Thesis (MEd)(Human Resource Studies)--University South Australia, 1996

No description available.

No description available.

A number of chronic disease and behavioural factors are recognised to increase the risk of cardiovascular and cerebrovascular diseases. These putative ???vascular??? risk factors have increasingly been recognised to increase the risk of cognitive impairment in the absence of clinically manifest ischemic events. Their relationship to structural brain changes has received limited attention. In this dissertation, I used high resolution magnetic resonance image (MRI) to examine two structural features of the brain, regional gray matter (GM) volumes and silent lacunar infarcts, and determined their association with vascular risk factors. I related these to cognitive function in both cross-sectional and longitudinal studies. The work was based on the data of three waves in two healthy cohorts drawn from the PATH Through Life Study, which is a population-based longitudinal study of ageing comprising 3 cohorts aged 20-24, 40-44, and 60-64 years, with about 2500 participants in each cohort. Random subsamples of Wave 1 of the cohort aged 60-64 years (N = 478) and Wave 2 of the 40+ cohort (aged 44-48 years) (N = 411) were examined cross-sectionally for the MRI sub-study. The MRI cohort aged 60-64 years was re-examined 4 years later in Wave 2. These studies showed that vascular risk factors are associated with lower regional GM volumes and this association varies at different ages. In adults aged 44-48 years, individual risk factors did not show a significant relationship with GM volumes, but the Framingham risk score was associated with less GM volumes in a number of brain regions, suggesting an additive effect of the risk factors. In the 60+ cohort, hypertension was independently associated with less regional GM volumes in bilateral medial frontal, right superior frontal, left superior temporal and precentral gyri. The same cohort, when examined in Wave 2, showed the negative association of hypertension with gray matter volumes to be more widespread. These associations were observed in men but not in women in either wave. Sex dimorphism was observed in the younger cohort as well, with greater GM volumes in temporal and occipital cortices, midbrain and cerebellum in men, while less GM volumes in cingulate and parietal cortices in comparison with women. Lacunar infarcts were present in 7.8 % of the 60+ cohort, and asymptomatic new lacunar lesions developed in 0.4 % per year in this group. The prevalence of lacunar infarcts was correlated with hypertension and a steeper decline in mental speed. These series of studies indicate the relationship of vascular risk factors with changes in brain structure and cognitive function in healthy middle-aged adults. It is suggested that modifying these vascular risk factors may protect the brain from silent lesions and cognitive impairment, and that intervention should begin early in life to have a major impact.

An aging population is one common challenge faced by many developed countries including Australia. The Australian government has realised that the existing healthcare system must be improved to provide better support longer-term for the healthcare needs of this population. This research examines one such opportunity by suggesting a reform on how the care needs of residents living in Australian residential aged care facilities (RACF) are assessed. A recent study has shown that the current assessment system, known as the Residential Classification Scale (RCS), is subjected to high administrative procedural overhead costs and significant deviations in assessment results. This thesis documents a technical feasibility study of a novel method aimed to solve issues related to the time demands and subjectivity of the RCS through the design and implementation of a Wireless Sensor Network (WSN). This WSN is engineered to unobtrusively collect data from wireless sensor nodes either embedded in the RACF environment or attached to the resident??s body. The collected data can be potentially used to provide automatic and accurate care level assessments for the resident. The methodology of preparing and conducting the experiments to prove the hypotheses is justified and described, including the experimental instruments and procedures involved. The results show that this WSN surpasses similar research systems in terms of its application scale, the number and types of sensor nodes involved and the complexity of its hardware and firmware architectures. The major contributions of this thesis are: ?? The WSN developed satisfies certain technical requirements to be declared fit for use in a mock Australian RACF. ?? The WSN provides high sensor detection accuracies (between 88% and 100%), superior location tracking capability (94.75%) and activities of daily living inference capability over similar studies. Opportunities for further improvements of this WSN include: ?? Fine tuning the detection accuracy of Passive Infra-red (PIR) motion sensors. ?? Minimising the down time of the sensor nodes due to firmware memory leak. ?? An extra location tracking mechanism to improve location accuracy determination.

No description available.

Four different case management programs delivered by UnitingCare Community Options (UCCO) in the eastern suburbs of Melbourne were examined against the expectations of case management as a policy solution to a range of perceived policy problems at the micro-, meso- and macro-levels. The micro-level expectations were related to client and family experiences of the service system and outcomes. At the meso-level expectations were focused on perceived service delivery problems such as poor matching of services to the needs of ‘complex’ clients including a lack of integration, flexibility and responsiveness to clients’ needs and preferences. Perceived macro-level policy problems were concerned with a variety of issues including increasing rates of institutionalisation, increasing costs to governments, lack of economic efficiency and the desire to create market or quasi-market conditions in the community care service delivery sector. (For complete abstract open document)

Despite the expansion of research into chronic nonmalignant pain, a majority of reported studies are based on patient populations of specialised pain management clinics, which may not adequately represent older people with chronic nonmalignant pain in the general community. Therefore, the overall aim of the present thesis was to fill some gaps in this knowledge base. / The findings of the present thesis support the notion that older people who attend multidisciplinary pain management centres are probably not representative of those with pain who live in the general community but do not attend specialised treatment centres. Indeed a conceptual framework developed from the findings suggest that less than 3 percent of a random community sample of older people with chronic pain share the profile of those who attend a multidisciplinary pain management centre. The majority (86 percent) of the community sample were found to have mild chronic pain that can be adequately managed in the community. However, about 11 percent of the community sample have moderate chronic pain, and it is probable that additional community-based pain management services can improve the management of pain. / Development of instruments to measure the perceived helpfulness and use of pain management strategies by community-dwelling older people with chronic pain is another area that has not received adequate attention. A preliminary survey questionnaire was developed to measure the use and perceived helpfulness of pain management strategies in community dwelling older people. The findings have provided new insight from the user’s perspective regarding the relative effectiveness of different pain management strategies, and highlighted the potential clinical application of strategies that are less commonly used, such as TENS (transcutaneous electrical nerve stimulation), and relaxation techniques that are beneficial for specific subgroups of older people with chronic pain. / The evaluation of the efficacy of a community-based intervention program that provides free choice of intervention for improving outcomes for older people with chronic pain showed that the program was successful in reducing pain and improving level of physical activity for those who completed the program when they were compared with matched subjects who did not participate. The findings also suggest that an educational seminar can have a positive impact that empower participants to make a more informed choice regarding interventions for managing pain. However, the long-term effect of the program has not been established. Therefore, further research will be needed to evaluate whether this approach is a viable alternative clinical option for effective, accessible, and low cost pain management for the general community of older people with chronic pain. / The pain management service model was developed based on a synthesis of the findings. The model was based on a targeted approach that focuses on community-based interventions designed to improve access and outcomes for the majority of community-dwelling older people with chronic non-malignant pain who do not use specialised pain management services. / Overall, the findings of the present thesis have enhanced our understanding of the management of chronic non-malignant pain in community-dwelling older people, which has important implications for the development of services, and has generated hypothesis for future research that may contribute to improve outcomes for older people with chronic non-malignant pain.

An aging population is one common challenge faced by many developed countries including Australia. The Australian government has realised that the existing healthcare system must be improved to provide better support longer-term for the healthcare needs of this population. This research examines one such opportunity by suggesting a reform on how the care needs of residents living in Australian residential aged care facilities (RACF) are assessed. A recent study has shown that the current assessment system, known as the Residential Classification Scale (RCS), is subjected to high administrative procedural overhead costs and significant deviations in assessment results. This thesis documents a technical feasibility study of a novel method aimed to solve issues related to the time demands and subjectivity of the RCS through the design and implementation of a Wireless Sensor Network (WSN). This WSN is engineered to unobtrusively collect data from wireless sensor nodes either embedded in the RACF environment or attached to the resident??s body. The collected data can be potentially used to provide automatic and accurate care level assessments for the resident. The methodology of preparing and conducting the experiments to prove the hypotheses is justified and described, including the experimental instruments and procedures involved. The results show that this WSN surpasses similar research systems in terms of its application scale, the number and types of sensor nodes involved and the complexity of its hardware and firmware architectures. The major contributions of this thesis are: ?? The WSN developed satisfies certain technical requirements to be declared fit for use in a mock Australian RACF. ?? The WSN provides high sensor detection accuracies (between 88% and 100%), superior location tracking capability (94.75%) and activities of daily living inference capability over similar studies. Opportunities for further improvements of this WSN include: ?? Fine tuning the detection accuracy of Passive Infra-red (PIR) motion sensors. ?? Minimising the down time of the sensor nodes due to firmware memory leak. ?? An extra location tracking mechanism to improve location accuracy determination.

Thesis (M.T.S.)--Catholic Theological Union at Chicago, 1989. / Vita. Includes bibliographical references (leaves 59-60).