Contrasting views and experiences of health professionals on the management of comorbid substance misuse and mental disorders

Objectives: To determine opinions and experiences of health professionals concerning the management of people with comorbid substance misuse and mental health disorders. Method: We conducted a survey of staff from mental health services and alcohol and drug services across Queensland. Survey items on problems and potential solutions had been generated by focus groups. Results: We analysed responses from 112 staff of alcohol and drug services and 380 mental health staff, representing a return of 79% and 42% respectively of the distributed surveys. One or more issues presented a substantial clinical management problem for 98% of respondents. Needs for increased facilities or services for dual disorder clients figured prominently. These included accommodation or respite care, work and rehabilitation programs, and support groups and resource materials for families. Needs for adolescent dual diagnosis services and after-hours alcohol and drug consultations were also reported. Each of these issues raised substantial problems for over 70% of staff. Another set of problems involved coordination of client care across mental health and alcohol and drug services, including disputes over duty of care. Difficulties with intersectoral liaison were more pronounced for alcohol and drug staff than for mental health. A majority of survey respondents identified 13 solutions as practical. These included routine screening for dual diagnosis at intake, and a range of proposals for closer intersectoral communication such as exchanging client information, developing shared treatment plans, conducting joint case conferences and offering consultation facilities. Conclusions: A wide range of problems for the management of comorbid disorders were identified. While solution of some problems will require resource allocation, many may be addressed by closer liaison between existing services.

Supervision practice for allied mental health professionals within a large mental health workforce : exploring the phenomenon

This paper reports on an exploration of the concept of 'supervision' as applied to allied health professionals within a large mental health service in one Australian State. A two-part methodology was used, with focus group interviews conducted with allied health professionals, and semi-structured telephone interviews with service managers. Fifty-eight allied health professionals participated in a series of seven focus groups. Semi-structured interviews were conducted with the Directors or Managers of mental health services in all 21 regions in the state. Allied health professionals and service managers both considered supervision to be an important mechanism for ensuring staff competence and best practice outcomes for consumers and carers. There was strong endorsement of the need for clarification and articulation of supervision policies within the organization, and the provision of appropriate resourcing to enable supervision to occur. Current practice in supervision was seen as ad hoc and of variable standard; the need for training in supervision was seen as critical. The supervision needs of newly graduated allied health professionals and those working in rural and regional areas were also seen as important. The need for a flexible and accessible model of supervision was clearly demonstrated.

Evidence-based decision making to strengthen local governance : nutritional health interventions in Bantul and Gunungkidul

Since 2001, district governments have had the main responsibility for providing public health care in Indonesia. One of the main public health challenges facing many district governments is improving nutritional standards, particularly among poorer segments of the population. Developing effective policies and strategies for improving nutrition requires a multi-sectoral approach encompassing agricultural development policy, access to markets, food security (storage) programs, provision of public health facilities, and promotion of public awareness of nutritional health. This implies a strong need for a coordinated approach involving multiple government agencies at the district level. Due to diverse economic, agricultural, and infrastructure conditions across the country, district governments’ ought to be better placed than central government both to identify areas of greatest need for public nutrition interventions, and devise policies that reflect local characteristics. However, in the two districts observed in this study—Bantul and Gunungkidul—it was clear that local government capacity to generate, obtain and integrate evidence about local conditions into the policy-making process was still limited. In both districts, decision-makers tended to rely more on intuition,anecdote, and precedent in formulating policy. The potential for evidence-based decision making was also severely constrained by a lack of coordination and communication between agencies, and current arrangements related to central government fiscal transfers, which compel local governments to allocate funding to centrally determined programs and priorities.

Evidence based decision making to strenghten local governance : nutritional health interventions

Since 2001, district governments have had the main responsibility for providing public health care in Indonesia. One of the main public health challenges facing many district governments is improving nutritional standards, particularly among poorer segments of the population. Developing effective policies and strategies for improving nutrition requires a multi-sectoral approach encompassing agricultural development policy, access to markets, food security (storage) programs, provision of public health facilities, and promotion of public awareness of nutritional health. This implies a strong need for a coordinated approach involving multiple government agencies at the district level. Due to diverse economic, agricultural,and infrastructure conditions across the country, district governments’ ought to be better placed than central government both to identify areas of greatest need for public nutrition interventions, and devise policies that reflect local characteristics. However, in the two districts observed in this study—Bantul and Gunungkidul—it was clear that local government capacity to generate, obtain and integrate evidence about local conditions into the policy-making process was still limited. In both districts, decision-makers tended to rely more on intuition,anecdote, and precedent in formulating policy. The potential for evidence-based decision making was also severely constrained by a lack of coordination and communication between agencies, and current arrangements related to central government fiscal transfers, which compel local governments to allocate funding to centrally determined programs and priorities.

Patterns of reporting to child protection services in Canada by healthcare and nonhealthcare professionals

Background: All Canadian jurisdictions require certain professionals to report suspected or observed child maltreatment. This study examined the types of maltreatment, level of harm and child functioning issues, controlling for family socioeconomic status, age and gender of the child reported by healthcare and non-healthcare professionals. Methods: We conducted chi-square analyses and logistic regression on a national child welfare sample from the 2003 Canadian Incidence Study of Reported Child Abuse and Neglect (CIS-2003) and compared the differences in professional reporting with its previous cycle (CIS-1998) using Bonferroni-corrected confidence intervals. Results: Our analysis of CIS-2003 data revealed that the majority of substantiated child maltreatment is reported to service agencies by non-healthcare professionals (57%), followed by non-professionals (33%) and healthcare professionals (10%). The number of professional reports increased 2.5 times between CIS-1998 and CIS-2003, while non-professionals’ increased 1.7 times. Of the total investigations, professional reports represented 59% in CIS-1998 and 67% in CIS-2003 (p<0.001). Compared to non-healthcare professionals, healthcare professionals more often reported younger children, children who experienced neglect and emotional maltreatment and those assessed as suffering harm and child functioning issues, but less often exposure to domestic violence. Conclusion: The results indicate that healthcare professionals played an important role in identifying children in need of protection considering harm and other child functioning issues. The authors discuss the reasons why underreporting is likely to remain an issue.

Recruiting older adults to health research studies : a systematic review

Objective: To provide a systematic review of papers comparing the effectiveness of different strategies to recruit older adults (aged 50 years and over) to participate in health research studies, to guide successful recruitment in future research. Methods: Four major databases were searched for papers published between 1995 and 2008 with: target group aged 50 years or over; participants allocated to receive one of two or more recruitment strategies; and an outcome measure of response rate or enrolment in study. Results: Twelve papers were included in the review. Conclusion: For postal questionnaires, recruitment strategies used with older adults had comparable outcomes to those used to recruit from the general population. For other types of studies, strategies involving face-to-face contact may be more effective than indirect methods, but this needs to be balanced against feasibility. Overall, little evidence on the topic exists and more rigorous investigation is necessary.

Measuring factors that influence the utilisation of preventive care services provided by general practitioners in Australia

Background: Relatively little research attention has been given to the development of standardised and psychometrically sound scales for measuring influences relevant to the utilisation of health services. This study aims to describe the development, validation and internal reliability of some existing and new scales to measure factors that are likely to influence utilisation of preventive care services provided by general practitioners in Australia.----- Methods: Relevant domains of influence were first identified from a literature review and formative research. Items were then generated by using and adapting previously developed scales and published findings from these. The new items and scales were pre-tested and qualitative feedback was obtained from a convenience sample of citizens from the community and a panel of experts. Principal Components Analyses (PCA) and internal reliability testing (Cronbach's alpha) were then conducted for all of the newly adapted or developed scales utilising data collected from a self-administered mailed survey sent to a randomly selected population-based sample of 381 individuals (response rate 65.6 per cent).----- Results: The PCA identified five scales with acceptable levels of internal consistency were: (1) social support (ten items), alpha 0.86; (2) perceived interpersonal care (five items), alpha 0.87, (3) concerns about availability of health care and accessibility to health care (eight items), alpha 0.80, (4) value of good health (five items), alpha 0.79, and (5) attitudes towards health care (three items), alpha 0.75.----- Conclusion The five scales are suitable for further development and more widespread use in research aimed at understanding the determinants of preventive health services utilisation among adults in the general population.

The role of self-efficacy in dental patients’ brushing and flossing: Testing an extended Health Belief Model

Objective: In an effort to examine the decreasing oral health trend of Australian dental patients, the Health Belief Model (HBM) was utilised to understand the beliefs underlying brushing and flossing self-care. The HBM states that perception of severity and susceptibility to inaction and an estimate of the barriers and benefits of behavioural performance influences people’s health behaviours. Self-efficacy, confidence in one’s ability to perform oral self-care, was also examined. Methods: In dental waiting rooms, a community sample (N = 92) of dental patients completed a questionnaire assessing HBM variables and self-efficacy, as well as their performance of the oral hygiene behaviours of brushing and flossing. Results: Partial support only was found for the HBM with barriers emerging as the sole HBM factor influencing brushing and flossing behaviours. Self-efficacy significantly predicted both oral hygiene behaviours also. Conclusion: Support was found for the control factors, specifically a consideration of barriers and self-efficacy, in the context of understanding dental patients’ oral hygiene decisions. Practice implications: Dental professionals should encourage patients’ self-confidence to brush and floss at recommended levels and discuss strategies that combat barriers to performance, rather than emphasising the risks of inaction or the benefits of oral self-care.

Vitamin D and sun protection : the impact of mixed public health messages in Australia

Exposure of the skin to sunlight can cause skin cancer and is also necessary for cutaneous vitamin D production. Media reports have highlighted the purported health benefits of vitamin D. Our aim was to examine attitudes and behaviours related to sun protection and vitamin D. A cross-sectional study of 2,001 residents in Queensland, Australia aged 20-70 years was undertaken. Information collected included: skin cancer risk factors; perceptions about levels of sun exposure required to maintain vitamin D; belief that sun protection increases risk of vitamin D deficiency; intention, and actual change in sun protection practices for adults and children. Multivariate models examined predictors of attitudinal and behavioural change. One-third (32%) believed a fair-skinned adult, and 31% thought a child required at least 30 minutes per day in summer sun to maintain vitamin D levels. Reductions in sun protection were reported by 21% of adults and 14% of children. Factors associated with belief that sun protection may result in not obtaining enough vitamin D included aged ≥ 60 years (OR=1.35, 95% CI 1.09-1.66) and having skin that tanned easily (OR=1.96, 95% CI 1.38-2.78). Participants from low income households, and those who frequently used sun protective clothing were more likely to have reduced sun protection practices (OR=1.33, 95% CI 1.10-1.73 and OR=1.73, 95% CI 1.36-2.20, respectively). This study provides evidence of reductions in sun protection practices in a population living in a high UV environment. There is an urgent need to re-focus messages regarding sun exposure and for continued sun protection practices.

Paving pathways : shaping the public health workforce through tertiary education

Public health educational pathways in Australia have traditionally been the province of Universities, with the Master of Public Health (MPH) recognised as the flagship professional entry program. Public health education also occurs within the fellowship training of the Faculty of Public Health Medicine, but within Australia this remains confined to medical graduates. In recent years, however, we have seen a proliferation of undergraduate degrees as well as an increasing public health presence in the Vocational Education and Training (VET) sector. ----- Following the 2007 Australian Federal election, the new Labour government brought with it a refreshing commitment to a more inclusive and strategic style of government. An important example of this was the 2020 visioning process that identified key issues of public health concern, including an acknowledgment that it was unacceptable to allocate less than 2% of the health budget towards disease prevention. This led to the recommendation for the establishment of a national preventive health agency (Australia: the healthiest country by 2020 National Preventative Health Strategy, Prepared by the Preventative Health Taskforce 2009). ----- The focus on disease prevention places a spotlight on the workforce that will be required to deliver the new investment in health prevention, and also on the role of public health education in developing and upskilling the workforce. It is therefore timely to reflect on trends, challenges and opportunities from a tertiary sector perspective. Is it more desirable to focus education efforts on selected lead issues such as the “obesity epidemic”, climate change, Indigenous health and so on, or on the underlying theory and skills that build a flexible workforce capable of responding to a range of health challenges? Or should we aspire to both? ----- This paper presents some of the key discussion points from 2008 – 2009 of the Public Health Educational Pathways workshops and working group of the Australian Network of Public Health Institutions. We highlight some of the competing tensions in public health tertiary education, their impact on public health training programs, and the educational pathways that are needed to grow, shape and prepare the public health workforce for future challenges.

Sex on premises venue (SOPV) health promotion project in response to sustained increases in HIV notifications

Background: Due to increases in HIV notifications in Queensland, a health promotion outreach project was developed with sex on premises venues (SOPV) in Brisbane. Methods: A health promotion officer (HPO) promoted safer sex behaviours among SOPV patrons over 14 months, including providing information, counselling and skills to enhance safer sexual behaviours and providing referrals. Surveys were introduced to facilitate discussions regarding HIV/sexually transmissible infections, testing and safer sex practices. Results: The project demonstrated feasibility within this highly sexualised environment, and was enhanced by careful monitoring and revising the procedure to improve patron/staff responses to the project. The introduction of a survey instrument was a significant contributor to the project’s effectiveness, providing opportunities for patrons to discuss a variety of key sexual health issues. Conclusions: This initiative reflected effective partnering between the Health Department, a community HIV/lesbian, gay, bisexual and transgender organisation and private industry. Despite initial difficulties, the presence of a health worker within an SOPV was acceptable to patrons and allowed for brief interventions to be conducted. This project was deemed effective for a limited time period and within certain constraints.

Ethics and public health

Note: see later edition of this work at http://eprints.qut.edu.au/47632/ This chapter introduces you to the basic ethical principles that underpin public health practice. The themes to be considered in this chapter include: the characteristics of ‘ethics’, the justification for reflecting on ethics and values, the foundations of public health ethics, whether and how we can incorporate ethics and values into our practice and the nature of some of the potential ethical complications of public health practice.

The impact of globalisation on health

After reading this chapter, you should be able to: • understand the concept of globalisation and appreciate its complexity • identify the significant impacts of globalisation on population health, particularly the incidence of communicable and non-communicable diseases • understand the distribution of the global burden of disease in high-, middle- and low-income countries • critically evaluate the factors contributing to the major causes of death in low-income countries • understand some of the achievements of the global public health community and appreciate the challenges it faces.

Anxiety among high school students in India : comparisons across gender, school type, social strata, and perceptions of quality time with parents

The broad objective of the study was to better understand anxiety among adolescents in Kolkata city, India. Specifically, the study compared anxiety across gender, school type, socio-economic background and mothers’ employment status. The study also examined adolescents’ perceptions of quality time with their parents. A group of 460 adolescents (220 boys and 240 girls), aged 13-17 years were recruited to participate in the study via a multi-stage sampling technique. The data were collected using a self-report semi-structured questionnaire and a standardized psychological test, the State-Trait Anxiety Inventory. Results show that anxiety was prevalent in the sample with 20.1% of boys and 17.9% of girls found to be suffering from high anxiety. More boys were anxious than girls (p<0.01). Adolescents from Bengali medium schools were more anxious than adolescents from English medium schools (p<0.01). Adolescents belonging to the middle class (middle socio-economic group) suffered more anxiety than those from both high and low socio-economic groups (p<0.01). Adolescents with working mothers were found to be more anxious (p<0.01). Results also show that a substantial proportion of the adolescents perceived they did not receive quality time from fathers (32.1%) and mothers (21.3%). A large number of them also did not feel comfortable to share their personal issues with their parents (60.0% for fathers and 40.0% for mothers).