Prevalence of health behaviours in pregnancy at service entry in a Queensland health service district

Objective: Limited prevalence data for unhealthy pregnancy health behaviours make it difficult to prioritise primary prevention efforts for maternal and infant health. This study's objective was to establish the prevalence of cigarette smoking, sufficient fruit and vegetable intake and sufficient physical activity among women accessing antenatal clinics in a Queensland (Australia) health service district. Method: Cross-sectional self-reported smoking status, daily fruit and vegetable intake, weekly physical activity and a range of socio-demographic variables were obtained from women recruited at their initial antenatal clinic visit, over a three-month recruitment phase during 2007. Results: Analyses were based on 262 pregnant women. The study sample was broadly representative of women giving birth in the district and state, with higher representation of women with low levels of education and high income. More than one quarter of women were smoking. Few women met the guidelines for sufficient fruit (9.2%), vegetables (2.7%) or physical activity (32.8%) during pregnancy. Conclusions: There were low levels of adherence to health behaviour recommendations for pregnancy in this sample. Implications: There is a clear need to develop and evaluate effective pregnancy behaviour interventions to improve primary prevention in maternal and infant health. Brief minimal contact interventions that can be delivered through primary care to create a greater primary prevention focus for maternal and infant health would be worth exploring.

Predictors of initiating and maintaining active commuting to work using transport and public health perspectives in Australia

Objective To identify predictors for initiating and maintaining active commuting (AC) to work following the 2003 Australia's Walk to Work Day (WTWD) campaign. Methods Pre- and post-campaign telephone surveys of a cohort of working age (18–65years) adults (n = 1100, 55% response rate). Two dependent campaign outcomes were assessed: initiating or maintaining AC (i.e., walk/cycle and public transport) on a single day (WTWD), and increasing or maintaining health-enhancing active commuting (HEAC) level (≥ 30min/day) in a usual week following WTWD campaign. Results A significant population-level increase in HEAC (3.9%) was observed (McNemar's χ2 = 6.53, p = 0.01) with 136 (19.0%) achieving HEAC at post campaign. High confidence in incorporating walking into commute, being active pre-campaign and younger age (< 46years) were positively associated with both outcomes. The utility of AC for avoiding parking hassles (AOR = 2.1, 95% CI: 1.2–3.6), for less expense (AOR = 1.8, 95% CI: 1.1–3.1), for increasing one's health (AOR = 2.5, 95% CI: 1.1–5.6) and for clean air (AOR = 2.2, 95% CI: 1.0–4.4) predicted HEAC outcome whereas avoiding the stress of driving (AOR = 2.6, 95% CI: 1.4–5.0) and the hassle of parking predicted the single-day AC. Conclusions Transportation interventions targeting parking and costs could be further enhanced by emphasizing health benefits of AC. AC was less likely to occur among inactive employees.

Screening for risk of later mental health problems : a longitudinal study

Purpose: This is one of the first studies to report that the Achenbach internalising scales were much more effective at identifying those with current comorbid depression and anxiety, rather than individual mood disorder. Introduction: The Achenbach behaviour checklists (YSR,YASR) are widely used, low cost screening tools used to assess problem behaviour. Several studies report good association between the checklists and psychiatric diagnoses; although with varying degrees of agreement. Most are cross-sectional studies involving adolescents referred to mental health services; few are in large community-based studies. This study examined the usefulness of the Achenbach internalising scales in the primary screening (both predictive and concurrent)for depression and anxiety. Methods: The sample was 2400 young adults from an Australian population-based prospective birth cohort study. The association between the empirical anxiety and depression scales were individually assessed against DSM-IV depression and anxiety diagnoses. Odds ratios and diagnostic efficiency tests report the findings. Results: Adolescents with internalising symptoms were twice (OR 2.3, 95%CI 1.7 to 3.1) as likely to be diagnosed with later DSM-IV depression. YASR internalising scale predicted DSM-IV mood disorders (depression OR = 6.9, 95% CI 5.0–9.5; anxiety OR = 5.1, 95% CI 3.8–6.7) in the previous 12 months. The internalising scales were much more effective at identifying those with comorbid depression and anxiety. Conclusions: Adolescence and early adulthood are key risk periods for the onset of anxiety and depression. This study found that young people with internalising behaviour problems were more likely to have comorbid depression and anxiety DSM-IV disorder.

Development of hospital disaster resilience : conceptual framework and potential measurement

Objective Despite ‘hospital resilience’ gaining prominence in recent years, it remains poorly defined. This article aims to define hospital resilience, build a preliminary conceptual framework and highlight possible approaches to measurement. Methods Searches were conducted of the commonly used health databases to identify relevant literature and reports. Search terms included ‘resilience and framework or model’ or ‘evaluation or assess or measure and hospital and disaster or emergency or mass casualty and resilience or capacity or preparedness or response or safety’. Articles were retrieved that focussed on disaster resilience frameworks and the evaluation of various hospital capacities. Result A total of 1480 potentially eligible publications were retrieved initially but the final analysis was conducted on 47 articles, which appeared to contribute to the study objectives. Four disaster resilience frameworks and 11 evaluation instruments of hospital disaster capacity were included. Discussion and conclusion Hospital resilience is a comprehensive concept derived from existing disaster resilience frameworks. It has four key domains: hospital safety; disaster preparedness and resources; continuity of essential medical services; recovery and adaptation. These domains were categorised according to four criteria, namely, robustness, redundancy, resourcefulness and rapidity. A conceptual understanding of hospital resilience is essential for an intellectual basis for an integrated approach to system development. This article (1) defines hospital resilience; (2) constructs conceptual framework (including key domains); (3) proposes comprehensive measures for possible inclusion in an evaluation instrument, and; (4) develops a matrix of critical issues to enhance hospital resilience to cope with future disasters.

Physiotherapists have accurate expectations of their patients’ future health-related quality of life after first assessment in a subacute rehabilitation setting

BACKGROUND Expectations held by health professionals and their patients are likely to affect treatment choices in subacute inpatient rehabilitation settings for older adults. There is a scarcity of empirical evidence evaluating whether health professionals expectations of the quality of their patients' future health states are accurate. METHODS A prospective longitudinal cohort investigation was implemented to examine agreement (kappa coefficients, exact agreement, limits-of-agreement, and intraclass-correlation coefficients) between physiotherapists' (n = 23) prediction of patients' discharge health-related quality of life (reported on the EQ-5D-3L) and the actual health-related quality of life self-reported by patients (n = 272) at their discharge assessment (using the EQ-5D-3L). The mini-mental state examination was used as an indicator of patients' cognitive ability. RESULTS Overall, 232 (85%) patients had all assessment data completed and were included in analysis. Kappa coefficients (exact agreement) ranged between 0.37-0.57 (58%-83%) across EQ-5D-3L domains in the lower cognition group and 0.53-0.68 (81%-85%) in the better cognition group. CONCLUSIONS Physiotherapists in this subacute rehabilitation setting predicted their patients' discharge health-related quality of life with substantial accuracy. Physiotherapists are likely able to provide their patients with sound information regarding potential recovery and health-related quality of life on discharge. The prediction accuracy was higher among patients with better cognition than patients with poorer cognition.

Managing health risks of extreme weather events : need for a systematic approach

The Climate Commission recently outlined the trend of major extreme weather events in different regions of Australia, including heatwaves, floods, droughts, bushfires, cyclones and storms. These events already impose an enormous health and financial burden onto society and are projected to occur more frequently and intensely. Unless we act now, further financial losses and increasing health burdens seem inevitable. We seek to highlight the major areas for interdisciplinary investigation, identify barriers and formulate response strategies.

SettleMEN : health and settlement among men from refugee backgrounds living in South East Queensland

Between 2008 and 2010, the SettleMEN study followed a cohort of 233 recently arrived men from refugee backgrounds living in urban and regional areas of South East Queensland with the aim of documenting their health and settlement experiences. This report presents the key findings of the study.

We have a lot to learn yet : a postcolonial lens in health promotion

Health promotion progresses a social justice and empowerment agenda and thus emphasises working with people to increase their control over their health. Certainly, Australia has experienced much success in this endeavour and is internationally recognised as a leader. However, health promotion has failed Indigenous Australians; a fact that is echoed in the health outcomes that ironically provide us with the “moral imperative” to act. Further investigation has also revealed health promotion’s foundation in colonial imaginings. Thus, this paper calls for the culture of health promotion to be examined as a risk factor for poor Indigenous health. To complement this call, this paper presents findings of an ethnographic study of Indigenous health promotion practice, undertaken from a postcolonial and critical whiteness framework. These findings provide a narrative of strength and innovative approaches, highlighting the value of Indigenous knowledge. These findings also contradict the biomedical tendency to construct culture as illness-producing. More broadly, this study’s findings entail important lessons for health promotion to consider, if it is to move beyond the rhetoric, to truly increase people’s control over their health.

The Fukushima nuclear power plant disaster and percetions of health risk communication : a case study

This case study was conducted to explore the perceptions of health risk messages sent by the Japanese Government following the Fukushima nuclear power plant disaster. The content of health risk messages from the Japanese Government and the Japanese national broadcaster (NHK) were analysed and semi-structured interviews were conducted with a sample of Tokyo residents. Initially, participants trusted these messages but as the crisis unfolded they became sceptical about the messages. Participants felt the messages did not communicate health risk information effectively because the messages were; not supported by evidence, inconsistent, delayed and changed over time. Despite widespread access to the internet, social media and mobile telephones, most participants relied on television news for information about the health risks. The Japanese Government urgently needs to re-build trust by engaging the community in the planning and development phases of health risk communication strategies.

Research participation by people with intellectual disability and mental health issues : an examination of the processes of consent

Balancing the demands of research and ethics is always challenging and even more so when recruiting vulnerable groups. Within the context of current legislation and international human rights declarations, it is strongly advocated that research can and must be undertaken with all recipients of health care services. Research in the field of intellectual disability presents particular challenges in regard to consenting processes. This paper is a critical reflection and analysis of the complex processes undertaken and events that occurred in gaining informed consent from people with intellectual disability to participate in a study exploring their experiences of being an inpatient in mental health hospitals within Aotearoa/New Zealand. A framework based on capacity, information and voluntariness is presented with excerpts from the field provided to explore consenting processes. The practical implications of the processes utilised are then discussed in order to stimulate debate regarding clearer and enhanced methods of gaining informed consent from people with intellectual disability.

Globalisation and Health : Challenges for Health Law and Bioethics

This timely collection explores ethical and legal dilemmas in healthcare arising from globalization. Conflicts between public interests and individual rights, the challenge of regulating professionals and access to health services, and the effects of a global market all feature prominently in contemporary debates in this area. As a result of globalization, issues in health law and bioethics can no longer be understood solely within political boundaries that define traditional notions of individuals and communities. Rather, solutions for emerging problems require a global conception of rights and obligations, including the re-evaluation of ethical frameworks and legal regimes that currently govern exchanges in healthcare. Leading scholars in bioethics, law, medicine and philosophy from various jurisdictions engage these themes in this volume, and demonstrate the need for transnational solutions in a global age of healthcare.