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2. Teaching and Learning in a Multilingual Europe: Findings from a Cross-European Study

Author

Dockrell, J. E., Papadopoulos, T. C., Mifsud, C. L., Bourke, L., Vilageliu, O., Bešic, E., Seifert, S., Gasteiger-Klicpera, B., Ralli, A., Dimakos, I., Karpava, S., Martins, M., Sousa, O., Castro, S., Søndergaard Knudsen, H. B., Donau, P., Haznedar, B., Mikulajová, M., and Gerdzhikova, N.

Abstract

School classrooms within the EU are multilingual learning environments. The diversity of pupils in classrooms raises significant challenges for teachers, but to date, there are no data from large-scale surveys that compare views within and across European countries. A bespoke questionnaire was designed to examine views of current classroom learning environments with respect to the multilingualism. The questionnaire was piloted and subsequently completed by 2792 teachers across different European countries. Eleven countries provided sufficient data for analyses. Results from structural equation modelling showed that teachers' attitudes could be reliably measured across Europe with the use of carefully devised questionnaire, whose loading and factor structure remained invariant across countries. Teachers' views about multilingualism were most challenged by the numbers of children in their classes, not the percentage of multilingual pupils in the class. Countries differed in how they perceived multilingualism, with their differences leading to distinctive country clusters. Gender and education level (elementary vs. secondary) differences were also observed irrespective of country. These findings enhance our understanding of the role that the characteristics of teachers and their classrooms play in a multilingual setting across diverse European settings. The practical relevance of the results and new opportunities for teacher training are discussed.

Published
2022
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5. Does Audio-Visual Binding as an Integrative Function of Working Memory Influence the Early Stages of Learning to Write?

Author

Davies, S. J., Bourke, L., and Harrison, N.

Abstract

Working memory has been proposed to account for the differential rates in progress young children make in writing. One crucial aspect of learning to write is the encoding (i.e., integration) and retrieval of the correct phoneme-grapheme pairings, known as binding. In addition to executive functions, binding is regarded as central to the concept of working memory. To test the developmental increase in binding ability and its comparative influence on writing, an experimental study assessed 5- and 6-year-olds' accuracy in retaining and retrieving bound audio-visual information alongside measures of verbal and visual complex working memory span (i.e., central executive functions), and transcription skills (i.e., alphabet and spelling). Results demonstrated an age-related increase in the ability to bind, and that binding had significant associations with working memory and early writing ability, but once binding and age were controlled for it was verbal working memory that made an independent contribution to individual differences in writing performance. Although the contribution this paper made was through an exploration and expansion of theoretical ideas within writing research, it is likely to make an important practical contribution to instruction in the future both at the level of transcription and text generation as writers develop those skills.

Published
2020
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8. NAFLD and MAFLD independently increase the risk of major adverse cardiovascular events (MACE): a 20-year longitudinal follow-up study from regional Australia

Author

Vaz, K, Kemp, W, Majeed, A, Lubel, J, Magliano, DJ, Glenister, KM, Bourke, L, Simmons, D, Roberts, SK, Vaz, K, Kemp, W, Majeed, A, Lubel, J, Magliano, DJ, Glenister, KM, Bourke, L, Simmons, D, and Roberts, SK

Abstract

BACKGROUND AND AIMS: The association between fatty liver disease (FLD) and cardiovascular disease (CVD) in an Australian context has yet to be defined. The primary aim of this study was to investigate the association between FLD and 3-point major adverse cardiovascular events (MACE). METHODS: This was a longitudinal follow-up study of a randomly sampled adult cohort from regional Australia between 2001 and 2003. Baseline covariates included demographic details, anthropometry, health and lifestyle data, and laboratory tests. Non-alcoholic fatty liver disease (NAFLD) and metabolic-(dysfunction) associated fatty liver disease (MAFLD) were diagnosed in participants with fatty liver index (FLI) ≥ 60 and meeting other standard criteria. ICD-10 codes were used to define clinical outcomes linked to hospitalisations. Three-point MACE defined as non-fatal myocardial infarction (MI) and cerebrovascular accident (CVA) and CVD death. RESULTS: In total, 1324 and 1444 participants met inclusion criteria for NAFLD and MAFLD analysis, respectively. Over 23,577 and 25,469 person-years follow-up, NAFLD and MAFLD were independent predictors for 3-point MACE, adjusting for demographic covariates and known cardiometabolic risk factors, whilst considering non-CVD death as a competing event (NAFLD: sub-hazard ratio [sHR] 1.56, 95% confidence interval [CI 1.12-2.19]; MAFLD: sHR 1.51, 95% CI 1.11-2.06). The results held true on several sensitivity analyses. CONCLUSIONS: Both forms of FLD increase the risk for CVD independent of traditional cardiometabolic risk factors.

Published
2024

10. P153 Artificial Intelligence to predict interleukin-23 signalling activity from H&E stained whole slide images of Inflammatory Bowel Disease

Author

Qaiser, T, primary, Hamidinekoo, A, additional, Daniel, S, additional, Zhang, I, additional, Kekic, M, additional, Lewis, A, additional, Angermann, B, additional, Bourke, L, additional, Gehrmann, U, additional, Neisen, J, additional, Tian, S, additional, Corridoni, D, additional, Marks, D, additional, Adissu, H, additional, and Burlutskiy, N, additional

Published
2024
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11. Cardiac injury in lupus

Author

Bourke, L. T.

Subjects
610
Abstract

Systemic lupus erythematosus (SLE) carries a significantly enhanced risk of developing cardiovascular disease (CVD) and remains a leading cause of death in these patients, accounting for ~25% of all causes of mortality. Although there is clear evidence li nking accelerated atherosclerosis to SLE (and consequently an increase in cardiovascular events), another factor that may contribute to CVD related morbidity and mortality is reperfusion injury that occurs post - ischaemia. This is termed ischaemic / reperfu sion (I/R) injury and is a known important contributor to the size of the eventual infarct in the heart, which in animal studies has been shown to account for up to 40 - 50% of the final infarct size. Hydroxychloroquine (HCQ), originally an anti - malarial dr ug, is now used to treat autoimmune disorders, including SLE. HCQ has been shown to modulate inflammation in rheumatic diseases such as SLE and rheumatoid arthritis as well as have potential cardiovascular benefits in these patients. One of the keys aims o f this thesis was to explore the potential use of HCQ in reducing cardiac I/R injury. HCQ was found to be cardioprotective in an in vitro neonatal cardiomyocytes simulated I/R injury model as well as in an in vivo cardiac I/R injury model. This was found to be through an ERK - dependent mechanism which was blocked in the presence of the ERK inhibitor U0126 both in vitro and in vivo . Another relevant question addressed in this thesis was if I/R injury is enhanced in lupus. There is evidence from an autoimmune prone mouse model that lupus IgG are pathogenic in mesenteric I/R injury . However, no study as yet has investigated human lupus IgG in a heart model. IgG was purified from the serum of SLE patients (aPL +ve vs aP L – ve), antiphospholipid syndrome (APS) patients, juvenile onset SLE (JSLE) patients and healthy volunteers. The pre - treatment of neonatal rat cardiomyocytes with IgG from all 3 patient groups enhanced simulated I/R injury. However, the most pathogenic wer e those who were aPL positive. Interestingly, JSLE patients who were all aPL negative, enhanced I/R injury to similar levels as those who tested positive in the adult patient cohort. An enhanced p38 MAPK phosphorylation was observed in the presence of aPL positive IgG and this pathogenic effect was blocked in the presence of the p38 inhibitor SB23580. The results ob tained in this thesis have identified a potential role for HCQ in the cardiovascular field as a cardioprotective therapeutic in myocardial I/R injury. Additionally , IgG purified from patients with SLE , APS and JSLE have been shown to accelerate myocardial I/R injury.

Published
2014

14. Correction: Teaching and learning in a multilingual Europe: findings from a cross-European study (European Journal of Psychology of Education, (2022), 37, 2, (293-320), 10.1007/s10212-020-00523-z)

Author

Dockrell, J.E. Papadopoulos, T.C. Mifsud, C.L. Bourke, L. Vilageliu, O. Bešić, E. Seifert, S. Gasteiger-Klicpera, B. Ralli, A. Dimakos, I. Karpava, S. Martins, M. Sousa, O. Castro, S. Søndergaard Knudsen, H.B. Donau, P. Haznedar, B. Mikulajová, M. Gerdzhikova, N. and Dockrell, J.E. Papadopoulos, T.C. Mifsud, C.L. Bourke, L. Vilageliu, O. Bešić, E. Seifert, S. Gasteiger-Klicpera, B. Ralli, A. Dimakos, I. Karpava, S. Martins, M. Sousa, O. Castro, S. Søndergaard Knudsen, H.B. Donau, P. Haznedar, B. Mikulajová, M. Gerdzhikova, N.

Abstract

The original version of the article unfortunately contained an error. In author’s personal details, middle names were not included in author Hanne B. Søndergaard Knudsen’s name, and the listed articles were therefore incorrect. © Springer Nature B.V. 2023.

Published
2023

15. Exclusions within Healthcare in a Regional Australian Setting: Voices of the Hardly Reached

Author

Shaburdin, ZM, Bourke, L, Mitchell, O, Shaburdin, ZM, Bourke, L, and Mitchell, O

Abstract

Health initiatives to improve inclusion of vulnerable people have tended to focus on a specific group with little evidence of improvement in health outcomes or attention to intersectionality. This study proposes that exclusion within health services can first be addressed through identification of common practices underpinning exclusion. A total of 119 seemingly hardly reached residents participated through individual interviews, small group interviews and focus group discussions. Undertaking a Derridean deconstruction analysis, the study identified three exclusionary practices commonly experienced by respondents when seeking healthcare in a regional setting. These are: i) language and communication, ii) assumptions and prejudice, and iii) exclusionary processes and systems. Although exclusion manifests differently between and within service user groups, the three identified forms of exclusion were commonly experienced by the hardly reached. Identifying and addressing common exclusionary practices in health services could focus inclusion strategies for health services with benefits to many service users.

Published
2023

16. Self-Rated Oral Health as a Valid Measure of Oral Health Status in Adults Living in Rural Australia

Author

Atala-Acevedo, C, McGrath, R, Glenister, K, Capurro, D, Bourke, L, Simmons, D, Morgan, M, Marino, R, Atala-Acevedo, C, McGrath, R, Glenister, K, Capurro, D, Bourke, L, Simmons, D, Morgan, M, and Marino, R

Abstract

It is unclear how well self-rated oral health (SROH) reflects actual oral health status in the rural Australian population. Therefore, this study aimed to compare the clinically assessed oral health status and SROH of adults living in rural Australia. The data were from 574 participants who took part in the Crossroads II cross-sectional study. Three trained and calibrated dentists evaluated the oral health status of participants based on WHO criteria. SROH was assessed with the question 'Overall, how would you rate the health of your teeth and gums?', with a score ranging from excellent = 5 to poor = 1. A logistic regression analysis (LRA) was performed, allowing us to assess factors associated with SROH. The mean age of participants was 59.2 years (SD 16.3), and 55.3% were female. The key results from the LRA show poorer SROH in those with more missing teeth (OR = 1.05; 95% CI; 1.01-1.08), more decayed teeth (OR = 1.28; 95% CI: 1.11-1.46), and more significant clinical attachment loss of periodontal tissue (6mm or more) (OR = 2.63; 95% CI: 1.29-5.38). This study found an association between negative SROH and clinical indicators used to measure poor oral health status, suggesting that self-rated oral health is an indicator of oral health status. When planning dental healthcare programs, self-reported oral health should be considered a proxy measure for oral health status.

Published
2023

17. Prevalence and factors associated with mental health problems of psychological distress and depression among rural Victorians - analysis of cross-sectional data (Crossroads II)

Author

Dashputre, A, Agho, KE, Piya, MK, Glenister, K, Bourke, L, Hannah, S, Bhat, R, Osuagwu, UL, Simmons, D, Dashputre, A, Agho, KE, Piya, MK, Glenister, K, Bourke, L, Hannah, S, Bhat, R, Osuagwu, UL, and Simmons, D

Abstract

BACKGROUND: Research suggests that rates of mental illness are similar in rural and urban Australia, although there are significant workforce shortages in rural regions along with higher rates of chronic disease and obesity and lower levels of socioeconomic status. However, there are variations across rural Australia and limited local data on mental health prevalence, risk, service use and protective factors. This study describes the prevalence of self-reported mental health problems of psychological distress and depression, in a rural region in Australia and aims to identify the factors associated with these problems. METHODS: The Crossroads II study was a large-scale cross-sectional study undertaken in the Goulburn Valley region of Victoria, Australia in 2016-18. Data were collected from randomly selected households across four rural and regional towns and then screening clinics from individuals from these households. The main outcome measures were self-reported mental health problems of psychological distress assessed by the Kessler 10 and depression assessed by Patient Health Questionnaire-9. Unadjusted odd ratios and 95% confidence intervals of factors associated with the two mental health problems were calculated using simple logistic regression with multiple logistic regression using hierarchical modelling to adjust for the potential confounders. RESULTS: Of the 741 adult participants (55.6% females), 67.4% were aged ≥ 55 years. Based on the questionnaires, 16.2% and 13.6% had threshold-level psychological distress and depression, respectively. Of those with threshold-level K-10 scores, 19.0% and 10.5% had seen a psychologist or a psychiatrist respectively while 24.2% and 9.5% of those experiencing depression had seen a psychologist or a psychiatrist, respectively in the past year. Factors such as being unmarried, current smoker, obesity, were significantly associated with a higher prevalence of mental health problems whereas physical activity, and community

Published
2023

18. Non-alcoholic fatty liver disease prevalence in Australia has risen over 15 years in conjunction with increased prevalence of obesity and reduction in healthy lifestyle

Author

Vaz, K, Kemp, W, Majeed, A, Lubel, J, Magliano, DJ, Glenister, KM, Bourke, L, Simmons, D, Roberts, SK, Vaz, K, Kemp, W, Majeed, A, Lubel, J, Magliano, DJ, Glenister, KM, Bourke, L, Simmons, D, and Roberts, SK

Abstract

BACKGROUND AND AIM: Non-alcoholic fatty liver disease (NAFLD) is the most prevalent liver condition globally. The aim of this study was to evaluate the change in age- and sex-standardized prevalence of NAFLD in regional Victoria over a 15-year period and explore the underlying factors associated with differences over time. METHODS: Repeated comparative cross-sectional studies in four towns in regional Victoria, Australia. Individuals randomly selected from households from residential address lists from local government organizations in 2001-2003 (CrossRoads I [CR1]) and 2016-2018 (CrossRoads II [CR2]) with 1040 (99%) and 704 (94%) participants from CR1 and CR2 having complete data for analysis. Primary outcome was change in prevalence estimates of NAFLD (defined by a fatty liver index ≥ 60 in the absence of excess alcohol and viral hepatitis) between 2003 and 2018. RESULTS: Crude prevalence of NAFLD increased from 32.7% to 38.8% (P < 0.01), while age-standardized/sex-standardized prevalence increased from 32.4% to 35.4% (P < 0.01). Concurrently, prevalence of obesity defined by BMI and elevated waist circumference increased 28% and 25%, respectively. Women had a greater increase in the prevalence of NAFLD than men, in parallel with increasing prevalence of obesity. Proportion of participants consuming takeaway food greater than once weekly increased significantly over time. Up to 60% of NAFLD patients require additional tests for assessment of significant fibrosis. CONCLUSIONS: Crude and age-standardized/sex-standardized prevalence of NAFLD have both increased significantly over the last 15 years, particularly among women, in association with a parallel rise in the prevalence of obesity.

Published
2023

19. A qualitative exploration of health student perspectives of rural and remote placements during the early stages of the COVID-19 pandemic

Author

Sheepway, L, Jessup, B, Podubinski, T, Heaney, S, Bailie, J, Ha, H, Bourke, L, Sheepway, L, Jessup, B, Podubinski, T, Heaney, S, Bailie, J, Ha, H, and Bourke, L

Abstract

Objective: To explore health student perspectives of rural and remote placements during the early stages of the COVID-19 pandemic. Setting: Australia. Participants: Allied health, nursing and medical students with a planned rural or remote placement between February and October 2020. Design: Semi-structured interviews (n = 29) with data thematically analysed. Results: Five main themes emerged from student experiences: (1) ‘Do we go? Don't we go? Like how much risk is involved?’ related to student concerns regarding acquiring and transmitting COVID-19 on placement; (2) ‘We are sort of just standing at the door trying to watch’ encompassed student perceptions of missed clinical learning opportunities in response to health and safety measures related to COVID-19; (3) ‘I, as a student, sort of fell under the radar’ related to student perceptions of suboptimal supervision; (4) ‘It was a bit more difficult to engage with that wider community’ recognised student feelings of social disconnection and their lack of opportunity for community immersion; and (5) ‘We felt like we got something that is more than we expected’ emerged from student reflections on training during the pandemic and alternative placements (virtual, simulated and non-clinical) that exceeded expectations for learning. Conclusions: Although most students were willing and able to undertake their rural or remote placement in some form during the early stages of the pandemic and identified unanticipated learning benefits, students recognised lost opportunities to build clinical skills, become culturally aware and connect with rural communities. It remains unknown how these rural and remote placement experiences will impact rural intention and in turn, rural workforce development.

Published
2023

20. Telehealth in remote Australia: a supplementary tool or an alternative model of care replacing face-to-face consultations?

Author

Mathew, S, Fitts, MS, Liddle, Z, Bourke, L, Campbell, N, Murakami-Gold, L, Russell, DJ, Humphreys, JS, Mullholand, E, Zhao, Y, Jones, MP, Boffa, J, Ramjan, M, Tangey, A, Schultz, R, Wakerman, J, Mathew, S, Fitts, MS, Liddle, Z, Bourke, L, Campbell, N, Murakami-Gold, L, Russell, DJ, Humphreys, JS, Mullholand, E, Zhao, Y, Jones, MP, Boffa, J, Ramjan, M, Tangey, A, Schultz, R, and Wakerman, J

Abstract

BACKGROUND: The COVID-19 pandemic increased the use of telehealth consultations by telephone and video around the world. While telehealth can improve access to primary health care, there are significant gaps in our understanding about how, when and to what extent telehealth should be used. This paper explores the perspectives of health care staff on the key elements relating to the effective use of telehealth for patients living in remote Australia. METHODS: Between February 2020 and October 2021, interviews and discussion groups were conducted with 248 clinic staff from 20 different remote communities across northern Australia. Interview coding followed an inductive approach. Thematic analysis was used to group codes into common themes. RESULTS: Reduced need to travel for telehealth consultations was perceived to benefit both health providers and patients. Telehealth functioned best when there was a pre-established relationship between the patient and the health care provider and with patients who had good knowledge of their personal health, spoke English and had access to and familiarity with digital technology. On the other hand, telehealth was thought to be resource intensive, increasing remote clinic staff workload as most patients needed clinic staff to facilitate the telehealth session and complete background administrative work to support the consultation and an interpreter for translation services. Clinic staff universally emphasised that telehealth is a useful supplementary tool, and not a stand-alone service model replacing face-to-face interactions. CONCLUSION: Telehealth has the potential to improve access to healthcare in remote areas if complemented with adequate face-to-face services. Careful workforce planning is required while introducing telehealth into clinics that already face high staff shortages. Digital infrastructure with reliable internet connections with sufficient speed and latency need to be available at affordable prices in remote commu

Published
2023

21. Let us not forget what the Romans did do - The impact of RHMT

Author

Bourke, L, Brand, A, Howard, C, Aitken, R, Argus, G, Brown, LJ, Debenham, J, Felton-Busch, C, Flood, V, Jones, D, Jones, M, Knight, S, Perrin, B, Thompson, S, Versace, V, Bourke, L, Brand, A, Howard, C, Aitken, R, Argus, G, Brown, LJ, Debenham, J, Felton-Busch, C, Flood, V, Jones, D, Jones, M, Knight, S, Perrin, B, Thompson, S, and Versace, V

Published
2023

22. Participation in rural community groups and links with psychological well-being and resilience: a cross sectional community based study

Author

Lyons, Anthony, Fletcher, Gillian, Farmer, Jane, Kenny, Amanda, Bourke, L, Carra, Kylie, and Bariola, Emily Jane

Subjects
Uncategorized
Abstract

Fostering the development of community groups can be an important part of boosting community participation and improving health and well-being outcomes in rural communities. In this article, we examine whether psychological well-being and resilience are linked to participating in particular kinds of rural community groups.Methods: We conducted a household survey involving 176 participants aged 18 to 94 years from a medium-sized rural Australian town. We gathered data on psychological well-being (Warwick-Edinburgh Mental Well-being Scale), resilience (Brief Resilience Scale), and the types of community groups that people participated in as well as a range of characteristics of those groups, such as size, frequency of group meetings, perceived openness to new members, and whether groups had leaders, defined roles for members, hierarchies, and rules. Results: Univariable regression analyses revealed significant links between particular group characteristics and individual psychological well-being and resilience, suggesting that the characteristics of the group that an individual participates in are strongly tied to that person's well-being outcomes. Multivariable analyses revealed two significant independent factors. First, psychological well-being was greatest among those who participated in groups without a hierarchy, that is, equal-status relationships between members. Second, resilience was greater among those who reported having a sense of influence within a group. Conclusions: Our findings suggest that policymakers wishing to promote participation in rural community groups for health and well-being benefits may do well to encourage the development of particular characteristics within those groups, in particular equal-status relationships and a sense of influence for all group members.

Published
2023
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25. Impact of COVID-19 on rural and remote student placements in Australia: A national study

Author

Hoang, H, Jessup, B, Obamiro, K, Bourke, L, Hellwege, B, Podubinski, T, Heaney, S, Sheepway, L, Farthing, A, Rasiah, R, Fitzroy, R, Jatrana, Santosh, Argus, G, Knight, S, Hoang, H, Jessup, B, Obamiro, K, Bourke, L, Hellwege, B, Podubinski, T, Heaney, S, Sheepway, L, Farthing, A, Rasiah, R, Fitzroy, R, Jatrana, Santosh, Argus, G, and Knight, S

Published
2022

26. Self-reported skin cancer-related behaviours in rural Victoria: results from repeat cross-sectional studies in 2001-2003 and 2016-2018.

Author

Glenister, K, Bougoulias, M, Zgibor, J, Bourke, L, Simmons, D, Glenister, K, Bougoulias, M, Zgibor, J, Bourke, L, and Simmons, D

Abstract

OBJECTIVE: To assess whether self-reported use of sun-protective measures and skin examination have changed between 2001 and 2018 in a rural setting. METHODS: Repeat cross-sectional survey of randomly selected households in four rural Victorian towns. People aged 16 years and older were eligible to participate. Logistic regression was used to identify demographic factors associated with sun-protective measures and skin examination. RESULTS: Overall, 5,328 participated in 2001-2003 and 2,680 in 2016-2018. Among participants who go out in the sun, the mean number of reported sun-protective measures (2.6±1.3 vs. 2.6±1.6, p=0.867) and the proportion of participants reporting usually/always using sun protection (65.1% vs. 63.9%, p=0.307) were unchanged between the two surveys. However, an increased proportion of participants reported avoiding the sun when outdoors in the more recent survey (from 18.8% to 34.3%, p<0.001). Avoiding the sun was associated with being older, female, of European origin and having post-secondary school education. Skin examination rates increased between the two surveys (32.7% to 40.8%, p<0.001). Skin examinations were associated with older age groups, European origin and post-secondary school education and being male. CONCLUSIONS: Given the small changes in sun protection over time, updated skin cancer campaigns are needed to encourage increased sun-protective behaviours and skin examinations among rural residents. IMPLICATIONS FOR PUBLIC HEALTH: Results suggest that updated health promotion campaigns targeted to rural areas are warranted.

Published
2022

27. 'It's a cultural thing': excuses used by health service providers on providing inclusive care

Author

Shaburdin, ZM, Bourke, L, Mitchell, O, Newman, T, Shaburdin, ZM, Bourke, L, Mitchell, O, and Newman, T

Abstract

Although health services in Australia have an aim to provide inclusive care for their patients/clients, this study highlights how barriers to care can lie at the centre of patient-provider interactions. Racial microaggression is a subtle form of racism that can occur in health settings, leading to further exclusion for First Nations Australians, immigrants and refugees. This paper is guided by Derrida's approach to deconstructionism by unpacking how language is used by health professionals - as holders of organisational power - and how they construct 'truths' or discourses about clients that historically have been marginalised by health services and system. Data comprise 21 interviews with staff from two rural health services. It identified three racial microaggressions were used to justify the challenges of providing care to people from First Nations, immigrant and refugee backgrounds: (1) Participants problematised culture(s) of service users; (2) participants implied cultural superiority in their conceptualisation of 'other' cultures; and (3) participants shared stories of inactions, discomfort and relegating of responsibility. The findings identified these discourses as forms of racial microaggression that can potentially lead to further exclusion of people seeking services and support.

Published
2022

28. 'I think we're getting a bit clinical here': A qualitative study of professionals' experiences of providing mental healthcare to young people within an Australian rural service

Author

Malatzky, C, Bourke, L, Farmer, J, Malatzky, C, Bourke, L, and Farmer, J

Abstract

This paper contributes to scholarship on the medicalisation of mental health support for young people through a case study of a multidisciplinary mental health service in rural Australia. All staff (n = 13) working at the service participated in semi-structured, individual interviews. Transcripts of interview data were read and selectively coded and interpreted in relation to the overarching question of how participants view and experience mental health care provision to a diverse range of young people. Following analytical reflection, codes pertaining to engagement, accessibility and care provision were re-examined using the concept of medicalisation to understand the biomedical underpinning of mental healthcare and how this plays out in the experiences and perceived challenges participants talked about in responding to the mental health concerns of diverse young people. The resulting analysis is presented under five theme headings: (a) privileging clinical expertise and priorities within service provision, which was an important source of conflict for some participants; (b) 'multidisciplinary' teams-a 'difficult kind of culture at times'; (c) articulations of where cultural barriers lie; (d) the tracks along which young people are directed to 'engage' with 'mental health'; and (e) a clinical 'feel' to space. We suggest that service and system investment needs to be given to alternative ways of thinking about and approaching mental health and care provision that are cognisant of, and engage with, the inherent connections between individual circumstance and social, place, cultural, economic and political contexts. This is particularly relevant to the provision of care in rural contexts because of limited service options and the complexities of access and providing care to a diverse range of young people living in isolated environments. Interdisciplinary frameworks need to be enacted and services must acknowledge their own cultural positions for alternative ways of w

Published
2022

29. Impact of renaming NAFLD to MAFLD in an Australian regional cohort: Results from a prospective population-based study

Author

Kemp, W, Clayton-Chubb, D, Majeed, A, Glenister, KM, Magliano, DJ, Lubel, J, Bourke, L, Simmons, D, Roberts, SK, Kemp, W, Clayton-Chubb, D, Majeed, A, Glenister, KM, Magliano, DJ, Lubel, J, Bourke, L, Simmons, D, and Roberts, SK

Abstract

BACKGROUND AND AIMS: Clinical and public health implications of the recent redefining of non-alcoholic fatty liver disease (NAFLD) to metabolic-associated fatty liver disease (MAFLD) remain unclear. We sought to determine the prevalence and compare MAFLD with NAFLD in a well-defined cohort. METHODS: A cross-sectional study was conducted in regional Victoria with participants from randomly selected households. Demographic and health-related clinical and laboratory data were obtained. Fatty liver was defined as a fatty liver index ≥ 60 with MAFLD defined according to recent international expert consensus. RESULTS: A total of 722 participants were included. Mean age was 59.3 ± 16 years, and 55.3% were women with a median body mass index of 27.8 kg/m2 . Most (75.2%) participants were overweight or obese. MAFLD was present in 341 participants giving an unadjusted prevalence of 47.2% compared with a NAFLD prevalence of 38.7%. Fifty-nine (17.5%) participants met the criteria of MAFLD but not NAFLD. The increased prevalence of MAFLD in this cohort was primarily driven by dual etiology of fatty liver. All participants classified as NAFLD met the new definition of MAFLD. Compared with NAFLD subjects, participants with MAFLD had higher ALT (26.0 [14.0] U/L vs 30.0 [23] U/L, P = 0.024), but there were no differences in non-invasive markers for steatosis or fibrosis. CONCLUSION: Metabolic-associated fatty liver disease is a highly prevalent condition within this large community cohort. Application of the MAFLD definition increased prevalence of fatty liver disease by including people with dual etiologies of liver disease.

Published
2022

30. Trends and Factors Associated with Obesity Prevalence in Rural Australian Adults-Comparative Analysis of the Crossroads Studies in Victoria over 15 Years

Author

Hannah, S, Agho, KE, Piya, MK, Glenister, K, Bourke, L, Osuagwu, UL, Simmons, D, Hannah, S, Agho, KE, Piya, MK, Glenister, K, Bourke, L, Osuagwu, UL, and Simmons, D

Abstract

This study examined the changes in the prevalence of obesity and associated lifestyle factors using data from repeated cross-sectional, self-reported surveys (Crossroads I: 2001-2003 and Crossroads II: 2016-2018, studies) and clinic anthropometric measurements collected from regional and rural towns in the Goulburn Valley, Victoria. Given that past community studies have only focused categorically on dietary intake, or assessed caloric energy intake, we examined the difference in broad dietary practices at two different times. Clinical assessments from randomly selected household participants aged ≥18 years were analyzed. Differences in obesity prevalence were calculated for each individual variable. Logistic regression was used to determine the odds ratios (95% confidence intervals (CI)) with and without adjustment for key lifestyle factors. There were 5258 participants in Crossroads I and 2649 in Crossroads II surveys. Obesity prevalence increased from 28.2% to 30.8% over 15 years, more among those who ate fried food, but decreased significantly among rural dwellers (31.7: 27.0, 36.8% versus 25.1: 22.9, 27.5%) and those who had adequate fruit intake (28.5: 25.0, 32.3% to 23.9: 21.8, 26.2%). Obesity was associated with older age (≥35 years), use of fat-based spreads for bread (adjusted odds ratio, aOR:1.26: 1.07, 1.48) and physical inactivity. The increase in obesity prevalence especially in the rural towns, was associated with unhealthy dietary behaviour which persisted over 15 years. Understanding and addressing the upstream determinants of dietary intake and choices would assist in the development of future health promotion Programs.

Published
2022

31. Social interaction and social inclusion in international rural health research

Author

Bourke, L, Anam, M, Shaburdin, ZM, Mitchell, O, Crouch, A, Bourke, L, Anam, M, Shaburdin, ZM, Mitchell, O, and Crouch, A

Abstract

There are particular attributes of rural communities that shape inclusion and exclusion in these settings. Social inclusion, or the opportunity for participation and access, together with its opposite, social exclusion, are central issues in rural contexts due to lower levels of income, education, and health outcomes as well as less access to health services. Adapting Wilkinson's interactional perspective of rural communities, this chapter focuses on how social interactions, or the ways local people talk, undertake activities and organize their daily lives, play a central role in understanding inclusion and exclusion within rural communities. This perspective underpins three case studies of inclusion research, one investigating the inclusion of socially and culturally diverse consumers in local health services in regional Australia, one working with a rural Australian health service to increase inclusion for local consumers, and a traditional healing approach to men's sexual health in rural Bangladesh. Key lessons from these case studies include the importance of developing genuine relationships and partnerships, working with local systems and "ways of doing things," progressing change slowly, and adopting pluralistic approaches to inclusion. Successful inclusion research was found to involve effective engagement, working with local networks, conducting long-term projects, and employing local researchers. The case studies highlight the need for more inclusive practices in rural health which can be assisted by research that challenges exclusionary interactions in rural communities.

Published
2022

39. Correction to: Teaching and learning in a multilingual Europe: findings from a cross-European study (European Journal of Psychology of Education, (2021), 10.1007/s10212-020-00523-z)

Author

Dockrell, J.E. Papadopoulos, T.C. Mifsud, C.L. Bourke, L. Vilageliu, O. Bešić, E. Seifert, S. Gasteiger-Klicpera, B. Ralli, A. Dimakos, I. Karpava, S. Martins, M. Sousa, O. Castro, S. Knudsen, H.B.S. Donau, P. Haznedar, B. Mikulajová, M. Gerdzhikova, N.

Abstract

The original version of the article unfortunately contained errors. The following author e-mails were omitted, A Ralli, asralli@psych.uoa.gr, I Dimakos idimakos@upatras.gr. There remained highlighted in yellow XXX (blinded for review) in the questionnaire section. This should be replaced with: Work Group 1 of COST IS 1401 (European Literacy Network). The footnotes and endnotes had been merged with footnotes. Footnote 1 should be Endnote 1, Footnote 2 should be Endnote 2, Endnote 3 should appear in the last sentence of DATA CLEANING AND MANAGEMENT section, next to the word "imputation" with a superscript. Endnote 3, top p. 10, should be Endnote 4, Endnote 4 should be Endnote 5, Endnote 5 should be Endnote 6, Endnote 6 should be Endnote 7. (F3), top, p. 9 should be F3 in plain font. On p. 12, the word ‘factors’ in the parenthesis should be capitalized (in Factors 1, 3 and 4). Finally Table 4 p should be * p

Published
2021

40. Elective cancer surgery in COVID-19–Free surgical pathways during the SARS-cov-2 pandemic: An international, multicenter, comparative cohort study

Author

James C Glasbey, Dmitri Nepogodiev, Joana Ff Simoes, Omar Omar, Elizabeth Li, Mary L Venn, Mohammad Abou Chaar, Vita Capizzi, Daoud Chaudhry, Anant Desai, Jonathan G Edwards, Jonathan P Evans, Marco Fiore, Jose Flavio Videria, Samuel J Ford, Ian Ganyli, Ewen A Griffiths, Rohan R Gujjuri, Angelos G Kolias, Haytham Ma Kaafarani, Ana Minaya-Bravo, Siobhan C McKay, Helen M Mohan, Keith Roberts, Carlos San Miguel-Méndez, Peter Pockney, Richard Shaw, Neil J Smart, Grant D Stewart, Sudha Sundar, Raghavan Vidya, Aneel A Bhangu, James C Glasbey, Omar Omar, Aneel A Bhangu, Kwabena Siaw-Acheampong, Ruth A Benson, Edward Bywater, Daoud Chaudhry, Brett E Dawson, Jonathan P Evans, James C Glasbey, Rohan R Gujjuri, Emily Heritage, Conor S Jones, Sivesh K Kamarajah, Chetan Khatri, Rachel A Khaw, James M Keatley, Andrew Knight, Samuel Lawday, Elizabeth Li, Harvinder S Mann, Ella J Marson, Kenneth A McLean, Siobhan C McKay, Emily C Mills, Dmitri Nepogodiev, Gianluca Pellino, Maria Picciochi, Elliott H Taylor, Abhinav Tiwari, Joana Ff Simoes, Isobel M Trout, Mary L Venn, Richard Jw Wilkin, Aneel A Bhangu, James C Glasbey, Neil J Smart, Ana Minaya-Bravo, Jonathan P Evans, Gaetano Gallo, Susan Moug, Francesco Pata, Peter Pockney, Salomone Di Saverio, Abigail Vallance, Dale Vimalchandran, Ewen A Griffiths, Sivesh K Kamarajah, Richard Pt Evans, Philip Townend, Keith Roberts, Siobhan McKay, John Isaac, Sohei Satoi, John Edwards, Aman S Coonar, Adrian Marchbank, Edward J Caruana, Georgia R Layton, Akshay Patel, Alessandro Brunelli, Samuel Ford, Anant Desai, Alessandro Gronchi, Marco Fiore, Max Almond, Fabio Tirotta, Sinziana Dumitra, Angelos Kolias, Stephen J Price, Daniel M Fountain, Michael D Jenkinson, Peter Hutchinson, Hani J Marcus, Rory J Piper, Laura Lippa, Franco Servadei, Ignatius Esene, Christian Freyschlag, Iuri Neville, Gail Rosseau, Karl Schaller, Andreas K Demetriades, Faith Robertson, Alex Alamri, Richard Shaw, Andrew G Schache, Stuart C Winter, Michael Ho, Paul Nankivell, Juan Rey Biel, Martin Batstone, Ian Ganly, Raghavan Vidya, Alex Wilkins, Jagdeep K Singh, Dinesh Thekinkattil, Sudha Sundar, Christina Fotopoulou, Elaine Leung, Tabassum Khan, Luis Chiva, Jalid Sehouli, Anna Fagotti, Paul Cohen, Murat Gutelkin, Rahel Ghebre, Thomas Konney, Rene Pareja, Rob Bristow, Sean Dowdy, T S Shylasree, R Kottayasamy Seenivasagam, Joe Ng, Keiiji Fujiwara, Grant D Stewart, Benjamin Lamb, Krishna Narahari, Alan McNeill, Alexandra Colquhoun, John McGrath, Steve Bromage, Ravi Barod, Veeru Kasivisvanathan, Tobias Klatte, Joana Ff Simoes, Tom Ef Abbott, Sadi Abukhalaf, Michel Adamina, Adesoji O Ademuyiwa, Arnav Agarwal, Murat Akkulak, Ehab Alameer, Derek Alderson, Felix Alakaloko, Markus Albertsmeiers, Osaid Alser, Muhammad Alshaar, Sattar Alshryda, Alexis P Arnaud, Knut Magne Augestad, Faris Ayasra, José Azevedo, Brittany K Bankhead-Kendall, Emma Barlow, David Beard, Ruth A Benson, Ruth Blanco-Colino, Amanpreet Brar, Ana Minaya-Bravo, Kerry A Breen, Chris Bretherton, Igor Lima Buarque, Joshua Burke, Edward J Caruana, Mohammad Chaar, Sohini Chakrabortee, Peter Christensen, Daniel Cox, Moises Cukier, Miguel F Cunha, Giana H Davidson, Anant Desai, Salomone Di Saverio, Thomas M Drake, John G Edwards, Muhammed Elhadi, Sameh Emile, Shebani Farik, Marco Fiore, J Edward Fitzgerald, Samuel Ford, Tatiana Garmanova, Gaetano Gallo, Dhruv Ghosh, Gustavo Mendonça Ataíde Gomes, Gustavo Grecinos, Ewen A Griffiths, Madalegna GrÜndl, Constantine Halkias, Ewen M Harrison, Intisar Hisham, Peter J Hutchinson, Shelley Hwang, Arda Isik, Michael D Jenkinson, Pascal Jonker, Haytham Ma Kaafarani, Debby Keller, Angelos Kolias, Schelto Kruijff, Ismail Lawani, Hans Lederhuber, Sezai Leventoglu, Andrey Litvin, Andrew Loehrer, Markus W Löffler, Maria Aguilera Lorena, Maria Marta Modolo, Piotr Major, Janet Martin, Hassan N Mashbari, Dennis Mazingi, Symeon Metallidis, Ana Minaya-Bravo, Helen M Mohan, Rachel Moore, David Moszkowicz, Susan Moug, Joshua S Ng-Kamstra, Mayaba Maimbo, Ionut Negoi, Milagros Niquen, Faustin Ntirenganya, Maricarmen Olivos, Kacimi Oussama, Oumaima Outani, Marie Dione Parreno-Sacdalanm, Francesco Pata, Carlos Jose Perez Rivera, Thomas D Pinkney, Willemijn van der Plas, Peter Pockney, Ahmad Qureshi, Dejan Radenkovic, Antonio Ramos-De la Medina, Keith Roberts, April C Roslani, Martin Rutegård, Juan José Segura-Sampedro, Irène Santos, Sohei Satoi, Raza Sayyed, Andrew Schache, Andreas A Schnitzbauer, Justina O Seyi-Olajide, Neil Sharma, Richard Shaw, Sebastian Shu, Kjetil Soreide, Antonino Spinelli, Grant D Stewart, Malin Sund, Sudha Sundar, Stephen Tabiri, Philip Townend, Georgios Tsoulfas, Gabrielle H van Ramshorst, Raghavan Vidya, Dale Vimalachandran, Oliver J Warren, Duane Wedderburn, Naomi Wright, C Allemand, L Boccalatte, M Figari, M Lamm, J Larrañaga, C Marchitelli, F Noll, D Odetto, M Perrotta, J Saadi, L Zamora, C Alurralde, E L Caram, D Eskinazi, J P Mendoza, M Usandivaras, R Badra, A Esteban, J S García, P M García, J I Gerchunoff, S M Lucchini, M A NIgra, L Vargas, T Hovhannisyan, A Stepanyan, T Gould, R Gourlay, B Griffiths, S Gananadha, M McLaren, J Cecire, N Joshi, S Salindera, A Sutherland, J H Ahn, G Charlton, S Chen, N Gauri, R Hayhurst, S Jang, F Jia, C Mulligan, W Yang, G Ye, H Zhang, M Ballal, D Gibson, D Hayne, J Moss, T Richards, P Viswambaram, U G Vo, J Bennetts, T Bright, M Brooke-Smith, R Fong, B Gricks, Y H Lam, B S Ong, M Szpytma, D Watson, K Bagraith, S Caird, E Chan, C Dawson, D Ho, E Jeyarajan, S Jordan, A Lim, G J Nolan, A Oar, D Parker, H Puhalla, A Quennell, L Rutherford, P Townend, M Von Papen, M Wullschleger, A Blatt, D Cope, N Egoroff, M Fenton, J Gani, N Lott, P Pockney, N Shugg, M Elliott, D Phung, D Phan, D Townend, C Bong, J Gundara, A Frankel, S Bowman, G R Guerra, J Bolt, K Buddingh, N N Dudi-Venkata, S Jog, H M Kroon, T Sammour, R Smith, C Stranz, M Batstone, K Lah, W McGahan, D Mitchell, A Morton, A Pearce, M Roberts, G Sheahan, B Swinson, N Alam, S Banting, L Chong, P Choong, S Clatworthy, D Foley, A Fox, M W Hii, B Knowles, J Mack, M Read, A Rowcroft, S Ward, G Wright, M Lanner, I Königsrainer, M Bauer, C Freyschlag, M Kafka, F Messner, D Öfner, I Tsibulak, K Emmanuel, M Grechenig, R Gruber, M Harald, L Öhlberger, J Presl, A Wimmer, I Namazov, E Samadov, D Barker, R Boyce, S Corbin, A Doyle, A Eastmond, R Gill, A Haynes, S Millar, M O'Shea, G Padmore, N Paquette, E Phillips, S St John, K Walkes, N Flamey, P Pattyn, W Oosterlinck, J Van den Eynde, R Van den Eynde, A Gatti, C Nardi, R Oliva, R De Cicco, I Cecconello, P Gregorio, L Pontual Lima, U Ribeiro Junior, F Takeda, R M Terra, M Sokolov, B Kidane, S Srinathan, M Boutros, N Caminsky, G Ghitulescu, G Jamjoum, J Moon, J Pelletier, T Vanounou, S Wong, M Boutros, S Dumitra, A Kouyoumdjian, B Johnston, C Russell, M Boutros, S Demyttenaere, R Garfinkle, J Abou-Khalil, C Nessim, J Stevenson, F Heredia, A Almeciga, A Fletcher, A Merchan, L O Puentes, J Mendoza Quevedo, G Bacic, D Karlovic, D Krsul, M Zelic, I Luksic, M Mamic, B Bakmaz, I Coza, E Dijan, Z Katusic, J Mihanovic, I Rakvin, K Frantzeskou, N Gouvas, G Kokkinos, P Papatheodorou, I Pozotou, O Stavrinidou, A Yiallourou, L Martinek, M Skrovina, I Szubota, J Žatecký, V Javurkova, J Klat, T Avlund, P Christensen, J L Harbjerg, L H Iversen, D W Kjaer, Hø Kristensen, M Mekhael, A L Ebbehøj, P Krarup, N Schlesinger, H Smith, A Abdelsamed, A Y Azzam, H Salem, A Seleim, A Abdelmajeed, M Abdou, N E Abosamak, M Al Sayed, F Ashoush, R Atta, E Elazzazy, M Elhoseiny, M Elnemr, M S Elqasabi, M E Elsayed Hewalla, I Elsherbini, E Essam, M Eweda, I Ghallab, E Hassan, M Ibrahim, M Metwalli, M Mourad, M S Qatora, M Ragab, A Sabry, H Saifeldin, M Saleh Mesbah Mohamed Elkaffas, A Samih, A Samir Abdelaal, S Shehata, K Shenit, D Attia, N Kamal, N Osman, A M Abbas, Has Abd Elazeem, M M Abdelkarem, S Alaa, A K Ali, A Ayman, M G Azizeldine, H Elkhayat, S M Elghazaly, F A Monib, M A Nageh, M M Saad, M Salah, M Shahine, E A Yousof, A Youssef, A Eldaly, M ElFiky, A Nabil, G Amira, I Sallam, M Sherief, A Sherif, A Abdelrahman, H Aboulkassem, G Ghaly, R Hamdy, A Morsi, H Salem, G Sherif, H Abdeldayem, I Abdelkader Salama, M Balabel, Y Fayed, A E Sherif, D Bekele, J Kauppila, E Sarjanoja, O Helminen, H Huhta, J H Kauppila, C Beyrne, L Jouffret, L Lugans, L Marie-Macron, E Chouillard, B De Simone, J Bettoni, S Dakpé, B Devauchelle, N Lavagen, S Testelin, S Boucher, R Breheret, A Gueutier, A Kahn, J KÜn-Darbois, A Barrabe, Z Lakkis, A Louvrier, S Manfredelli, P Mathieu, A Chebaro, V Drubay, M El Amrani, C Eveno, K Lecolle, G Legault, L Martin, G Piessen, F R Pruvot, S Truant, P Zerbib, Q Ballouhey, B Barrat, J Laloze, H Salle, A Taibi, J Usseglio, D Bergeat, A Merdrignac, Roy B Le, L O Perotto, A Scalabre, A Aimé, A Ezanno, B Malgras, P Bouche, S Tzedakis, E Cotte, O Glehen, V Kepenekian, J Lifante, G Passot, A D'Urso, E Felli, D Mutter, P Pessaux, B Seeliger, J Bardet, R Berry, G Boddaert, S Bonnet, E Brian, C Denet, D Fuks, D Gossot, M Grigoroiu, A Laforest, Y Levy-Zauberman, C Louis-Sylvestre, A Moumen, G Pourcher, A Seguin-Givelet, E Tribillon, E Duchalais, F Espitalier, C Ferron, O Malard, U Bork, M Distler, J Fritzmann, J Kirchberg, C Praetorius, C Riediger, J Weitz, T Welsch, P Wimberger, K Beyer, C Kamphues, J Lauscher, F N Loch, C Schineis, M Albertsmeier, M Angele, A Kappenberger, H Niess, T Schiergens, J Werner, R Becker, J Jonescheit, I Pergolini, D Reim, C Boeker, I Hakami, J Mall, P Liokatis, W Smolka, K Nowak, T Reinhard, F Hölzle, A Modabber, P Winnand, M Knitschke, P Kauffmann, S Wolfer, J Kleeff, K Lorenz, C Michalski, U Ronellenfitsch, R Schneider, E Bertolani, A Königsrainer, M W Löffler, M Quante, C Steidle, L ÜberrÜck, C Yurttas, C S Betz, J Bewarder, A Böttcher, S Burg, C Busch, M Gosau, A Heuer, J Izbicki, T O Klatte, D Koenig, N Moeckelmann, C Nitschke, M Priemel, R Smeets, U Speth, S Thole, F G Uzunoglu, T Vollkommer, N Zeller, M J Battista, K Gillen, A Hasenburg, S Krajnak, V Linz, R Schwab, K Angelou, D Haidopoulos, A Rodolakis, P Antonakis, K Bramis, L Chardalias, I Contis, N Dafnios, D Dellaportas, G Fragulidis, A Gklavas, M Konstadoulakis, N Memos, I Papaconstantinou, A Polydorou, T Theodosopoulos, A Vezakis, M I Antonopoulou, D K Manatakis, N Tasis, N Arkadopoulos, N Danias, P Economopoulou, P Kokoropoulos, A Larentzakis, N Michalopoulos, J Selmani, T Sidiropoulos, V Tsaousis, P Vassiliu, K Bouchagier, S Klimopoulos, D Paspaliari, G Stylianidis, K Baxevanidou, K Bouliaris, P Chatzikomnitsa, M Efthimiou, A Giaglaras, C Kalfountzos, G Koukoulis, A M Ntziovara, K Petropoulos, K Soulikia, I Tsiamalou, K Zervas, S Zourntou, I Baloyiannis, A Diamantis, E Gkrinia, J Hajiioannou, C Korais, O Koukoura, K Perivoliotis, A Saratziotis, C Skoulakis, D Symeonidis, K Tepetes, G Tzovaras, D Zacharoulis, V Alexoudi, K Antoniades, I Astreidis, P Christidis, D Deligiannidis, T Grivas, O Ioannidis, I Kalaitsidou, L Loutzidou, A Mantevas, D Michailidou, K Paraskevopoulos, S Politis, A Stavroglou, D Tatsis, I Tilaveridis, K Vahtsevanos, G Venetis, I Karaitianos, T Tsirlis, A Charalabopoulos, T Liakakos, E Mpaili, D Schizas, E Spartalis, A Syllaios, C Zografos, C Anthoulakis, C Christou, V Papadopoulos, A Tooulias, D Tsolakidis, G Tsoulfas, D Zouzoulas, E Athanasakis, E Chrysos, J Tsiaoussis, S Xenaki, E Xynos, K Futaba, M F Ho, S F Hon, Twc Mak, Ssm Ng, C C Foo, B Banky, N Suszták, M Aremu, A Canas-Martinez, O Cullivan, C Murphy, P Owens, L Pickett, L Akmenkalne, J Byrne, M Corrigan, C Cullinane, A Daly, C Fleming, P Jordan, S Killeen, N Lynch, A McCarthy, H Mustafa, S O'Brien, P O'Leary, Was Syed, L Vernon, D Callanan, L Huang, A Ionescu, P Sheahan, I Balasubramanian, M Boland, K Conlon, D Evoy, N Fearon, T Gallagher, J Geraghty, H Heneghan, N Kennedy, D Maguire, D McCartan, E W McDermott, R S Prichard, D Winter, D Alazawi, C Barry, T Boyle, W Butt, E M Connolly, N Donlon, C Donohue, B A Fahey, R Farrell, C Fitzgerald, J Kinsella, J O Larkin, P Lennon, P J Maguire, P Mccormick, B J Mehigan, H Mohan, T Nugent, H O'Sullivan, N Ravi, J V Reynolds, A Rogers, P Shokuhi, J Smith, L A Smith, C Timon, Y Bashir, G Bass, T Connelly, B Creavin, H Earley, J A Elliott, A Gillis, D Kavanagh, P Neary, J O'riordan, I S Reynolds, D Rice, P Ridgway, M Umair, M Whelan, P Carroll, C Collins, K Corless, L Finnegan, A Fowler, A Hogan, M Kerin, A Lowery, P McAnena, K McKevitt, K Nizami, É Ryan, A Samy, J C Coffey, R Cunningham, M Devine, D Nally, C Peirce, S Tormey, N Hardy, P Neary, S O'Malley, M Ryan, S Macina, N M Mariani, E Opocher, A Pisani Ceretti, F Ferrari, F Odicino, E Sartori, C Cotsoglou, S Granieri, F Bianco, A Camillo, M Colledan, S Tornese, M F Zambelli, G Bissolotti, S Fusetti, F Lemma, M V Marino, A Mirabella, G Vaccarella, C Agostini, G Alemanno, I Bartolini, C Bergamini, A Bruscino, C Checcucci, R De Vincenti, A Di Bella, M Fambrini, L Fortuna, G Maltinti, P Muiesan, F Petraglia, P Prosperi, M N Ringressi, M Risaliti, F Sorbi, A Taddei, R Tucci, C Bassi, L Bortolasi, T Campagnaro, L Casetti, M De Pastena, A Esposito, M Fontana, A Guglielmi, L Landoni, G Malleo, G Marchegiani, S Nobile, S Paiella, C Pedrazzani, S Rattizzato, A Ruzzenente, R Salvia, G Turri, M Tuveri, P Bellora, G D'Aloisio, M Ferrari, E Francone, S Gentilli, H Nikaj, M Bianchini, M Chiarugi, F Coccolini, G Di Franco, N Furbetta, D Gianardi, S Guadagni, L Morelli, M Palmeri, D Tartaglia, G Anania, P Carcoforo, M Chiozza, A De Troia, M Koleva Radica, M Portinari, M G Sibilla, A Urbani, N Fabbri, C V Feo, S Gennari, S Parini, E Righini, L Ampollini, L Bellanti, M Bergonzani, G Bertoli, G Bocchialini, G D'Angelo, D Lanfranco, L Musini, T Poli, G P Santoro, A Varazzani, L Aguzzoli, G Borgonovo, C Castro Ruiz, S Coiro, G Falco, V D Mandato, V Mastrofilippo, M T Montella, V Annessi, M Zizzo, U Grossi, S Novello, M Romano, S Rossi, G Zanus, G Esposito, F Frongia, A Pisanu, M Podda, C Belluco, A Lauretta, G Montori, L Moras, M Olivieri, F Bussu, A G Carta, M L Cossu, P Cottu, A Fancellu, C F Feo, G C Ginesu, G Giuliani, M Madonia, T Perra, A Piras, A Porcu, D Rizzo, A M Scanu, A Tedde, M Tedde, P Delrio, D Rega, G Badalamenti, G Campisi, A Cordova, M Franza, G Maniaci, G Rinaldi, F Toia, M Calabrò, F Farnesi, E G Lunghi, A Muratore, N S Pipitone Federico, F Bàmbina, G D'Andrea, P Familiari, V Picotti, G De Palma, G Luglio, G Pagano, F P Tropeano, L Baldari, G A Beltramini, L Boni, E Cassinotti, A Gianni, L Pignataro, S Torretta, C Abatini, M Baia, D Biasoni, G Bogani, P Cadenelli, V Capizzi, Spb Cioffi, D Citterio, L V Comini, M Cosimelli, M Fiore, S Folli, M Gennaro, L Giannini, A Gronchi, M Guaglio, A Macchi, F Martinelli, V Mazzaferro, A Mosca, S Pasquali, C Piazza, F Raspagliesi, L Rolli, R Salvioni, G Sarpietro, C Sarre, L Sorrentino, A Agnes, S Alfieri, F Belia, A Biondi, V Cozza, A D'Amore, D D'Ugo, V De Simone, A Fagotti, G Gasparini, L Gordini, F Litta, C P Lombardi, L Lorenzon, A A Marra, F Marzi, A Moro, A Parello, E Perrone, R Persiani, C Ratto, F Rosa, G Saponaro, G Scambia, O Scrima, G Sganga, R Tudisco, A Belli, V Granata, F Izzo, R Palaia, R Patrone, F M Carrano, M M Carvello, A De Virgilio, F Di Candido, F Ferreli, F Gaino, G Mercante, V Rossi, A Spinelli, G Spriano, D M Donati, T Frisoni, E Palmerini, A Aprile, F Barra, P Batistotti, S Ferrero, P Fregatti, S Scabini, M Sparavigna, E Asti, D Bernardi, L Bonavina, A Lovece, L Adamoli, M Ansarin, S Cenciarelli, F Chu, R De Berardinis, U Fumagalli Romario, F Mastrilli, G Pietrobon, M Tagliabue, E Badellino, A Ferrero, R Massobrio, A De Manzoni Garberini, P Federico, P Maida, E Marra, G Marte, A Petrillo, T Tammaro, A Tufo, M Berselli, G Borroni, E Cocozza, L Conti, M Desio, L Livraghi, V Quintodei, A Rizzi, A Zullo, C Baldi, C Corbellini, G M Sampietro, P Cellerino, E Baldini, P Capelli, L Conti, S M Isolani, M Ribolla, A Bondurri, F Colombo, L Ferrario, C Guerci, A Maffioli, T Armao, M Ballabio, P Bisagni, A Gagliano, M Longhi, M Madonini, P PizziCni, A M 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Uyanik, B Göksoy, E Bozkurt, B Citgez, M Mihmanli, M Tanal, G Yetkin, M Akalin, C Arican, E K Avci, C Aydin, S Demirli Atici, M Emiroglu, T Kaya, E Kebabçi, G Kilinc, Y Kirmizi, H Ogucu, S Salimoglu, I Sert, C Tugmen, K Tuncer, G Uslu, D Yesilyurt, E Karaman, A Kolusari, A Yildiz, O Benson, H Lule, J Agilinko, A Ahmeidat, M Barabasz, M Bekheit, L K Cheung, T Colloc, W Cymes, M Elhusseini, G Gradinariu, A Hannah, B S Kamera, G Mignot, S Shaikh, P Sharma, I Abu-Nayla, A Agrawal, A Al-Mohammad, S Ali, J Ashcroft, A Azizi, O Baker, A Balakrishnan, M Byrne, A Colquhoun, A Cotter, P Coughlin, R J Davies, A Durrani, M Elshaer, S Fordington, P Forouhi, F Georgiades, H Grimes, A Habeeb, V Hudson, P Hutchinson, E Irune, A Jah, D Z Khan, A Kolias, H Kyriacou, B Lamb, S Liau, L Luke, R Mahmoud, R Mannion, L Masterson, C G Mitrofan, M Mohan, A Morris, S Murphy, R O'Neill, S Price, J Pushpa-Rajah, W Raby-Smith, J Ramzi, S Rooney, T Santarius, A Singh, G D Stewart, X S Tan, A Townson, E Tweedle, C Walker, S Waseem, S Yordanov, T Jones, A Kattakayam, C Loh, R Lunevicius, S Pringle, A Schache, R Shaw, A Sheel, C Rossborough, D Angelou, M Choynowski, B McAree, A McCanny, D Neely, G Tutoveanu, S Ahad, Mfi De La Cruz Monroy, F Mosley, V Oktseloglou, A Alanbuki, M Patel, A Shabana, E Perera, D Raveendran, K Ravi-Shankar, J Thiruchelvam, L Arrowsmith, W Campbell, T Grove, C Kontovounisios, O Warren, P Rolland, A Aggarwal, S Brown, C Jelley, N Neal, R Clifford, N Eardley, E Krishnan, N Manu, E Martin, S Roy Mahapatra, O L Serevina, C Smith, D Vimalachandran, M Bordenave, R Houston, G Putnam, A Robson, H Tustin, K Emslie, P L Labib, A Marchbank, D Miller, G Minto, J Natale, H Nwinee, P Panahi, L Rogers, A Abubakar, M M Akhter Rahman, E Chan, Kyk Ko, H O'Brien, K Sasapu, H Woodun, R Inglis, H J Ng, A De Gea Rico, N Ghazali, J Lambert, G Markose, S Math, I Sarantitis, D Shrestha, A Sultana, M Taggarsi, S Timbrell, O P Vaz, L Vitone, A Day, H Dent, M Fahim, S Waheed, A Hunt, N Laskar, A Gupta, J Steinke, S Thrumurthy, E Massie, K McGivern, D Rutherford, M Wilson, J Hardie, S Kazzaz, S Handa, M Kaushal, A Kler, P Patel, J Redfern, S Tezas, Y Aawsaj, S Amonkar, C Barry, L Blackwell, D Blake, J Carter, H Emerson, A Fisher, M Katory, P Korompelis, W McCormick, A Mustafa, L Pearce, N Ratnavelu, R Reehal, L Kretzmer, L Lalou, B Manku, I Parwaiz, J Stafford, M Abdelkarim, A Asqalan, T Gala, S Ibrahim, A Maw, R Mithany, R Morgan, G Sundaram Venkatesan, K Ang, E J Caruana, M F Chowdhry, A Mohammad, A Nakas, S Rathinam, M Boal, O Brown, S Dwerryhouse, S Higgs, A Vallance, E Boyd, V Irvine, A Kirk, G Bakolas, A Boulton, A Chandock, T Khan, M Kumar, P Agoston, A Bille, B Challacombe, S Fraser, K Harrison-Phipps, J King, G Mehra, L Mills, M Najdy, R Nath, L Okiror, J Pilling, V Rizzo, T Routledge, A Sayasneh, L Stroman, A Wali, M Fehervari, C Fotopoulou, N Habib, S Hamrang-Yousefi, Z Jawad, L Jiao, M Pai, J Ploski, P Rajagopal, S Saso, M Sodergren, D Spalding, S Laws, C Hardie, C McNaught, R Alam, A Budacan, J Cahill, M Kalkat, S Karandikar, L Kenyon, D Naumann, A Patel, J Ayorinde, T Chase, T Cuming, A Ghanbari, L Humphreys, S Tayeh, A Aboelkassem Ibrahim, R Bichoo, H Cao, Akw Chai, J Choudhury, C Evans, H Fitzjohn, H Ikram, M Langstroth, M Loubani, A McMillan, S Nazir, Ssa Qadri, A Robinson, E Ross, T Sehgal, A Wilkins, J Dixon, J Dunning, K Freystaetter, M Jha, S Lester, A Madhavan, S V Thulasiraman, Y Viswanath, T Curl-Roper, C Delimpalta, Ccl Liao, V Velchuru, E Westwood, E Belcher, G Bond-Smith, S Chidambaram, F Di Chiara, K Fasanmade, L Fraser, H Fu, M Ganau, S Gore, J Graystone, D Jeyaretna, H Khatkar, M Lami, M Maher, S Mastoridis, R Mihai, R Piper, S Prabhu, Obf Risk, U Selbong, K Shah, R Smillie, H Soleymani Majd, S Sravanam, D Stavroulias, G D Tebala, M Vatish, C Verberne, K Wallwork, S Winter, M I Bhatti, H Boyd-Carson, E Elsey, E Gemmill, P Herrod, M Jibreel, E Lenzi, T Saafan, D Sapre, T Sian, N Watson, A Athanasiou, G Bourke, L Bradshaw, A Brunelli, J Burke, P Coe, F Costigan, H Elkadi, M Ho, J Johnstone, A Kanatas, V Kantola, A Kaufmann, A Laios, S Lam, E MacInnes, S Munot, C Nahm, M Otify, C Pompili, I Smith, G Theophilou, G Toogood, R Wade, D Ward, C West, S Annamalai, C Ashmore, A Boddy, T Hossain, A Kourdouli, A Gvaramadze, A Jibril, L Prusty, D Thekkinkattil, A Harky, M Shackcloth, A Askari, C Chan, N Cirocchi, S Kudchadkar, K Patel, J Sagar, S Shaw, R Talwar, M Abdalla, R Edmondson, O Ismail, D Jones, K Newton, N Stylianides, A Aderombi, U Andaleeb, O Bajomo, K Beatson, W Garrett, M Mehmood, V Ng, R Al-Habsi, G S Divya, B Keeler, B Al-Sarireh, R Egan, R Harries, A Henry, M Kittur, Z Li, K Parkins, F Soliman, N Spencer, D Thompson, C Burgess, C Gemmell, C Grieco, M Hollyman, L Hunt, J Morrison, S Ojha, N Ryan, F Abbadessa, S Barnard, C Chan, N Dawe, J Hammond, Ali F Mahmoud, I McPherson, C Mellor, J Moir, S Pandanaboyana, J Powell, B Rai, A Rogers, C Roy, A Sachdeva, C Saleh, S Tingle, T Williams, J Manickavasagam, C McDonald, N McGrath, N McSorley, K Ragupathy, L Ramsay, A Solth, O Kakisi, K Seebah, I Shaikh, L Sreedharan, M Youssef, J Shah, P Ameerally, N McLarty, S Mills, A Shenfine, K Sahnan, J Abu, E Addae-Boateng, D Bratt, L Brock, N Burnside, S Cadwell-Sneath, K Gajjar, C Gan, C Grundy, K Hallam, K Hassell, M Hawari, A Joshi, H Khout, K Konstantinidi, Rxn Lee, D Nunns, R Schiemer, T Walton, H Weaver, L Whisker, K Williamson, J McVeigh, R Myatt, M A Williams, R Kaur, E Leung, S Sundar, M Michel, S Patil, S Ravindran, J Sarveswaran, L Scott, M Edmond, E King, M Almond, A Bhangu, O Breik, L D Cato, A Desai, S Ford, E Griffiths, M Idle, M Kamal, A Kisiel, R Kulkarni, Jkc Mak, T Martin, P Nankivell, A Parente, S Parmar, A M Pathanki, L Phelan, P Praveen, S Saeed, N Sharma, J Singh, F Tirotta, D Vijayan, A Geddes, J McCaul, J McMahon, A H Khan, F Khan, A Mansuri, S Mukherjee, M Patel, M Sarigul, S Singh, K L Tan, A Woodham, A Adiamah, H Brewer, A Chowdhury, J Evans, D Humes, J Jackman, A Koh, C Lewis-Lloyd, O Oyende, J Reilly, D Worku, P Cool, G Cribb, K Shepherd, C Bisset, S Moug, N Elson, G Faulkner, P Saleh, C Underwood, G Brixton, L Findlay, T Klatte, A Majkowska, J Manson, R Potter, A Bhalla, Z Chia, P Daliya, A Goyal, E Grimley, A Hamad, A Kumar, F L Malcolm, E Theophilidou, J Bowden, N Campain, I Daniels, C Evans, G Fowler, J John, L Massey, F McDermott, J McGrath, A McLennan, M Ng, J Pascoe, N Rajaretnam, S Bulathsinhala, B Davidson, G Fusai, C Hidalgo Salinas, N Machairas, T Pissanou, J M Pollok, D A Raptis, F Soggiu, H Tzerbinis, S E Xyda, A Beamish, E Davies, R Foulkes, D Magowan, H Nassa, R Ooi, C Price, L Smith, F Solari, A Tang, G Williams, Y Al-Tamimi, A Bacon, N Beasley, D Chew, M Crank, N Ilenkovan, M Macdonald, B Narice, O Rominiyi, A Thompson, I Varley, T Drake, E Harrison, G Linder, J Mayes, R McGregor, R Skipworth, V Zamvar, E Davies, P Hawkin, T Raymond, O Ryska, R Baron, D Dunne, S Gahunia, C Halloran, N Howes, R McKinney, F McNicol, J Russ, P Szatmary, J R Tan, A Thomas, P Whelan, A Anzak, A Banerjee, O Fuwa, F Hughes, J D Jayasinghe, C Knowles, H Kocher, I Leal Silva, F S Ledesma, A Minicozzi, L Navaratne, R Rahman, R Ramamoorthy, C Sohrabi, M Thaha, B Thakur, M Venn, V Yip, R Baumber, J Parry, S Evans, L Jeys, G Morris, M Parry, J Stevenson, N Ahmadi, G Aresu, Z M Barrett-Brown, A S Coonar, H Durio Yates, D Gearon, J Hogan, M King, A Peryt, I S Pradeep, C Smith, M Adishesh, R Atherton, K Baxter, M Brocklehurst, M Chaudhury, N Krishnamohan, J McAleer, G Owens, E Parkin, P Patkar, I Phang, A Aladeojebi, M Ali, B Barmayehvar, A Gaunt, M Gowda, E Halliday, M Kitchen, F Mansour, M Thomas, D Zakai, N Abbassi-Ghadi, H Assalaarachchi, A Currie, M Flavin, A Frampton, M Hague, C Hammer, J Hopper, J Horsnell, S Humphries, A Kamocka, T K Madhuri, S Preston, P Singh, J Stebbing, A Tailor, D Walker, F Aljanadi, M Jones, P Mhandu, C O'Donnell, R Turkington, Z Al-Ishaq, S Bhasin, A S Bodla, A Burahee, A Crichton, R Fossett, N Pigadas, S Pickford, E Rahman, D Snee, R Vidya, N Yassin, F Colombo, D Fountain, M T Hasan, K Karabatsou, R Laurente, O Pathmanaban, A Al-Mukhtar, S Brown, J Edwards, A Giblin, C Kelty, M Lee, G Lye, T Newman, A Sharkey, C Steele, N Sureshkumar Shah, E Whitehall, R Athwal, A Baker, L Jones, C Konstantinou, S Ramcharan, S Singh, J Vatish, R Wilkin, M Ethunandan, G K Sekhon, H Shields, R Singh, F Wensley, S Lawday, A Lyons, T Abbott, S Anwar, K Ghufoor, C Sohrabi, E Chung, R Hagger, A Hainsworth, A Karim, H Owen, A Ramwell, K Williams, C Baker, A Davies, J Gossage, M Kelly, W Knight, J Hall, G Harris, G James, C Kang, D J Lin, A D Rajgor, T Royle, R Scurrah, B Steel, L J Watson, D Choi, R Hutchison, A Jain, V Luoma, H Marcus, R May, A Menon, B Pramodana, L Webber, I A Aneke, P Asaad, B Brown, J Collis, S Duff, A Khan, F Moura, B Wadham, H Warburton, T Elmoslemany, M Jenkinson, C Millward, R Zakaria, S Mccluney, C Parmar, S Shah, J Allison, M S Babar, B Collard, S Goodrum, K Lau, A Patel, R Scott, E Thomas, H Whitmore, D Balasubramaniam, B Jayasankar, S Kapoor, A Ramachandran, A Elhamshary, Smb Imam, K Kapriniotis, V Kasivisvanathan, J Lindsay, S Rakhshani-Moghadam, N Beech, M Chand, L Green, N Kalavrezos, H Kiconco, R McEwen, C Schilling, D Sinha, J Pereca, J Singh, S Chopra, D Egbeare, R Thomas, T Combellack, Sef Jones, M Kornaszewska, M Mohammed, A Sharma, G Tahhan, V Valtzoglou, J Williams, P Eskander, K Gash, L Gourbault, M Hanna, T Maccabe, C Newton, J Olivier, S Rozwadowski, E Teh, D West, H Al-Omishy, M Baig, H Bates, G Di Taranto, K Dickson, N Dunne, C Gill, D Howe, D Jeevan, A Khajuria, K Martin-Ucar AMcEvoy, P Naredla, V Ng, S Robertson, M Sait, D R Sarma, S Shanbhag, T Shortland, S Simmonds, J Skillman, N Tewari, G Walton, M A Akhtar, A Brunt, J McIntyre, K Milne, M M Rashid, A Sgro, K E Stewart, A Turnbull, M Aguilar Gonzalez, S Talukder, C Boyle, D Fernando, K Gallagher, A Laird, D Tham, M Bath, P Patki, C Sohrabi, C Tanabalan, T Arif, C Magee, T Nambirajan, S Powell, R Vinayagam, I Flindall, A Hanson, V Mahendran, S Green, M Lim, L MacDonald, V Miu, L Onos, K Sheridan, R Young, F Alam, O Griffiths, C Houlden, R Jones, V S Kolli, A K Lala, S Leeson, R Peevor, Z Seymour, L Chen, E Henderson, A Loehrer, K Brown, D Fleming, A Haynes, C Heron, C Hill, H Kay, E Leede, K McElhinney, K Olson, E C Osterberg, C Riley, P Srikanth, M Thornhill, D Blazer, G DiLalla, E S Hwang, W Lee, M Lidsky, J Plichta, L Rosenberger, R Scheri, K Shah, K Turnage, J Visgauss, S Zani, J Farma, J Clark, D Kwon, E Etchill, H E Gabre-Kidan AJenny, A Kent, M Ladd, C Long, H Malapati, A Margalit, S Rapaport, J Rose, K Stevens, L Tsai, D Vervoort, P Yesantharao, A Dehal, D Klaristenfeld, K Huynh, L Brown, I Ganly, J Mullinax, N Gusani, J Hazelton, J Maines, J S Oh, A Ssentongo, P Ssentongo, M Azam, A Choudhry, W Marx, J Fleming, A Fuson, J Gigliotti, A Ovaitt, Y Ying, M K Abel, V Andaya, K Bigay, M A Boeck, L Chen, H Chern, C Corvera, I El-Sayed, A Glencer, P Ha, Bcs Hamilton, C Heaton, K Hirose, D M Jablons, K Kirkwood, L Z Kornblith, J R Kratz, R Lee, P N Miller, E Nakakura, B Nunez-Garcia, R O'Donnell, D Ozgediz, P Park, B Robinson, A Sarin, B Sheu, M Varma, K Wai, R Wustrack, M J Xu, D Beswick, J Goddard, J Manor, J Song, T Fullmer, C Gaskill, N Gross, K Kiong, C L Roland, S N Zafar, M Abdallah, A Abouassi, M Almasri, G Kulkarni, H Marwan, M Mehdi, S Aoun, V S Ban, H H Batjer, J Caruso, D Abbott, A Acher, T Aiken, J Barrett, E Foley, P Schwartz, S N Zafar, A Hawkins, A Maiga, J Laufer, S Scasso

Subjects
Aged, 80 and over, Male, Critical Care, SARS-CoV-2, International Cooperation, COVID-19, Middle Aged, Cohort Studies, Logistic Models, Postoperative Complications, Elective Surgical Procedures, Neoplasms, Outcome Assessment, Health Care, Humans, Female, Epidemics, Aged
Abstract

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks.

Published
2021

42. Discourses within the roles of Remote Area Nurses in Northern Territory (Australia) government-run health clinics

Author

Bourke, L, Dunbar, T, Murakami-Gold, L, Bourke, L, Dunbar, T, and Murakami-Gold, L

Abstract

The Northern Territory (NT) government operates remote clinics which are primarily staffed by Aboriginal Health Practitioners and Remote Area Nurses (RANs). RAN practice has been described as particularly complex due to high health needs, workforce shortages and high levels of turnover in remote Aboriginal communities. While individual incentives are offered, there has been little examination of the role and why the work takes such a toll on RANs. This study aims to identify dominant discourses underpinning RAN practice and how these discourses reflect tensions and reinforce power relations that impact on the RAN role. Discourses were identified from a Foucauldian-inspired discourse analysis of 29 interviews with RANs in six remote NT communities. Five dominant discourses were identified, namely, that permanent RANs are preferred to agency RANs, RANs portray themselves as experienced and certain, RANs use autonomous clinical judgement, Aboriginal staff are important and RAN's belief in making a difference. However, the experience of RANs suggested that there are many types of employment that learning from was also important, RANs often struggled to work with Aboriginal staff and they were unsure if they were making a difference. Furthermore, these discourses created tensions between RANs who were permanent-agency, older-younger, experienced-newer and certain-reflexive. Deconstructing these rigid discourses could allow the RAN role to be reconstructed in ways that lead to better retention, job satisfaction and health outcomes.

Published
2021

43. Building readiness for inclusive practice in mainstream health services: A pre-inclusion framework to deconstruct exclusion

Author

Bourke, L, Mitchell, O, Shaburdin, ZM, Malatzky, C, Anam, M, Farmer, J, Bourke, L, Mitchell, O, Shaburdin, ZM, Malatzky, C, Anam, M, and Farmer, J

Abstract

Across the globe, people are not equitably included or respected by health services. This results in some people being 'hardly reached' and having less access to safe and appropriate care. While some health services have adopted specific agendas to increase inclusion, these services can struggle to implement such strategies because the underlying reasons for exclusion have not been addressed. This calls for preparation prior to implementation of inclusion approaches that deconstructs discourses and practices of exclusion. This paper presents a pre-inclusion framework that seeks to deconstruct exclusion in health services. Authors developed this framework from action research in four 'mainstream' regional health services in southeast Australia over five years. Research identified dominant discourses of exclusion among staff in these services. The study also identified common experiences of residents hardly reached by these services. Following, a range of change activities were undertaken within these services to deconstruct exclusion. Researchers also kept journals, reflected on their impact, and identified lessons learned from trying to deconstruct exclusion. Triangulating these analyses, researchers developed an interdisciplinary framework that weaves together Foucauldian theory on power/discourse with continuous quality improvement processes to embed cultural humility and voices of the hardly reached in health care. The framework outlines five foundational concepts (power as productive, deconstruction, use of continuous quality improvement processes, cultural humility and voices of service users), followed by six principles (a journey, expect resistance, whole of service approach, make visible the reasons for change, we are all cultural beings and people centred care) and six actions undertaken within health services (commitment, assessment of exclusion, action plans, structural change, reflective discussions and engagement). Until such approaches to deconstruct e

Published
2021

44. A qualitative evaluation of the implementation of a cultural competence project in rural Victoria

Author

Mitchell, O, Bourke, L, Shaburdin, ZM, Mitchell, O, Bourke, L, and Shaburdin, ZM

Abstract

OBJECTIVE: To explore the complex factors influencing the implementation of cultural competency frameworks for Aboriginal and Torres Strait Islander peoples within rural, Victorian, mainstream health and community service organisations. METHODS: Semi-structured telephone interviews were conducted with key individuals from 20 public health and community services in rural Victoria who had participated in the Koolin Balit Aboriginal Health Cultural Competence Project (KB-AHCC project). Interviews were recorded and transcribed verbatim and a content analysis was undertaken. The findings informed the selection of six case study sites for more in-depth analysis. Following this, an expert reference group provided feedback on the findings. Findings from the different data were triangulated to identify eight factors. RESULTS: Key factors acting as barriers and/or enablers to implementing cultural competence frameworks were: comprehensive, structured tools; project workers; communication; organisational responsibility for implementation; prioritising organisational cultural competence resourcing; resistance to focussing on one group of people; and accountability. CONCLUSIONS: Embedding cultural competence frameworks within rural, mainstream health and community services requires sustained government resourcing, prioritisation and formal accountability structures. Implications for public health: Findings will inform and guide the future development, implementation and evaluation of organisational cultural competence projects for rural public health and community services.

Published
2021

45. Prevalence of non-alcoholic fatty liver disease in regional Victoria: a prospective population-based study

Author

Roberts, SK, Majeed, A, Glenister, K, Magliano, D, Lubel, JS, Bourke, L, Simmons, D, Kemp, WW, Roberts, SK, Majeed, A, Glenister, K, Magliano, D, Lubel, JS, Bourke, L, Simmons, D, and Kemp, WW

Abstract

OBJECTIVES: To investigate the prevalence of non-alcoholic fatty liver disease (NAFLD) and its risk factors in regional Victoria. DESIGN: Prospective cross-sectional observational study (sub-study to CrossRoads II health study in Shepparton and Mooroopna). SETTING: Four towns (populations, 6300-49 800) in the Goulburn Valley of Victoria. PARTICIPANTS: Randomly selected from households selected from residential address lists provided by local government organisations for participation in the CrossRoads II study. MAIN OUTCOME MEASURES: Age- and sex-adjusted estimates of NAFLD prevalence, defined by a fatty liver index score of 60 or more in people without excessive alcohol intake or viral hepatitis. RESULTS: A total of 705 invited adults completed all required clinical, laboratory and questionnaire evaluations of alcohol use (participation rate, 37%); 392 were women (56%), and their mean age was 59.1 years (SD, 16.1 years). Of the 705 participants, 274 met the fatty liver index criterion for NAFLD (crude prevalence, 38.9%; age- and sex-standardised prevalence, 35.7%). The mean age of participants with NAFLD (61 years; SD, 15 years) was higher than for those without NAFLD (58 years; SD, 16 years); a larger proportion of people with NAFLD were men (50% v 41%). Metabolic risk factors more frequent among participants with NAFLD included obesity (69% v 15%), hypertension (66% v 48%), diabetes (19% v 8%), and dyslipidaemia (63% v 33%). Mean serum alanine aminotransferase levels were higher (29 U/L; SD, 17 U/L v 24 U/L; SD, 14 U/L) and mean median liver stiffness greater (6.5 kPa; SD, 5.6 kPa v 5.3kPa; SD, 2.0 kPa) in participants with NAFLD. CONCLUSION: The prevalence of NAFLD among adults in regional Victoria is high. Metabolic risk factors are more common among people with NAFLD, as are elevated markers of liver injury.

Published
2021

46. Patterns of use of oral health care services in Australian rural adults: the Crossroads-II Dental sub-study

Author

Marino, R, Glenister, K, Bourke, L, Morgan, M, Atala-Acevedo, C, Simmons, D, Marino, R, Glenister, K, Bourke, L, Morgan, M, Atala-Acevedo, C, and Simmons, D

Abstract

BACKGROUND: As part of a larger study, the Crossroads-II Dental sub-study determined the patterns of, and barriers to, oral health care service utilization in a rural area of Victoria. METHODS: In this cross-sectional sub-study predisposing, enabling, needs-related, and oral health variables were considered in association with patterns of oral health care utilization. A logistic regression was performed to explain the use of oral health care services. RESULTS: Overall, 574 adults participated, with 50.9% reporting having visited an oral health care service in the previous 12 months. Age, number of chronic health conditions and holding a health card; were associated with increased visit to a dentist (OR = 1.01; 95% CI: 1.00-1.03; OR = 1.08; 95% CI: 1.01-1.16; OR = 2.06; 95% CI: 1.26-3.36, respectively). Perceived barriers to care and number of missing teeth decreased the odds of using services (OR = 0.46; 95% CI: 0.36-0.58; OR = 0.95; 95% CI: 0.92-0.98, respectively). CONCLUSIONS: Results suggest that use of oral health care services is associated with a range of financial, educational, health and structural barriers. Increasing the use of oral health care services in rural populations requires additional efforts beyond the reduction of financial barriers.

Published
2021

47. Understanding and responding to the cost and health impact of short-term health staffing in remote and rural Aboriginal and Torres Strait Islander community-controlled health services: a mixed methods study protocol

Author

Fitts, MS, Humphreys, J, Dunbar, T, Bourke, L, Mulholland, E, Guthridge, S, Zhao, Y, Jones, MP, Boffa, J, Ramjan, M, Murakami-Gold, L, Tangey, A, Comerford, C, Schultz, R, Campbell, N, Mathew, S, Liddle, Z, Russell, D, Wakerman, J, Fitts, MS, Humphreys, J, Dunbar, T, Bourke, L, Mulholland, E, Guthridge, S, Zhao, Y, Jones, MP, Boffa, J, Ramjan, M, Murakami-Gold, L, Tangey, A, Comerford, C, Schultz, R, Campbell, N, Mathew, S, Liddle, Z, Russell, D, and Wakerman, J

Abstract

INTRODUCTION: Access to high-quality primary healthcare is limited for remote residents in Australia. Increasingly, remote health services are reliant on short-term or 'fly-in, fly-out/drive-in, drive-out' health workforce to deliver primary healthcare. A key strategy to achieving health service access equity, particularly evident in remote Australia, has been the development of Aboriginal Community Controlled Health Services (ACCHSs). This study aims to generate new knowledge about (1) the impact of short-term staffing in remote and rural ACCHSs on Aboriginal and Torres Strait Islander communities; (2) the potential mitigating effect of community control; and (3) effective, context-specific evidence-based retention strategies. METHODS AND ANALYSIS: This paper describes a 3-year, mixed methods study involving 12 ACCHSs across three states. The methods are situated within an evidence-based programme logic framework for rural and remote primary healthcare services. Quantitative data will be used to describe staffing stability and turnover, with multiple regression analyses to determine associations between independent variables (population size, geographical remoteness, resident staff turnover and socioeconomic status) and dependent variables related to patient care, service cost, quality and effectiveness. Qualitative assessment will include interviews and focus groups with clinical staff, clinic users, regionally-based retrieval staff and representatives of jurisdictional peak bodies for the ACCHS sector, to understand the impact of short-term staff on quality and continuity of patient care, as well as satisfaction and acceptability of services. ETHICS AND DISSEMINATION: The study has ethics approval from the Human Research Ethics Committee of the Northern Territory Department of Health and Menzies School of Health Research (project number DR03171), Central Australian Human Research Ethics Committee (CA-19-3493), Western Australian Aboriginal Health Ethics Committee

Published
2021

48. Characteristics of patients who access zero, one or multiple general practices and reasons for their choices: a study in regional Australia

Author

Glenister, KM, Guymer, J, Bourke, L, Simmons, D, Glenister, KM, Guymer, J, Bourke, L, and Simmons, D

Abstract

BACKGROUND: Most people in Australia visit a General Practitioner each year and are free to choose their General Practitioner and/or practice on each occasion. A proportion of people visit multiple general practices, which can reduce continuity of care, a core value of general practice. Utilisation of multiple general practices is associated with metropolitan residence and younger age. However, it is unclear which factors are associated with utilisation of multiple general practices in rural areas, where there are often General Practitioner workforce shortages and higher proportions of patients who may benefit from continuity of care, including older people and people living with chronic disease. The aim of this study was to compare the characteristics of people in a rural Australian area who accessed multiple general practices in the previous year with people who had accessed one practice, or none. METHODS: A cross-sectional survey assessed self-reported utilisation and perspective of general practice services, uses of multiple practices, associated reasons, lifestyle advice and screening services received in four regional Victorian towns. Households were randomly selected and residents aged 16+ were eligible to participate in the adult survey. RESULTS: Most people had attended a single general practice (78.9%), while 14.4% attended more than one practice and 6.7% attended no practices in the previous 12 months. Compared with utilisation of a single general practice, multiple general practice attendance in the previous year was associated with younger age (adjusted odds ratio (aOR 95% confidence interval) 0.98 per year (0.97-0.99), residence in the regional centre aOR 2.90(2.22-3.78), emergency department (ED) attendance in the last 12 months aOR 1.65(1.22-2.21) and no out of pocket costs aOR 1.36(1.04-1.79)). Reasons for multiple general practice attendance included availability of appointments, cost and access to specific services. Compared with multiple general

Published
2021

49. National analysis of the Modified Monash Model, population distribution and a socio-economic index to inform rural health workforce planning

Author

Versace, VL, Skinner, TC, Bourke, L, Harvey, P, Barnett, T, Versace, VL, Skinner, TC, Bourke, L, Harvey, P, and Barnett, T

Abstract

AIMS: To describe the population distribution and socio-economic position of residents across all states and territories of Australia, stratified using the 7 Modified Monash Model classifications. The numerical summary, and the methods described, can be applied by a variety of end users including workforce planners, researchers, policy-makers and funding bodies for guiding future investment under different scenarios, and aid in evaluating geographically focused programs. CONTEXT: The Commonwealth Department of Health is transitioning to the Modified Monash Model to objectively describe geographical access. This change applies to the Rural Health Multidisciplinary Training Program, one of the Australian Government's key policies to address the maldistribution of the rural health workforce. Unlike the previously applied Australian Statistical Geography Standard-Remoteness Areas, a summary of the population in each Modified Monash Model classification is not available, nor is a socio-economic overview of the communities within these areas. APPROACH: Spatial analysis of Australian Bureau of Statistics data (Modified Monash Model, population data and the Index of Relative Socio-economic Advantage and Disadvantage collected or derived from the 2016 census) at the Statistical Area 1-the smallest unit for the release of census data. CONCLUSION: Linking the Modified Monash Model, a socio-economic index and granular population data at the national level highlights the disadvantage of many residents in small rural towns (Modified Monash 5). The Modified Monash Model does not exhibit a continuum of the largest population residing in the most accessible classification and the smallest population residing in the least accessible classification that is seen in the Australian Statistical Geography Standard-Remoteness Areas. Coupled with policy relevance, the advantage of using the Modified Monash Model as the basis for analysis is that it highlights areas that have both a critical

Published
2021

50. Perceptions of work-integrated learning in rural health and human services under the National Disability Insurance Scheme in Australia

Author

Quilliam, C, Bourke, L, Quilliam, C, and Bourke, L

Abstract

The impact of Australian disability policy reform, known as the National Disability Insurance Scheme, on the capacity of rural health and human service organizations to facilitate higher education has been poorly investigated. This study explored how health professionals perceive the impact of the National Disability Insurance Scheme on nursing and allied health work-integrated learning (WIL) in rural host organizations during the scheme’s implementation in Victoria, Australia. Data collected from 20 health professionals across rural Victoria were thematically analyzed and mapped onto WIL dimensions. This process revealed themes relating to shifts in WIL purpose, context, nature and responsibilities. The findings suggest the National Disability Insurance Scheme may have limited rural organizational capacity to host students undertaking WIL, and in turn, contributed to a decline in rural health education during the implementation phase. Thus, WIL partners may need to pay greater attention to the policy framework surrounding rural WIL opportunities.

Published
2021

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