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Abstract Background The continued increase in hospital admissions is a significant and complex issue facing health services. There is little research exploring patient perspectives or examining individual admissions among patients with frequent admissions for chronic ambulatory care sensitive (ACS) conditions. This paper aims to describe characteristics of older, rural patients frequently admitted with ACS conditions and identify factors associated with their admissions from the patient perspective. Methods Patients aged 65+ resident in North Coast NSW with three or more admissions for selected ACS chronic conditions within a 12 month period, were invited to participate in a postal survey and follow up telephone call. Survey and telephone data were linked to admission and health service program data. Descriptive statistics were generated for survey respondents; logistic regression models developed to compare characteristics of patients with 3 or with 4+ admissions; and comparisons made between survey respondents and non-respondents. Results Survey respondents (n=102) had a mean age of 77.1 years (range 66–95 years), and a mean of 4.1 admissions within 12 months; 49% had at least three chronic conditions; the majority had low socioeconomic status; one in five (22%) reported some difficulty affording their medication; and 35% lived alone. The majority reported psychological distress with 31% having moderate or severe psychological distress. While all had a GP, only 38% reported having a written GP care plan. 22% of those who needed regular help with daily tasks did not have a close friend or relative who regularly cared for them. Factors independently associated with more frequent (n=4+) relative to less frequent (n=3) admissions included having congestive heart failure (p=0.003), higher social isolation scores (p=0.040) and higher Charlson Comorbidity Index scores (p=0.049). Most respondents (61%) felt there was nothing that could have avoided their most recent admission, although some potential avoidability of admission was described around medication and health behaviours. Respondents were younger and less sick than non-respondents. Conclusions This study provides a detailed description of older patients with multiple chronic conditions and a history of frequent admission in rural Australia. Our results suggest that programs targeting medication use, health behaviours and social isolation may help reduce multiple hospital admissions for chronic disease.

Abstract Background Frequent and potentially avoidable hospital admission amongst older patients with ambulatory care sensitive (ACS) chronic conditions is a major topic for research internationally, driven by the imperative to understand and therefore reduce hospital admissions. Research to date has mostly focused on analysis of routine data using ACS as a proxy for 'potentially avoidable'. There has been less research on the antecedents of frequent and/or avoidable admission from the perspectives of patients or those offering community based care and support for these patients. This study aimed to explore community based service providers' perspectives on the factors contributing to admission among older patients with chronic disease and a history of frequent and potentially avoidable admission. Methods 15 semi-structured interviews with community based providers of health care and other services, and an emergency department physician were conducted. Summary documents were produced and thematic analysis undertaken. Results A range of complex barriers which limit or inhibit access to services were reported. We classified these as external and internal barriers. Important external barriers included: complexity of provision of services, patients' limited awareness of different services and their inexperience in accessing services, patients needing a higher level or longer length of service than they currently have access to, or an actual lack of available services, patient poverty, rurality, and transport. Important internal barriers included: fear (of change for example), a 'stoic' attitude to life, and for some, the difficulty of accepting their changed health status. Conclusions The factors underlying frequent and/or potentially avoidable admission are numerous and complex. Identifying strategies to improve services or interventions for this group requires understanding patient, carer and service providers' perspectives. Improving accessibility of services is also complex, and includes consideration of patients' social, emotional and psychological ability and willingness to use services as well as those services being available and easily accessed.

Abstract Background Air pollution in Darwin, Northern Australia, is dominated by smoke from seasonal fires in the surrounding savanna that burn during the dry season from April to November. Our aim was to study the association between particulate matter less than or equal to 10 microns diameter (PM10) and daily emergency hospital admissions for cardio-respiratory diseases for each fire season from 1996 to 2005. We also investigated whether the relationship differed in indigenous Australians; a disadvantaged population sub-group. Methods Daily PM10 exposure levels were estimated for the population of the city from visibility data using a previously validated model. We used over-dispersed Poisson generalized linear models with parametric smoothing functions for time and meteorology to examine the association between admissions and PM10 up to three days prior. An interaction between indigenous status and PM10 was included to examine differences in the impact on indigenous people. Results We found both positive and negative associations and our estimates had wide confidence intervals. There were generally positive associations between respiratory disease and PM10 but not with cardiovascular disease. An increase of 10 μg/m3 in same-day estimated ambient PM10 was associated with a 4.81% (95%CI: -1.04%, 11.01%) increase in total respiratory admissions. When the interaction between indigenous status and PM10 was assessed a statistically different association was found between PM10 and admissions three days later for respiratory infections of indigenous people (15.02%; 95%CI: 3.73%, 27.54%) than for non-indigenous people (0.67%; 95%CI: -7.55%, 9.61%). There were generally negative estimates for cardiovascular conditions. For non-indigenous admissions the estimated association with total cardiovascular admissions for same day ambient PM10 and admissions was -3.43% (95%CI: -9.00%, 2.49%) and the estimate for indigenous admissions was -3.78% (95%CI: -13.4%, 6.91%), although ambient PM10 did have positive (non-significant) associations with cardiovascular admissions of indigenous people two and three days later. Conclusion We observed positive associations between vegetation fire smoke and daily hospital admissions for respiratory diseases that were stronger in indigenous people. While this study was limited by the use of estimated rather than measured exposure data, the results are consistent with the currently small evidence base concerning this source of air pollution.

Abstract Background The effect of individual pollutants and the period(s) during pregnancy when pollutant levels are likely to have most impact on preterm birth is not clear. We evaluated the effect of prenatal exposure to six common urban air pollutants in the Sydney metropolitan area on preterm birth. Methods We obtained information on all births in metropolitan Sydney between January 1, 1998 and December 31, 2000. For each birth, exposure to each air pollutant was estimated for the first trimester, the three months preceding birth, the first month after the estimated date of conception and the month prior to delivery. Gestational age was analysed as a categorical variable in logistic regression models. Results There were 123 840 singleton births in Sydney in 1998–2000 and 4.9% were preterm. Preterm birth was significantly associated with maternal age, maternal smoking, male infant, indigenous status and first pregnancy. Air pollutant levels in the month and three months preceding birth had no significant effect on preterm birth after adjusting for maternal and infant covariates. Ozone levels in the first trimester of pregnancy and spring months of conception and sulphur dioxide were associated with increased risks for preterm births. Nitrogen dioxide was associated with a decreased risk of preterm births. Conclusion We found more protective than harmful associations between ambient air pollutants and preterm births with most associations non-significant. In view of these inconsistent associations, it is important to interpret the harmful effects with caution. If our results are confirmed by future studies then it will be imperative to reduce Sydney's already low air pollution levels even further.

Modelling and forecasting of air pollution from bushfires or hazardous reduction burnings is important in providing information and allowing measures to be taken to reduce the exposure of people from harmful effect of air pollutants from fire events. In this work, the meteorological, chemical transport model and air quality models developed by the Commonwealth Scientific and Industrial Research Organisation of Australia are used in conjunction with the smoke emission model to simulate the formation and dispersion of particle aerosols (PM2.5) in the Greater Metropolitan Region of Sydney as the results of emission of different pollutant species from hazardous reduction burnings or from bushfires. The smoke emission model is based on a fire model describing two distinct fire behaviours: flaming and smothering. There are several schemes that can be used to estimate the emission factors of different emitted species from fire of various vegetation types. A comparison of these schemes is performed by comparing the air quality model output from air quality model with observation from monitoring stations in a case study, the May 2016 prescribed burning winter period, which caused elevated particle concentrations in the Sydney basin. The PM2.5 prediction over the Greater Metropolitan Region of Sydney from the forecasting modelling tool will then be used to calculate the population exposure and health impacts due to the May 2016 fire event as a case study. The three main health endpoints considered for health impacts are mortality, respiratory-related and cardiovascular hospitalisations. The results are comparable with other studies using non-modelling methods of determining the exposure and health impacts on this event. [ABSTRACT FROM AUTHOR]

Purpose: Socioecological factors are understudied in relation to trauma patients' outcomes. This study investigated the association of neighborhood socioeconomic disadvantage (SED) and remoteness of residence on acute length of hospital stay days (ALSD) and inpatient mortality. Methods: A retrospective cohort study was conducted on adults hospitalized for major trauma in a Level 1 trauma center in southeast Queensland from 2014 to 2017. Neighborhood SED and remoteness indices were linked to individual patient variables. Step‐wise multivariable negative binomial regression and proportional hazards regression analyses were undertaken, adjusting for injury and patient factors. Outcomes were ALSD and inpatient mortality. Findings: We analyzed 1,025 patients. Statistically significant increased hazard of inpatient mortality was found for older age (HR 3.53, 95% CI: 1.77‐7.11), injury severity (HR 5.27, 95% CI: 2.78‐10.02), remoteness of injury location (HR 1.75, 95% CI: 1.06‐2.09), and mechanisms related to intentional self‐harm or assault (HR 2.72, 95% CI: 1.48‐5.03,). Excess mortality risk was apparent for rural patients sustaining less severe injuries (HR 4.20, 95% CI: 1.35‐13.10). Increased risk for longer ALSD was evident for older age (RR 1.35, 95% CI: 1.07‐1.71), head injury (RR 1.39, 95% CI: 1.19‐1.62), extremity injuries (RR 1.82, 95% CI: 1.55‐2.14), and higher injury severity scores (ISS) (RR 1.51, 95%: CI: 1.29‐1.76). Conclusions: Severely injured rural trauma patients are more likely to be socioeconomically disadvantaged and sustain injuries predisposing them to worse hospital outcomes. Further research is needed to understand more about care pathways and factors influencing the severity, mechanism and clinical consequences of rural‐based traumatic injuries. [ABSTRACT FROM AUTHOR]

We describe factors related to the social vulnerability of populations that experienced major river flooding in northern New South Wales (NSW), Australia. Using geographical information system methods, maps of 2017 flood-affected areas in the Lismore and Murwillumbah regions were combined with 2016 National census data to compare aspects of social vulnerability with the wider region and the region with Sydney. We also used individual-level data from the NSW 45 and Up Study to compare lifestyle, behavioural and health characteristics of residents of these flood-affected areas with the broader region (n = 13,561). Populations living in the Lismore Town Centre flood footprint exhibited significantly higher levels of social vulnerability over a range of factors; in particular, almost 82% resided in the most disadvantaged socio-economic quintile neighbourhoods. The flood-affected areas of Murwillumbah and Lismore regions included 47% and 60% of residents in the most disadvantaged quintile neighbourhoods compared to 27% for whole region and 16% for Sydney. This pattern of increased vulnerability was also apparent from the 45 and Up study; participants residing in the Lismore Town Centre flood footprint had significantly higher rates of riskier lifestyle-related behaviours (smoking, alcohol consumption), pre-existing mental health conditions (depression and anxiety) and poorer health. This detailed case study demonstrates extreme local vulnerability of flood-exposed populations, over and above the already highly vulnerable regional rural populations. This information is important to inform disaster planning and response and also reinforces the importance of having a detailed understanding of affected populations. [ABSTRACT FROM AUTHOR]