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Biomedical subjects

John Wakerman

Publications and source records attributed to John Wakerman.

8 recordsLinked to original sources
PubMed2006

Zinc and vitamin A supplementation in Indigenous Australian children hospitalised with lower respiratory tract infection: a randomised controlled trial.

OBJECTIVE: To evaluate the efficacy of supplementation with zinc and vitamin A in Indigenous children hospitalised with acute lower respiratory infection (ALRI). DESIGN: Randomised controlled, 2-by-2 factorial trial of supplementation with zinc and vitamin A. SETTING AND PARTICIPANTS: 187 Indigenous children aged < 11 years hospitalised with 215 ALRI episodes at Alice Springs Hospital (April 2001 to July 2002). INTERVENTIONS: Vitamin A was administered on Days 1 and 5 of admission at a dose of 50 000 IU (infants under 12 months), or 100 000 IU; and zinc sulfate was administered daily for 5 days at a daily dose of 20 mg (infants under 12 months) or 40 mg. MAIN OUTCOME MEASURE: Time to clinical recovery from fever and tachypnoea, duration of hospitalisation, and readmission for ALRI within 120 days. RESULTS: There was no clinical benefit of supplementation with vitamin A, zinc or the two combined, with no significant difference between zinc and no-zinc, vitamin A and no-vitamin A or zinc + vitamin A and placebo groups in time to resolution of fever or tachypnoea, or duration of hospitalisation. Instead, we found increased morbidity; children given zinc had increased risk of readmission for ALRI within 120 days (relative risk, 2.4; 95% CI, 1.003-6.1). CONCLUSION: This study does not support the use of vitamin A or zinc supplementation in the management of ALRI requiring hospitalisation in Indigenous children living in remote areas. Even in populations with high rates of ALRI and poor living conditions, vitamin A and zinc therapy may not be useful. The effect of supplementation may depend on the prevalence of deficiency of these micronutrients in the population.

Child↗
PubMed2006

What do we mean by sustainable rural health services? Implications for rural health research.

The concept of health service sustainability, endorsed by the Australian Health Ministers as a key dimension of the National Performance Framework, is particularly important in rural and remote communities. To date, however, few Australian studies have demonstrated how the real drivers of sustainability inter-relate or are translated into sustainable rural and remote health services. This article highlights the need for a systemic approach in which the integrated nature of sustainability components are recognised and evaluated in terms of access to rural and remote health services, quality of care and cost of provision.

Australia↗
PubMed2005

Sustainable chronic disease management in remote Australia.

The Sharing Health Care Initiative (SHCI) demonstration project, which aimed to improve management of chronic diseases, was implemented in four small remote communities in the Katherine region which are serviced by the Katherine West Health Board, a remote Aboriginal-community-controlled health organisation in the Northern Territory. We reviewed the project proposal, final report, evaluation reports and transitional funding proposal, and supplemented these with in-depth interviews with key individuals. We determined factors critical to the sustainability of the SHCI project in relation to context, community engagement, systems flexibility and adaptability, the availability and effect of information systems, and the human nature of health care and policy. The project had a significant impact on community awareness of chronic disease and an improvement in clinic processes. We found that a number of interrelated factors promoted sustainability, including: An implementation strategy sufficiently flexible to take account of local conditions; A high level of community engagement; Appropriate timeframes, timing and congruence between national policy and local readiness to implement a chronic disease project; Effective communication between participating organisations; Project champions (key individuals) in participating organisations; Effective use of monitoring and evaluation data; and Adequate and ongoing funding. The absence of a number of these factors, such as poor communication, inhibited sustainability. Other factors could both promote and inhibit. For example, the impact of key individuals was important, but could be idiosyncratic and have negative effects.

Catchment Area, Health↗
PubMed2005

Zinc and vitamin A supplementation in Australian Indigenous children with acute diarrhoea: a randomised controlled trial.

OBJECTIVE: To evaluate the role of zinc and vitamin A supplementation in the recovery of Indigenous children hospitalised for acute diarrhoea. DESIGN: A randomised controlled 2 by 2 factorial trial of supplementation with zinc and vitamin A. SETTING AND PARTICIPANTS: Aboriginal children (aged < 11 years) hospitalised for acute diarrhoea at Alice Springs Hospital, Northern Territory, April 2001-July 2002. MAIN OUTCOME MEASURES: Duration of diarrhoeal illness; re-admission for diarrhoeal illness within 120 days. RESULTS: Our study involved 392 Aboriginal children with 436 episodes of diarrhoea. Supplementation with zinc, vitamin A, or combined zinc and vitamin A had no significant effect on duration of diarrhoea or rate of re-admission compared with placebo. Median diarrhoea duration after starting supplementation was 3.0 days for the vitamin A and zinc supplemented and placebo groups (P values 0.25 and 0.69, respectively). The number of re-admissions did not differ significantly between those receiving vitamin A or zinc and the relevant placebo groups (relative risk [95% CI], 1.2 [0.7-2.1] and 1.3 [0.8-2.1], respectively). CONCLUSION: Vitamin A and zinc supplementation may not be indicated for in-hospital management of acute diarrhoeal disease in Aboriginal children living in remote areas. This finding may not apply to children with malnutrition, for whom other studies suggest a benefit. Larger trials incorporating more comprehensive data on the vitamin A and zinc status as well as nutritional status of study populations might help to explain the different results in different populations.

Acute Disease↗
PubMed2004

Defining remote health.

OBJECTIVE: To develop a definition of the discipline of Remote Health. DESIGN: A broad literature search using key words and an Internet search of industry-recognised web sites were carried out. RESULTS: Fifty-five relevant citations and nine web sites were reviewed, covering Australia, Canada, New Zealand, the United Kingdom and United States. The papers offered a variety of definitions of geographical and practice-based approaches to 'remoteness', and definitions of 'remote and rural health'. CONCLUSIONS: None of the single current definitions in the literature adequately reflect all of the characteristics of Remote Health in Australia. A definition is offered: Remote Health is an emerging discipline with distinct sociological, historical and practice characteristics. Its practice in Australia is characterised by geographical, professional and, often, social isolation of practitioners; a strong multidisciplinary approach; overlapping and changing roles of team members; a relatively high degree of GP substitution; and practitioners requiring public health, emergency and extended clinical skills. These skills and remote health systems, need to be suited to working in a cross-cultural context; serving small, dispersed and often highly mobile populations; serving populations with relatively high health needs; and a physical environment of climatic extremes.

Australia↗
PubMed2002

Rural health: why it matters.

Australia needs a distinctive "rural health" approach that recognises the valuable role played by the "outback" in our economy and our national psyche.

Australia↗
PubMed2002

A case study in strategic change: developing a strategic research program to address cardiovascular disease and related disorders in aboriginal and Torres Strait Islander peoples and rural and remote settings.

This paper presents an analysis of a strategic change process. It identifies and reviews the critical factors that impact on, and need to be considered in order to successfully initiate and implement change. The problem was the narrow focus and priorities of a well-established research program. We undertook a stringent process to refocus the program to the areas of greatest need. The paper provides information on the process undertaken to achieve the change and other factors that impacted. The outcome has been considered successful in the first instance. However the long-term picture may not be as positive. Reviewing and presenting the process and influential factors provides the reader with the opportunity to compare this scenario with their own experience and thereby develop their own change strategies.

Australia↗