smear to establish a recent prevalence of cervical abnormalities within a select population in Vanuatu, a developing country., Methods: Cervical smears (n=907) were collected from Ni-Vanuatu women from both urban and rural islands within Vanuatu between August 2001 and September 2005., Results: The prevalence of low-grade epithelial abnormalities for the total population was 2.9% and the prevalence of the high-grade epithelial abnormalities/cancer was 2.0%. There was a significant difference (p<0.05) in prevalence of high-grade epithelial abnormalities/cancer between the urban and rural populations sampled, with a higher prevalence in the urban population., Conclusions: The prevalence of pre-cancer and cancer in Vanuatu is high compared with Victorian (Australian) statistics yet comparable with other developing countries with no cervical screening programs available., Implications: This study will hopefully assist in future planning of women's health programs and relevant preventive strategies to combat cervical cancer in Vanuatu.

Aims: This study describes the epidemiology of sudden cardiac arrest patients in Victoria, Australia, as captured via the Victorian Ambulance Cardiac Arrest Register (VACAR). We used the VACAR data to construct a new model of out-of-hospital cardiac arrest (OHCA), which was specified in accordance with observed trends., Patients: All cases of cardiac arrest in Victoria that were attended by Victorian ambulance services during the period of 2002-2005., Results: Overall survival to hospital discharge was 3.8% among 18,827 cases of OHCA. Survival was 15.7% among 1726 bystander witnessed, adult cardiac arrests of presumed cardiac aetiology, presenting in ventricular fibrillation or ventricular tachycardia (VF/VT), where resuscitation was attempted. In multivariate logistic regression analysis, bystander CPR, cardiac arrest (CA) location, response time, age and sex were predictors of VF/VT, which, in turn, was a strong predictor of survival. The same factors that affected VF/VT made an additional contribution to survival. However, for bystander CPR, CA location and response time this additional contribution was limited to VF/VT patients only. There was no detectable association between survival and age younger than 60 years or response time over 15min., Conclusion: The new model accounts for relationships among predictors of survival. These relationships indicate that interventions such as reduced response times and bystander CPR act in multiple ways to improve survival.

Objective: To identify potentially preventable prehospital deaths following traumatic cardiac arrest., Methods: Deaths following prehospital traumatic cardiac arrest during 2003 were reviewed in the state of Victoria, Australia. Possible survival with optimal bystander first-aid and shorter ambulance response times were identified. Injury Severity Scores (ISS) were calculated. Victims with an ISS <50 and signs of life were reviewed for potentially preventable factors contributing to death including signs of airway obstruction, excessive bleeding and/or delayed ambulance response times., Results: We reviewed 112 cases that had full ambulance care records, hospital records and autopsy details in Victoria 2003. Most deaths involved road trauma and 55 victims had an ISS <50. Twelve patients received first-aid from bystanders. Ambulance response times >10 min might have contributed to five deaths with an ISS <25., Conclusion: Five (4.5%) potentially preventable prehospital trauma deaths were identified. Three deaths potentially involved airway obstruction and two involved excessive bleeding. There is a case for increased awareness of the need for bystander first-aid at scene following major trauma.

Objective: To compare the survival rate from out-of-hospital cardiac arrest in rural and urban areas of Victoria, and to investigate the factors associated with these differences., Design: Retrospective case series using data from the Victorian Ambulance Cardiac Arrest Registry., Setting: All out-of-hospital cardiac arrests occurring in Victoria that were attended by Rural Ambulance Victoria or the Metropolitan Ambulance Service., Participants: 1790 people who suffered a bystander-witnessed cardiac arrest between January 2002 and December 2003., Results: Bystander cardiopulmonary resuscitation was more likely in rural (65.7%) than urban areas (48.4%) (P = 0.001). Urban patients with bystander-witnessed cardiac arrest were more likely to arrive at an emergency department with a cardiac output (odds ratio [OR], 2.92; 95% CI, 1.65-5.17; P < 0.001), and to be discharged from hospital alive than rural patients (urban, 125/1685 [7.4%]; rural, 2/105 [1.9%]; OR, 4.13; 95% CI, 1.09-34.91). Major factors associated with survival to hospital admission were distance of cardiac arrest from the closest ambulance branch (OR, 0.87; 95% CI, 0.82-0.92), endotracheal intubation (OR, 3.46; 95% CI, 2.49-4.80), and the presence of asystole (OR, 0.50; 95% CI, 0.38-0.67) or pulseless electrical activity (OR, 0.73; 95% CI, 0.56-0.95) on arrival of the first ambulance crew., Conclusions: Survival rates differ between urban and rural cardiac arrest patients. This is largely due to a difference in ambulance response time. As it is impractical to substantially decrease response times in rural areas, other strategies that may improve outcome after cardiac arrest require investigation.

Objective: To determine the proportion of patients in Victoria treated within the British Heart Foundation 90-minute call-to-needle (CTN) time benchmark for thrombolysis of ST-elevation myocardial infarction (STEMI), and to validate the British Heart Foundation 90-minute benchmark with respect to mortality., Design: Cohort study., Setting: 20 hospitals and two ambulance services in the State of Victoria, Australia., Participants: 1147 patients with STEMI transported to hospital by ambulance and eligible for thrombolysis., Main Outcome Measures: CTN time, and in-hospital mortality., Results: Median CTN time was 83 minutes (mean, 93.2 min; range, 29-894 min). Median door-to-needle (DTN) time was 37 minutes (mean, 46.5 min; range, 0-853 min). 61% of patients received thrombolysis within the 90-minute benchmark. Patients with CTN times > 90 minutes had an increased risk of dying (relative risk, 1.8; 95% CI, 1.3-2.7). Factors associated with CTN time < 90 minutes were lower DTN time, prior notification of the receiving hospital and transport time less than 20 minutes., Conclusion: The British Heart Foundation CTN time benchmark is being met for 61% of eligible STEMI patients in Victoria. Strategies to reduce CTN time should be region-specific, and should include attempts to reduce DTN and to enhance ambulance-hospital communication. Prehospital thrombolysis may be appropriate for some regions.