2001 Volvo Award winner in clinical studies : effects of a media campaign on back pain beliefs and its potential influence on management of low back pain in general practice

Study Design. Quasi-experimental, nonrandomized, nonequivalent, parallel group-controlled study involving before and after telephone surveys of the general population and postal surveys of general practitioners was conducted, with an adjacent state used as a control group.


Objectives. To evaluate the effectiveness of a population-based intervention designed to alter beliefs about back pain, influence medical management, and reduce disability and workers’ compensation–related costs.


Summary of Background Data. A multimedia campaign begun during 1997 in Victoria, Australia, positively advised patients with back pain to stay active and exercise, not to rest for prolonged periods, and to remain at work.


Methods. The campaign’s impact on population beliefs about back pain and fear-avoidance beliefs was measured in telephone surveys, and the effect of the campaign on the potential management of low back pain by general practitioners was assessed by eliciting their likely approach to two hypothetical scenarios in mailed surveys. Demographically identical population groups in Victoria and the control state, New South Wales, were surveyed at three times: before, during, and after intervention in Victoria.


Results. The studies were completed by 4730 individuals in the general population and 2556 general practitioners. There were large statistically significant improvements in back pain beliefs over time in Victoria (mean scores on the Back Beliefs Questionnaire, 26.5, 28.4, and 29.7), but not in New South Wales (26.3, 26.2, and 26.3, respectively). Among those who reported back pain during the previous year, fear-avoidance beliefs about physical activity improved significantly in Victoria (mean scores on the Fear-Avoidance Beliefs Questionnaire for physical activity, 14, 12.5, and 11.6), but not in New South Wales (13.3, 13.6, and 12.7, respectively). General practitioners in Victoria reported significant improvements over time in beliefs about back pain management, as compared with their interstate colleagues. There were statistically significant interactions between state and time for 7 of 10 responses on management of acute low back pain, and for 6 of 10 responses on management of subacute low back pain.


Conclusion. A population-based strategy of providing positive messages about back pain improves the beliefs of the general population and general practitioners about back pain and appears to influence medical management.

The Tastes of a Nation: M.F.K. Fisher and the Genre of Culinary Literature

This project works to situate this gastronomic revolution within a historical context, arguing at greater length that our contemporary food culture in the United States is in part the legacy of the body of food representations. Here we witness the evolution of a particular culinary sensibility that appealed to readers differently in different historical moments, as exhibited by the variety of ways that Fisher’s body of work was publicly received. By the end of the twentieth century, Fisher’s ethos reigned supreme, because Americans began to view food with less fear and anxiety as they slowly became more comfortable expressing their physical appetites and desires. By the millennium, Americans began to respect and honor the physical appetite and give more consideration to the quality and origin of the foods that they consumed. Feelings of guilt associated with the enjoyment of food began to diminish as well.

Cervical cancer services for Indigenous Women: Advocacy, Community-Based Research and Policy Change in Australia

Collaborative research undertaken in the state of Queensland, Australia, resulted in major changes in cervical cancer screening and treatment for Indigenous women. Guided by an Indigenous statewide reference group and with an Indigenous researcher playing a lead role, qualitative data were collected using interviews, focus groups, and larger community meetings; and case studies were conducted with health workers and community members from diverse rural, remote and urban communities, to explore the different cultural and structural factors affecting understanding and awareness of cervical cancer and Indigenous women's use of and access to health services for screening, diagnosis and treatment. These data were supplemented by an analysis of clinical data and health service checklists. We discuss the methodology and summarize the key social and structural factors that discourage women from presenting for screening or returning for follow-up. These include women's misunderstanding of cervical cancer screening, fear of cancer, distrust of health services, poor recall and follow-up systems, and the economic and social burden to women presenting for treatment. We describe how the research process and subsequent activities provided Indigenous women with a vehicle for their own advocacy, resulting in important policy and program changes.

Socio-cultural Degeneration and State Patronage of the Arts: Mapplethorpe, Cultural Crisis, and the NEA

The goal of this paper is to investigate how the Untied States federal government, specifically through the National Endowment for the Arts, or NEA, has acted in the position of an arts patron in the past few decades. Specifically, this paper will focus on the past decade and a half since the 'arts crisis' of the late 1980s and the social and political backlash against the art community in the 1990s, which was only against ‘offensive’ art that was seen as morally and culturally corruptive. I explore the political, social, and economic forms the backlash took, particularly rooted in a perceived fear of degenerative arts as a corruption of and a catalyst for the eventual collapse of American culture and values. Additionally, I analyse the role the federal government played in ‘ameliorating’ the situation. I investigate how state arts patronage has affected and continues to affect both the concepts behind and the manifestations of art, as well as who is encouraged, sanctioned, or neglected in the production of art. To accomplish this, I explore how and why the federal government employs the arts to define and redefine morality and culture, and how does it express/allow the expressions of these through art.

Metabolic and cardiac outcomes after acute myocardial infarction

The original DIGAMI protocol recommended using intravenous insulin to manage myocardial infarction from first presentation followed by subcutaneous insulin for 3 months in patients with diabetes. This paper describes the metabolic and cardiac outcomes and barriers to implementing a protocol designed to match the DIGAMI principles across our emergency and cardiology departments. Patients managed using the revised DIGAMI protocol achieved better blood glucose control and had fewer reinfarcts than those managed without insulin. The major barrier to using the protocol appeared to be staff fear of causing hypoglycaemia.

Is China's rise a threat? Understanding the 'China' challenge

TOPICS
Introduction
In fear of China in the United States
Deconstructing the 'China threat' image
The IChina' challenge revisited
Future predictions

The early postnatal period : exploring women's views, expectations and experiences of care using focus groups in Victoria, Australia

Background: There is growing evidence from Australia and overseas that the care provided in hospital in the early postnatal period is less than ideal for both women and care providers. Many health services face increasing pressure on hospital beds and have limited physical space available to care for mothers and their babies. We aimed to gain a more in-depth understanding of women's views, expectations and experiences of early postnatal care.

Methods: We conducted focus groups in rural and metropolitan Victoria, Australia in 2006. Fifty-two people participated in eight focus groups and four interviews. Participants included eight pregnant women, of whom seven were pregnant with their first baby; 42 women who were in the postpartum period (some up to twelve months after the birth of their baby); and two partners. All participants were fluent in English. Focus group guides were developed specifically for the study and explored participants' experiences and/or expectations of early postnatal care in hospital and at home, with an emphasis on length of hospital stay, professional and social support, continuity of care, and rest. Discussions were audio-taped and transcribed verbatim. A thematic network was constructed to describe and connect categories with emerging basic, organizing, and global themes.

Results: Global themes that emerged were: anxiety and/or fear; and the transition to motherhood and parenting. The needs of first time mothers were considered to be different to the needs of women who had already experienced motherhood. The women in this study were generally concerned about the safety of their new baby, and lacked confidence in themselves as new mothers regarding their ability to care for their baby. There was a consistent view that the physical presence and availability of professional support helped alleviate these concerns, and this was especially the case for women having a first baby.

Conclusion: Women have anxieties and fears around early parenting and their changing role, and may consider that the physical availability of professional care providers will help during this time. Care providers should be cognisant of these potential issues. It is crucial that women's concerns and needs be considered when service delivery changes are planned. If anxiety around new parenting is a predominant view then care providers need to recognise this and ensure care is individualised to address each woman's/families particular concerns.

Children's conception of police authority when responding to requests for assistance

Children (five to six and seven to eight years old) were presented with scenarios in which various adults (a police officer, a teacher, and an unspecified adult) requested assistance from a child. Six scenarios were presented (two per adult) with half involving a reasonable request (requiring little effort from the child) and the others unreasonable. For each scenario, the participants stated: (i) whether the child in the story should comply with the adult's request, (ii) the reason for the compliance decision, (iii) the consequences of non-compliance, and (iv) the legitimacy of the adult's request. Compliance and perceived legitimacy of the request was highest for the police officer compared to the teacher, with both figures commanding greater compliance than the unspecified adult. Children's justifications suggested that the positive relationship between obedience and social status was due (albeit in part) to fear of punishment for non-compliance, particularly in the younger age group.

Cultural racism, language prejudice and discrimination in hospital contexts : an Australian study

This article explores the idea that racial and ethnic disparities in healthcare may be expressive of unacknowledged practices of cultural racism. In conducting this exploration, the researchers identify, describe and discuss the practice of language prejudice and discrimination by health service providers, discovered serendipitously in the context of a broader study exploring cultural safety and cultural competency in an Australian healthcare context. The original study involved individual and focus groups interviews with 145 participants recruited from over 17 different organisational and domestic home sites. Participants included health service managers, ethnic liaison officers, qualified health interpreters, cultural trainers/educators, ethnic welfare organisation staff, registered nurses, allied health professionals, and healthcare consumers. Participants self-identified as being from over 27 different ethnocultural and language backgrounds.

Analysis of the data revealed that English language proficiency, like skin colour, was used as a social marker to classify, categorise, and negatively evaluate people of non-English speaking backgrounds (NESB) in the contexts studied. Negative evaluations, in turn, were used to justify the exclusion of NESB people from healthcare relationships and resources. Further data analysis revealed that underpinning the negative attitudes and behaviours in hospital domains concerning people who spoke accented English or who did not speak English proficiently were a dislike of difference, fear of difference, intolerance of difference, fear of competition for scarce healthcare resources, repressed hostility toward difference, and ignorance.

Highlighting the implications of language prejudice for the safety and quality care of NESB people, the researchers call for further internationally comparative research and debate on the subject.

The failure of dissertation advice books : toward alternative pedagogies for doctoral writing

Anxious doctoral researchers can now call on a proliferation of advice books telling them how to produce their dissertations. This article analyzes some characteristics of this self-help genre, including the ways it produces an expert–novice relationship with readers, reduces dissertation writing to a series of linear steps, reveals hidden rules, and asserts a mix of certainty and fear to position readers "correctly." The authors argue for a more complex view of doctoral writing both as text work/identity work and as a discursive social practice. They reject transmission pedagogies that normalize the power-saturated relations of protégé and master and point to alternate pedagogical approaches that position doctoral researchers as colleagues engaged in a shared, unequal, and changing practice

Politics and technology : friends or enemies of the story?

Taking its cue from the conference at which it was presented, this article considers both old stories and new ways, and addresses the question of the impact not only of new technology but also of politics upon 'the story'. Fundamental is the question of whether politics and technology might be considered friends or enemies of the story. Drawing on her long term experiences as an interviewer, the author interrogates particular oral history projects undertaken into children's play lore and play ways, to show how children's games and play time activities have been politicised. Locating her analysis in an international context of US legislation and British and Australian research, the author examines how play itself has become the plaything of both politicians and fear. She then examines the impact of high fidelity recording equipment and the universal accessibility of material located on the internet to address the question of technology as friend of the story, ultimately concluding that the story and the question will both go on.

The empowerment process in people with diabetes : an Iranian perspective

Background: Empowerment and power are well-researched concepts concerning people with chronic diseases. However, few researchers have focused specifically on the process of empowerment in Iranian people with diabetes. Understanding the empowerment process could help health professionals facilitate empowerment.
Aim: To explore the empowerment process in Iranian people with diabetes.
Method: A grounded theory research design was used incorporating in-depth interviews to collect the data from men and women aged 21–73 years (n = 16). Data were collected between February and July 2007. Constant comparative analysis was undertaken to identify key categories.
Findings: Participants indicated being embarrassed by the diagnosis, thirsting to learn, living in the shadow of fear, accepting diabetes as reality, managing diabetes and feeling empowered were distinct but interconnected phases in the empowerment process. The empowerment process was influenced by cultural and religious beliefs including the concept of the doctor as holy man, accepting diabetes as God's will, caring for the body because it was God's gift, paying attention to symptomatic disease, and support from peers and family, especially daughters.
Conclusion: The empowerment process consists of several distinct but interconnected phases. The findings will help health professionals develop a deeper understanding of how Iranian people with diabetes become empowered.

Masculine gender role stress and the pursuit of muscularity.

The relationship between masculine gender role stress and body change was examined in 129 men, aged between 18 and 40 years (M = 24.38; SD = 6.04), who completed the Masculine Gender Role Stress scale (MGRS), the Drive for Muscularity Scale, the Eating Disorder Inventory, and the Eating Disorder Examination-Questionnaire. Significant relationships were observed between MGRS and drive for muscularity and, to a lesser extent, drive for thinness and disordered eating symptomatology. These relationships were mediated by body dissatisfaction, and several of the relationships were positively moderated by self-reported affective problems and personal ineffectiveness. Although interpretation of the results is limited by the cross-sectional design employed, the results are consistent with the proposition that a fear of deviating from the masculine gender role, particularly in men who feel ineffective and who have difficulty controlling and accessing their emotions, is related to concern with, and pursuit of, muscularity and leanness.

Leaders and their teams : learning to improve performance with emotional intelligence and using choice theory

Looks at the relationship between emotional intelligence and choice theory in the work world, with particular emphasis on the implications on health and productivity. Most of us have a managing or leading role of some sort, whether at home, in community life, or at work. Also, as a professional, one can be leading through professional expertise and not necessarily because of one's place in the organizational hierarchy. There is an increasing awareness of the role of leadership and team development in organizational development, for example in health care where change is needed to manage the chronic disease burden (Dunbar et al., 2007) and utilizing and retaining a dwindling workforce (Schoo, Stagnitti, Mercer, & Dunbar, 2005). This is forcing leaders and their teams to work as smart as they can with resources that are available to them. Positive leadership has been associated with outcomes that include happy relationships, teamwork, learning, recognition, staff retention, and health and wellbeing. There is evidence that emotionally intelligent leaders in workplaces are able to bring about these positive out- comes because they are attuned to the emotions that move people around them (Goleman, Boyatzis, & McKee, 2002). In this sense, emotion can be defined as aroused energy that takes a direction (Hunt, 2004a) (Latin: e = from, movere = to move). Valerie Hunt regards emotion as the metronome of life (Hunt, 2004b). Although emotion can be a feeling state (e.g., fear, anger, joy, hate or sorrow) associated with action, its energy is, according to Hunt, directed to action, to behave(Hunt, 2004b). As mentioned in an earlier publication (Schoo, 2005), Pert (Flowers, Grubin, & Meryman-Brunner, 1993) regards emotions as a bridge that connects the mental and physical realities (p.187), and sees neuropeptides as the physical representations of these emotions. Negative thoughts and emotions such as excitement and anger have been found to increase gut motility, cancer risk and arterial plaque formation which can lead to a heart infarct (Pert, 1997), whereas positive emotions seem to do the opposite.