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Objective: The relationship between chronic pain and complementary and alternative medicine (CAM) use is poorly understood, and the situation in rural Australia is particularly unclear. The objective here was to determine the socio‐demographic factors associated with the use of CAM for the treatment of chronic pain in a region of rural Australia. Methods: This secondary analysis used data from a population health survey, Crossroads‐II, to assess the relationships of various socio‐demographic factors with the use of CAM by those suffering from chronic pain. Design: Face‐to‐face surveys at households randomly selected from residential address lists. Setting: A large regional centre and three nearby rural towns in northern Victoria, Australia. Participants: Sixteen years of age and older. Main Outcome Measures: Use of a CAM service to treat chronic pain. Results: Being female (2.40 [1.47, 3.93], p < 0.001) and having a bachelorʼs degree (OR 2.24 [1.20, 4.20], p < 0.001) had a significant positive relationship with the use of CAM overall to redress chronic pain and those 50 years and older had greater odds of using manipulation therapies relative to those below 50 years (50–64: OR 0.52 [0.32, 0.86], p = 0.010; 65+: 0.37 [0.18, 0.75], p = 0.005). Conclusion: In the studied region, females and those with university education have the greatest odds of using CAM to treat chronic pain. This study needs to be complemented with more mechanistic investigations into the reasons people make the decisions they make about using CAM for the management of chronic pain. [ABSTRACT FROM AUTHOR]

Objective: This study determines whether the distribution of self-reported private health insurance (PHI) status in the 2004/05 National Health Survey (NHS) is representative of PHI coverage in Australia. Methods: Weighted estimates from the NHS 2004/05 are compared with PHI status reported for 2004/05 by the Private Health Insurance Administration Council (PHIAC, the independent regulator of the private health insurance industry). PHI status was imputed to children in the NHS based on PHI status of the adult in the household. The two data sources were deemed to be different if the PHIAC results were not within the 95% CI range for the NHS estimate. Results: PHI status reported in the NHS and PHIAC are generally comparable except for some categories such as hospital cover of males aged 5-9 years and females aged 85 years and older where the NHS estimates are below PHIAC numbers; and males aged 25-29, 35-39, and 50-54 years where the NHS estimates are higher. Conclusions: The findings suggest that while the NHS 2004/05 estimates may accurately represent coverage in Australia particularly when examined at an aggregated level, there is some variation in the NHS estimates when examined by sex and age group. Implications: Researchers need to be aware of the potential for sampling and reporting bias to contribute to some misrepresentation of PHI status when using the NHS to generalise to the Australian population. Exploring corrective measures will ensure that the NHS continues to be a valuable data resource for health researchers in Australia. Key words: Private health insurance, National Health Survey, benchmark, validation doi: 10.1111/j.1753-6405.2010.00626.x

Objective: To estimate the fraction of remaining life lived with and without dementia among Australian males and females at later life. Method: Analysis was performed by applying the life table technique that integrates mortality and morbidity statistics to derive a single population health indicator. Observed prevalence rates were used to calculate life expectancy with dementia. Results: At the age of 65 years, males are expected to live an additional 18 years, of which 6% would be lived with dementia. Females surviving to 65 years, are likely to live a further 22 years, 9% of which is expected to be lived with dementia. At the age of 85 years, males live a further six years; one-sixth of this life spent with dementia. Females surviving to this age would live an additional seven years, with one-fourth of that life with dementia. The portion of life lived with dementia out of total remaining years of life increases with age at the rate of 20 to 30% every five years beyond the age of 65. Conclusion: The extension of life expectancy is associated with increased duration of life lived with dementia. As females live longer than males, they experience a greater impact of dementia. Key words: dementia, dementia free life expectancy, Australia

Objective: To compare the National Health Survey (NHS) derived estimates of hospital admissions with the number of hospital separations registered in the National Hospital Morbidity Dataset (NHMD). Methods: Using the person weights in the NHS, the Expanded Confidential Unit Record File of the 2004-05 NHS was used to derive a population estimate of the number of hospital admissions in the 12 months preceding the conduct of the survey. These estimates, by age and sex categories and whether or not the admission involved an overnight stay, were compared with the number of hospital separations registered in the NHMD. Results: The number of hospital admissions estimated from the NHS was approximately two thirds the number of hospital separations registered in the NHMD. The discrepancy between the two data sources was greater when hospital episodes did not involve an overnight stay in hospital. Conclusion: There are systematic differences between the number of admissions/separations derived by the NHS and the NHMD for reasons including the technical difference between a hospital admission and a separation, and the sampling frame and scope of the NHS. Researchers looking for individual level data on hospital utilisation must take note of the differences between NHS and the NHMD, and recognise that there are methods to simulate a representative population by enhancing an existing dataset with information from multiple data sources, thus providing researchers a cost-effective data resource. Keywords: Hospital surveys, hospital separations, morbidity, population surveillance, population register, hospitalisation.

Objective: To assess the skin irritant potential of a range of laboratory grown cyanobacterial species using skin-patch testing on human volunteers. Methods: Cell suspensions and extracts of cyanobacterial cultures of Microcystis aeruginosa (non-toxic strain), Anabaena circinalis and Nodularia spumigena were applied to 64 volunteers in one trial, and Microcystis aeruginosa (toxic strain), Apanocapsa incerta and Cylindrospermopsis raciborskii were applied to 50 volunteers in a second trial. Six cell concentrations of each organism in the range from less than 5,000 to greater than 200,000 cells/mL were applied in random order using adhesive skin patches (Finn Chambers[R]). In addition, the applications included two treatments of each cyanobacterial species, involving whole and lysed cells, and positive (sodium lauryl sulphate) and negative (culture media) controls. Patches were removed after 24 hours and assessment of erythema was made by a dermatologist blinded to the species, cell type and concentration. Results: On average, between 20% and 24% of individuals with 95% confidence interval [+ or -] 8% reacted across the concentration range tested for these cyanobacterial species. The reaction rates were lower (11% to 15%) among the subset of subjects not reacting to negative controls. The reaction was mostly mild, and in all cases was resolved without treatment. This was the case for both whole and lysed cells with little difference in reaction rates between these two treatments. There was also no dose-response across the concentration range for any of the cyanobacterial species tested. Conclusion: A small proportion of healthy people (around 20%) may develop a skin reaction to cyanobacteria in the course of normal water recreation, but the reaction is mild and resolved without treatment.

Abstract Background In the 21st century, government and industry are supplementing hierarchical, bureaucratic forms of organization with network forms, compatible with principles of devolved governance and decentralization of services. Clinical networks are employed as a key health policy approach to engage clinicians in improving patient care in Australia. With significant investment in such networks in Australia and internationally, it is important to assess their effectiveness and sustainability as implementation mechanisms. Methods In two purposively selected, musculoskeletal clinical networks, members and stakeholders were interviewed to ascertain their perceptions regarding key factors relating to network effectiveness and sustainability. We adopted a three-level approach to evaluating network effectiveness: at the community, network, and member levels, across the network lifecycle. Results Both networks studied are advisory networks displaying characteristics of the ‘enclave’ type of non-hierarchical network. They are hybrids of the mandated and natural network forms. In the short term, at member level, both networks were striving to create connectivity and collaboration of members. Over the short to medium term, at network level, both networks applied multi-disciplinary engagement in successfully developing models of care as key outputs, and disseminating information to stakeholders. In the long term, at both community and network levels, stakeholders would measure effectiveness by the broader statewide influence of the network in changing and improving practice. At community level, in the long term, stakeholders acknowledged both networks had raised the profile, and provided a ‘voice’ for musculoskeletal conditions, evidencing some progress with implementation of the network mission while pursuing additional implementation strategies. Conclusions This research sheds light on stakeholders’ perceptions of assessing clinical network effectiveness at community, network, and member levels during the network’s timeline, and on the role of networks and their contribution. Overall, stakeholders reported positive momentum and useful progress in network growth and development, and saw their networks as providing valuable mechanisms for meeting instrumental goals and pursuing collaborative interests. Network forms can prove their utility in addressing ‘wicked problems,’ and these Australian clinical networks present a practical approach to the difficult issue of clinician engagement in state-level implementation of best practice for improving patient care and outcomes.

Abstract Background Communities of Practice (CoPs) are promoted in the healthcare sector as a means of generating and sharing knowledge and improving organisational performance. However CoPs vary considerably in the way they are structured and operate in the sector. If CoPs are to be cultivated to benefit healthcare organisations, there is a need to examine and understand their application to date. To this end, a systematic review of the literature on CoPs was conducted, to examine how and why CoPs have been established and whether they have been shown to improve healthcare practice. Methods Peer-reviewed empirical research papers on CoPs in the healthcare sector were identified by searching electronic health-databases. Information on the purpose of establishing CoPs, their composition, methods by which members communicate and share information or knowledge, and research methods used to examine effectiveness was extracted and reviewed. Also examined was evidence of whether or not CoPs led to a change in healthcare practice. Results Thirty-one primary research papers and two systematic reviews were identified and reviewed in detail. There was a trend from descriptive to evaluative research. The focus of CoPs in earlier publications was on learning and exchanging information and knowledge, whereas in more recently published research, CoPs were used more as a tool to improve clinical practice and to facilitate the implementation of evidence-based practice. Means by which members communicated with each other varied, but in none of the primary research studies was the method of communication examined in terms of the CoP achieving its objectives. Researchers are increasing their efforts to assess the effectiveness of CoPs in healthcare, however the interventions have been complex and multifaceted, making it difficult to directly attribute the change to the CoP. Conclusions In keeping with Wenger and colleagues' description, CoPs in the healthcare sector vary in form and purpose. While researchers are increasing their efforts to examine the impact of CoPs in healthcare, cultivating CoPs to improve healthcare performance requires a greater understanding of how to establish and support CoPs to maximise their potential to improve healthcare.

Abstract Background Healthcare organisations seeking to manage knowledge and improve organisational performance are increasingly investing in communities of practice (CoPs). Such investments are being made in the absence of empirical evidence demonstrating the impact of CoPs in improving the delivery of healthcare. A realist evaluation is proposed to address this knowledge gap. Underpinned by the principle that outcomes are determined by the context in which an intervention is implemented, a realist evaluation is well suited to understand the role of CoPs in improving healthcare practice. By applying a realist approach, this study will explore the following questions: What outcomes do CoPs achieve in healthcare? Do these outcomes translate into improved practice in healthcare? What are the contexts and mechanisms by which CoPs improve healthcare? Methods The realist evaluation will be conducted by developing, testing, and refining theories on how, why, and when CoPs improve healthcare practice. When collecting data, context will be defined as the setting in which the CoP operates; mechanisms will be the factors and resources that the community offers to influence a change in behaviour or action; and outcomes will be defined as a change in behaviour or work practice that occurs as a result of accessing resources provided by the CoP. Discussion Realist evaluation is being used increasingly to study social interventions where context plays an important role in determining outcomes. This study further enhances the value of realist evaluations by incorporating a social network analysis component to quantify the structural context associated with CoPs. By identifying key mechanisms and contexts that optimise the effectiveness of CoPs, this study will contribute to creating a framework that will guide future establishment and evaluation of CoPs in healthcare.

Abstract Background Communities of practice and social-professional networks are generally considered to enhance workplace experience and enable organizational success. However, despite the remarkable growth in interest in the role of collaborating structures in a range of industries, there is a paucity of empirical research to support this view. Nor is there a convincing model for their systematic evaluation, despite the significant potential benefits in answering the core question: how well do groups of professionals work together and how could they be organised to work together more effectively? This research project will produce a rigorous evaluation methodology and deliver supporting tools for the benefit of researchers, policymakers, practitioners and consumers within the health system and other sectors. Given the prevalence and importance of communities of practice and social networks, and the extent of investments in them, this project represents a scientific innovation of national and international significance. Methods and design Working in four conceptual phases the project will employ a combination of qualitative and quantitative methods to develop, design, field-test, refine and finalise an evaluation framework. Once available the framework will be used to evaluate simulated, and then later existing, health care communities of practice and social-professional networks to assess their effectiveness in achieving desired outcomes. Peak stakeholder groups have agreed to involve a wide range of members and participant organisations, and will facilitate access to various policy, managerial and clinical networks. Discussion Given its scope and size, the project represents a valuable opportunity to achieve breakthroughs at two levels; firstly, by introducing novel and innovative aims and methods into the social research process and, secondly, through the resulting evaluation framework and tools. We anticipate valuable outcomes in the improved understanding of organisational performance and delivery of care. The project's wider appeal lies in transferring this understanding to other health jurisdictions and to other industries and sectors, both nationally and internationally. This means not merely publishing the results, but contextually interpreting them, and translating them to advance the knowledge base and enable widespread institutional and organisational application.

A cross-sectional study was conducted to determine the blood lead concentration and iron among pre-school children of Central Sydney, Australia. Researchers compared the results of stratified random sampling and the opportunistic sampling strategy. The mean blood lead was .40 and .34 respectively. The results showed that opportunistic sampling survey was not a good substitute for traditional random sampling.

An editorial is presented to the article has well established that bushfires and other natural disasters have long-term effects on the mental health of affected individuals and communities. Topics include rural communities have vulnerable to bushfires, and the 2019–2020 bushfire events impacted Australian rural communities; and the bushfires has a devastating impact on rural agricultural-based communities.