Going public : do risk and choice explain differences in caesarean birth rates between public and private places of birth in Australia?

Background: Women who birth in private facilities in Australia are more likely to have a caesarean birth than women who birth in public facilities and these differences remain after accounting for sector differences in the demographic and health risk profiles of women. However, the extent to which women’s preferences and/or freedom to choose their mode of birth further account for differences in the likelihood of caesarean birth between the sectors remains untested. Method: Women who birthed in Queensland, Australia during a two-week period in 2009 were mailed a self-report survey approximately three months after birth. Seven hundred and fifty-seven women provided cross-sectional retrospective data on where they birthed (public or private facility), mode of birth (vaginal or caesarean) and risk factors, along with their preferences and freedom to choose their mode of birth. A hierarchical logistic regression was conducted to determine the extent to which maternal risk and freedom to choose one’s mode of birth explain sector differences in the likelihood of having a caesarean birth. Findings: While there was no sector difference in women’s preference for mode of birth, women who birthed in private facilities had higher odds of feeling able to choose either a vaginal or caesarean birth, and feeling able to choose only a caesarean birth. Women had higher odds of having caesarean birth if they birthed in private facilities, even after accounting for significant risk factors such as age, body mass index, previous caesarean and use of assisted reproductive technology. However, there was no association between place of birth and odds of having a caesarean birth after also accounting for freedom to choose one’s mode of birth. Conclusions: These findings call into question suggestions that the higher caesarean birth rate in the private sector in Australia is attributable to increased levels of obstetric risk among women birthing in the private sector or maternal preferences alone. Instead, the determinants of sector differences in the likelihood of caesarean births are complex and are linked to differences in the perceived choices for mode of birth between women birthing in the private and public systems.

Negotiating family, navigating resettlement : family connectedness amongst resettled youth with refugee backgrounds living in Melbourne, Australia

Refugee adolescents resettling in a new country face many challenges, and being part of a supportive family is a critical factor in assisting them to achieve wellbeing and create positive futures. This longitudinal study documents experiences of family life in the resettlement context of 120 young people with refugee backgrounds living in Melbourne, Australia. Family instability was a core feature of the early settlement period. In this paper, we focus specifically on changing household composition, and levels of trust, attachment, discipline and conflict in family settings during young people’s first years of resettlement. Our results suggest that while families are central to the wellbeing of these young people, changing family dynamics can also pose a threat to wellbeing and successful settlement. We argue that youth focused settlement services must explicitly engage with family contexts in assisting refugee youth to achieve wellbeing and successfully resettle.

Effect of Australia's walk to work day campaign on adults' active commuting and physical activity behavior

Purpose. To determine whether Australia's Walk to Work Day media campaign resulted in behavioural change among targeted groups. Methods. Pre- and postcampaign telephone surveys of a cohort of adults aged 18 to 65 years (n = 1100, 55% response rate) were randomly sampled from Australian major melropolitan areas. Tests for dependent samples were applied (McNemax chi(2) or paired t-test). Results. Among participants who did not usually actively commute to work was a significant decrease in car only use an increase in walking combined with public transport. Among those who were employed was a significant increase in total time walking (+16 min/wk; t [780] = 2.04, p < .05) and in other moderate physical activity (+120 min/wk; t [1087] = 4.76, p < .005), resulting in a significant decrease in the proportion who were inactive (chi(2) (1) = 6.1, p < .05). Conclusion. Although nonexperimental, the Walk to Work Day initiative elicited short-term changes in targeted behaviors among target groups. Reinforcement by integrating worksite health promotion strategies may be required for sustained effects.

Spatial and temporal analysis of Barmah Forest virus disease in Queensland, Australia

Barmah Forest virus (BFV) disease is one of the most widespread mosquito-borne diseases in Australia. The number of outbreaks and the incidence rate of BFV in Australia have attracted growing concerns about the spatio-temporal complexity and underlying risk factors of BFV disease. A large number of notifications has been recorded continuously in Queensland since 1992. Yet, little is known about the spatial and temporal characteristics of the disease. I aim to use notification data to better understand the effects of climatic, demographic, socio-economic and ecological risk factors on the spatial epidemiology of BFV disease transmission, develop predictive risk models and forecast future disease risks under climate change scenarios. Computerised data files of daily notifications of BFV disease and climatic variables in Queensland during 1992-2008 were obtained from Queensland Health and Australian Bureau of Meteorology, respectively. Projections on climate data for years 2025, 2050 and 2100 were obtained from Council of Scientific Industrial Research Organisation. Data on socio-economic, demographic and ecological factors were also obtained from relevant government departments as follows: 1) socio-economic and demographic data from Australian Bureau of Statistics; 2) wetlands data from Department of Environment and Resource Management and 3) tidal readings from Queensland Department of Transport and Main roads. Disease notifications were geocoded and spatial and temporal patterns of disease were investigated using geostatistics. Visualisation of BFV disease incidence rates through mapping reveals the presence of substantial spatio-temporal variation at statistical local areas (SLA) over time. Results reveal high incidence rates of BFV disease along coastal areas compared to the whole area of Queensland. A Mantel-Haenszel Chi-square analysis for trend reveals a statistically significant relationship between BFV disease incidence rates and age groups (ƒÓ2 = 7587, p<0.01). Semi-variogram analysis and smoothed maps created from interpolation techniques indicate that the pattern of spatial autocorrelation was not homogeneous across the state. A cluster analysis was used to detect the hot spots/clusters of BFV disease at a SLA level. Most likely spatial and space-time clusters are detected at the same locations across coastal Queensland (p<0.05). The study demonstrates heterogeneity of disease risk at a SLA level and reveals the spatial and temporal clustering of BFV disease in Queensland. Discriminant analysis was employed to establish a link between wetland classes, climate zones and BFV disease. This is because the importance of wetlands in the transmission of BFV disease remains unclear. The multivariable discriminant modelling analyses demonstrate that wetland types of saline 1, riverine and saline tidal influence were the most significant risk factors for BFV disease in all climate and buffer zones, while lacustrine, palustrine, estuarine and saline 2 and saline 3 wetlands were less important. The model accuracies were 76%, 98% and 100% for BFV risk in subtropical, tropical and temperate climate zones, respectively. This study demonstrates that BFV disease risk varied with wetland class and climate zone. The study suggests that wetlands may act as potential breeding habitats for BFV vectors. Multivariable spatial regression models were applied to assess the impact of spatial climatic, socio-economic and tidal factors on the BFV disease in Queensland. Spatial regression models were developed to account for spatial effects. Spatial regression models generated superior estimates over a traditional regression model. In the spatial regression models, BFV disease incidence shows an inverse relationship with minimum temperature, low tide and distance to coast, and positive relationship with rainfall in coastal areas whereas in whole Queensland the disease shows an inverse relationship with minimum temperature and high tide and positive relationship with rainfall. This study determines the most significant spatial risk factors for BFV disease across Queensland. Empirical models were developed to forecast the future risk of BFV disease outbreaks in coastal Queensland using existing climatic, socio-economic and tidal conditions under climate change scenarios. Logistic regression models were developed using BFV disease outbreak data for the existing period (2000-2008). The most parsimonious model had high sensitivity, specificity and accuracy and this model was used to estimate and forecast BFV disease outbreaks for years 2025, 2050 and 2100 under climate change scenarios for Australia. Important contributions arising from this research are that: (i) it is innovative to identify high-risk coastal areas by creating buffers based on grid-centroid and the use of fine-grained spatial units, i.e., mesh blocks; (ii) a spatial regression method was used to account for spatial dependence and heterogeneity of data in the study area; (iii) it determined a range of potential spatial risk factors for BFV disease; and (iv) it predicted the future risk of BFV disease outbreaks under climate change scenarios in Queensland, Australia. In conclusion, the thesis demonstrates that the distribution of BFV disease exhibits a distinct spatial and temporal variation. Such variation is influenced by a range of spatial risk factors including climatic, demographic, socio-economic, ecological and tidal variables. The thesis demonstrates that spatial regression method can be applied to better understand the transmission dynamics of BFV disease and its risk factors. The research findings show that disease notification data can be integrated with multi-factorial risk factor data to develop build-up models and forecast future potential disease risks under climate change scenarios. This thesis may have implications in BFV disease control and prevention programs in Queensland.

The experiences of novices in an enhanced graduated driver licensing program in Queensland, Australia

- Young novice drivers - The Queensland graduated driver licensing (GDL) context - Pre-July 2007 (‘Original-GDL’) - Post-July 2007 (‘Enhanced-GDL’) - Experiences of Learners in Queensland’s enhanced-GDL program - Pre-/post-July 2007 comparison - Post-July 2007 only - Implications - Strengths and limitations

Inequities, alternatives and future directions : inside perspectives of Indigenous sentencing in Queensland

In Australia, sentencing researchers have generally focussed on whether there is statistical equality/inequality in outcomes by reference to Indigenous status. However, contextualising the sentencing process requires us to move away from a reliance on statistical analyses alone, as this approach cannot tell us whether sentencing is an equitable process for Indigenous people. Consultation with those working at the sentencing ‘coal face’ provides valuable insight into the nexus between Indigenous status and sentencing. This article reports the main themes from surveys of the judiciary and prosecutors, and focus groups of Community Justice Groups undertaken in Queensland. The aim is to understand better the sentencing process for Indigenous Queenslanders. Results suggest that while there have been some positive developments in sentencing (e.g. the Murri Court, Community Justice Groups) Indigenous offenders still face a number of inequities.

Regulation of land access for resource development: A coal seam gas case study from Queensland

A number of regulatory statutes provide for agreements with landowners which are given extended effect, that is, are binding upon the landowner’s successors (‘statutory agreements’). Several Queensland statutes require a project proponent to enter into a statutory agreement with a landowner before a resource development activity can be carried out on private land or by accessing private land. Provisions of Queensland’s Petroleum and Gas (Production and Safety) Act 2004 make certain types of statutory agreements binding upon successors and assigns of the landowner, but do not clearly prescribe the nature and contents of an agreement, nor require that the agreement be recorded on the land title or petroleum register. If statutory agreements are to be used for such purposes, their purpose and content should be more clearly defined by statute and they should be recorded on a searchable register.

Review: "Transfigured Stages : Major Practitioners and Theatre Aesthetics in Australia" by Margaret Hamilton

In Transfigured Stages: Major Practitioners and Theatre Aesthetics in Australia, Margaret Hamilton traces the emergence of a postdramatic performance aesthetic in Australian theatre in the 1980s, 1990s and early 2000s through what she characterizes as an ‘analysis’ (p. 15) or ‘critique’ (p. 16)of a series of pivotal productions. For Hamilton, the transfigured aesthetic in the spotlight here is one typified by a focus on memory, imagination, desire, fear or disgust as facets of the human condition; by a visual, televisual or interactive dramaturgy; and, most critically, by a metatheatrical tendency to make tensions in the theatre-making process part and parcel of the tensions in the performance itself (pp.18–20)...

Ageing out of place: health and well-being needs and access to home and aged care services for recently arrived older refugees in Melbourne, Australia

Recently arrived older refugees in resettlement countries are a particularly vulnerable population who face many risks to their health and well-being, and many challenges in accessing services.This paper reports on a project undertaken in Victoria,Australia to explore the needs of older people from 14 recently arrived refugee communities, and the barriers to their receiving health and aged care. Findings from consultations with community workers and service providers highlight the key issues of isolation, family conflict and mental illness affecting older refugees, and point to ways in which policy-makers and service providers can better respond to these small but deserving communities.

Meaning or measurement? Researching the social contexts of health and settlement among newly-arrived refugee youth in Melbourne, Australia

What are the most appropriate methodological approaches for researching the psychosocial determinants of health and wellbeing among young people from refugee backgrounds over the resettlement period? What kinds of research models can involve young people in meaningful reflections on their lives and futures while simultaneously yielding valid data to inform services and policy? This paper reports on the methods developed for a longitudinal study of health and wellbeing among young people from refugee backgrounds in Melbourne, Australia. The study involves 100 newly-arrived young people 12 to 18 years of age, and employs a combination of qualitative and quantitative methods implemented as a series of activities carried out by participants in personalized settlement journals. This paper highlights the need to think outside the box of traditional qualitative and/or quantitative approaches for social research into refugee youth health and illustrates how integrated approaches can produce information that is meaningful to policy makers, service providers and to the young people themselves.

Sources of hydrochemical variability and implications associated with CSG water extraction

Coal Seam Gas (CSG) production is achieved by extracting groundwater to depressurize coal seam aquifers in order to promote methane gas desorption from coal micropores. CSG waters are characteristically alkaline, have a neutral pH (~7), are of the Na-HCO3-Cl type, and exhibit brackish salinity. In 2004, a CSG exploration company carried out a gas flow test in an exploration well located in Maramarua (Waikato Region, New Zealand). This resulted in 33 water samples exhibiting noteworthy chemical variations induced by pumping. This research identifies the main causes of hydrochemical variations in CSG water, makes recommendations to manage this effect, and discusses potential environmental implications. Hydrochemical variations were studied using Factor Analysis and this was supported with hydrochemical modelling and a laboratory experiment. This reveals carbon dioxide (CO2) degassing as the principal source of hydrochemical variability (about 33%). Factor Analysis also shows that major ion variations could also reflect changes in hydrochemical composition induced by different pumping regimes. Subsequent chloride, calcium, and TDS variations could be a consequence of analytical errors potentially committed during laboratory determinations. CSG water chemical variations due to degassing during pumping can be minimized with good completion and production techniques; variations due to sample degassing can be controlled by taking precautions during sampling, transit, storage and analysis. In addition, the degassing effect observed in CSG waters can lead to an underestimation of their potential environmental effect. Calcium precipitation due to exposure to normal atmospheric pressure results in a 23% increase in SAR values from Maramarua CSG water samples.

Evaluation of implementation of a healthy food and drink supply strategy throughout the whole school environment in Queensland state schools, Australia

BACKGROUND/OBJECTIVES: This paper reports on the evaluation of the Smart Choices healthy food and drink supply strategy for Queensland schools (Smart Choices) implementation across the whole school environment in state government primary and secondary schools in Queensland, Australia. SUBJECTS/METHODS: Three concurrent surveys using different methods for each group of stakeholders that targeted all 1275 school Principals, all 1258 Parent and Citizens’ Associations (P&Cs) and a random sample of 526 tuckshop convenors throughout Queensland. Nine hundred and seventy-three Principals, 598 P&Cs and 513 tuckshop convenors participated with response rates of 78%, 48% and 98%, respectively. RESULTS: Nearly all Principals (97%), P&Cs (99%) and tuckshop convenors (97%) reported that their school tuckshop had implemented Smart Choices. The majority of Principals and P&Cs reported implementation, respectively, in: school breakfast programs (98 and 92%); vending machine stock (94 and 83%); vending machine advertising (85 and 84%); school events (87 and 88%); school sporting events (81 and 80%); sponsorship and advertising (93 and 84%); fundraising events (80 and 84%); and sporting clubs (73 and 75%). Implementation in curriculum activities, classroom rewards and class parties was reported, respectively, by 97%, 86% and 75% of Principals. Respondents also reported very high levels of understanding of Smart Choices and engagement of the school community. CONCLUSIONS: The results demonstrated that food supply interventions to promote nutrition across all domains of the school environment can be implemented successfully.

Legal issues related to Accountable-eHealth systems in Australia

Information privacy requirements of patients and information requirements of healthcare providers (HCP) are competing concerns. Reaching a balance between these requirements have proven difficult but is crucial for the success of eHealth systems. The traditional approaches to information management have been preventive measures which either allow or deny access to information. We believe that this approach is inappropriate for a domain such as healthcare. We contend that introducing information accountability (IA) to eHealth systems can reach the aforementioned balance without the need for rigid information control. IA is a fairly new concept to computer science, hence; there are no unambiguously accepted principles as yet. But the concept delivers promising advantages to information management in a robust manner. Accountable-eHealth (AeH) systems are eHealth systems which use IA principles as the measure for privacy and information management. AeH systems face three main impediments; technological, social and ethical and legal. In this paper, we present the AeH model and focus on the legal aspects of AeH systems in Australia. We investigate current legislation available in Australia regarding health information management and identify future legal requirements if AeH systems are to be implemented in Australia.