Barriers to and facilitators of cervical screening practice among African immigrant women from refugee and non-refugee backgrounds living in Brisbane

This thesis investigated and compared barriers and facilitators of cervical screening among African-born refugee and non-refugee women living in Brisbane. Refugee women were more likely to have limited or no knowledge about cervical cancer and the screening test and also less likely to use Pap smear services than non-refugee women. The analysis identified belief systems, lack of knowledge about cervical cancer and screening practices, and lack of culturally appropriate screening programs as major barriers. In the context of health promotion interventions, these findings will contribute to addressing major differential screening needs among African immigrant refugee and non-refugee women.

Spirituality in Indian University students and its associations with socioeconomic status, religious background, social support, and mental health

The present study aimed to understand spirituality and its relationships with socioeconomic status (SES), religious background, social support, and mental health among Indian university students. It was hypothesized that: - (1) female university students will be more spiritual than male university students, - (2) four domains of spirituality will differ significantly across socioeconomic and religious background of the university students in addition to social support, and; - (3) there will be a positive relationship between spirituality and mental health of university students, irrespective of gender. A group of 475 postgraduate students aged 20–27 years, 241 males and 234 females, from various disciplines of Pondicherry University, India, participated in the study. Students’ background was collected using a structured questionnaire. Overall spirituality and its four dimensions were measured using the Spirituality Attitude Inventory, while mental health status was estimated based on scores of the psychological subscale of the WHO Quality of Life Questionnaire. Female students were significantly more spiritual than male students, particularly in spiritual practice and sense of purpose/connection. Hindu religion and lower family income were associated with lower spirituality. Higher spirituality was associated with congenial family environment and more support from teachers and classmates. There was a strong association between overall spirituality and two spirituality domains (spiritual belief and sense of purpose/connection) with better mental health. Findings suggest an opportunity for open dialogue on spirituality for university students as part of their mental health and support services that fosters a positive mind set and enhancement of resilience.

Social determinants of health and diabetic foot disease

Background Diabetic foot disease (DFD) is the leading cause of hospitalisation and lower extremity amputation (LEA) in people with diabetes. Many studies have established the relationship between DFD and clinical risk factors, such as peripheral neuropathy and peripheral arterial disease. Other studies have identified the relationship between diabetes and non-clinical risk factors termed social determinants of health (SDoH), such as socioeconomic status. However, it appears very few studies have investigated the relationship between DFD and SDoH. This paper aims to review the existing literature investigating the relationship between DFD and the SDoH factors socioeconomic status (SES), race and geographical remoteness (remoteness). Process Electronic databases (MEDLINE, CINAHL, and PubMed) were searched for studies reporting SES, race (including Aboriginal and Torres Strait Islander in Australia) and remoteness and their relationship to DFD and LEA. Exclusion criteria were studies conducted in developing countries and studies published prior to 2000. Findings Forty-eight studies met the inclusion criteria and were reviewed; 10 in Australia. Overall, 28 (58%) studies investigated LEA, 10 (21%) DFD, and 10 (21%) DFD and LEA as the DFD-related outcome. Thirty-six (75%) studies investigated the SDoH risk factor of race, 22 (46%) SES, and 20 (42%) remoteness. SES, race and remoteness were found to be individually associated with LEA and DFD in the majority of studies. Only four studies investigated interactions between SES, race and remoteness and DFD with contrasting findings. All four studies used only LEA as their investigated outcome. No Australian studies investigate the interaction of all three SDoH risk factors on DFD outcomes. Conclusions The SDoH risk factors of SES, race and GR appear to be individually associated with DFD. However, only few studies investigated the interaction of these three major SDoH risk factors and DFD outcomes with contrasting results. There is a clear gap in this area of DFD research and particularly in Australia. Until urgent future research is performed, current practice and policy does not adequately take into consideration the implication of SDoH on DFD.

Evidence-based practice

This chapter traces the history of evidence-based practice (EBP) from its roots in evidence-based medicine to contemporary thinking about its usefulness to public health practice. It defines EBP and differentiates it from ‘evidence-based medicine’, ‘evidence-based policy’ and ‘evidence-based healthcare’. As it is important to understand the subjective nature of knowledge and the research process, this chapter describes the nature and production of knowledge. This chapter considers the necessary skills for EBP, and the processes of attaining the necessary evidence. We examine the barriers and facilitators to identifying and implementing ‘best practice’, and when EBP is appropriate to use. There is a discussion about the limitations of EBP and the use of other information sources to guide practice, and concluding information about the application of evidence to guide policy and practice.

Futility and the law: Knowledge, practice and attitudes of doctors in end of life care

Despite the potential harm to patients (and others) and the financial cost of providing futile treatment at the end of life, this practice occurs. This article reports on empirical research undertaken in Queensland that explores doctors’ perceptions about the law that governs futile treatment at the end of life, and the role it plays in medical practice. The findings reveal that doctors have poor knowledge of their legal obligations and powers when making decisions about withholding or withdrawing futile treatment at the end of life; their attitudes towards the law were largely negative; and the law affected their clinical practice and had or would cause them to provide futile treatment.

Preparing health science students for interdisciplinary professional practice

In 2002, a number of lecturers from different clinical schools within the Faculty of Health Sciences at La Trobe University embarked on the development of a new interdisciplinary professional practice subject to be undertaken by all final-year undergraduate health science students. The subject was designed to better prepare students for their first professional appointment by introducing them to the concepts of interdisciplinary teamwork, the health care context, and the challenges and constraints that organizational contexts present. This report details the background of the project, the consultation and development that took place in the design of the subject, and implementation of the subject. The uniqueness of the project is explained by the number of disciplines involved, the online delivery, and the focus on a set of generic graduate attributes for health science students. It is hoped that students who have undertaken this subject will have a better understanding of the roles of other health professionals and the context in which they will be working by grappling with many real-life professional issues that they will face when they graduate and enter the workforce.

Does psychological stress mediate social deprivation in tooth loss?

It is unclear which theoretical dimension of psychological stress affects health status. We hypothesized that both distress and coping mediate the relationship between socio-economic position and tooth loss. Cross-sectional data from 2915 middle-aged adults evaluated retention of < 20 teeth, behaviors, psychological stress, and sociodemographic characteristics. Principal components analysis of the Perceived Stress Scale (PSS) extracted 'distress' (a = 0.85) and 'coping' (a =0.83) factors, consistent with theory. Hierarchical entry of explanatory variables into age- and sex-adjusted logistic regression models estimated odds ratios (OR) and 95% confidence intervals [95% CI] for retention of < 20 teeth. Analysis of the separate contributions of distress and coping revealed a significant main effect of coping (OR = 0.7 [95% CI = 0.7-0.8]), but no effect for distress (OR = 1.0 [95% CI = 0.9-1.1]) or for the interaction of coping and distress. Behavior and psychological stress only modestly attenuated socio-economic inequality in retention of < 20 teeth, providing evidence to support a mediating role of coping.

Exploratory spatial analysis of social and environmental factors associated with the incidence of Ross River Virus in Brisbane, Australia

We used geographic information systems and a spatial analysis approach to explore the pattern of Ross River virus (RRV) incidence in Brisbane, Australia. Climate, vegetation and socioeconomic data in 2001 were obtained from the Australian Bureau of Meteorology, the Brisbane City Council and the Australian Bureau of Statistics, respectively. Information on the RRV cases was obtained from the Queensland Department of Health. Spatial and multiple negative binomial regression models were used to identify the socioeconomic and environmental determinants of RRV transmission. The results show that RRV activity was primarily concentrated in the northeastern, northwestern, and southeastern regions in Brisbane. Multiple negative binomial regression models showed that the spatial pattern of RRV disease in Brisbane seemed to be determined by a combination of local ecologic, socioeconomic, and environmental factors.

Relationships between employees and their nomadic, non-territorial work environment

Recent and current socio-cultural trends are significant factors impacting on how business is conduced and correspondingly, on how work environments are designed. New communication technology is helping to break physical boundaries and change the way and speed of conducting business. One of the main characteristics of these new workplaces is non-permanency wherein the individual employee has no dedicated personally assigned office, work station, or desk. In this non-territorial, nomadic situation, employees undertake their work tasks in a wide variety of work settings inside and outside the office building. Such environments are understood to be must suitable where there is the need for high interaction with others as well as a high level of concentrated, independent work. This thesis reports on a project designed to develop a deeper understanding of the relationships between people (P) and their built environment (E) in the context of everyday work practice in a nomadic and non-territorial work environment. To achieve this, the study focuses on the experiences of employees as they understand them in relation to their work and the designed/ physical work environment. In this sense, the study is qualitative and grounded in nature. It does not assume any previously established theory nor test any presenting hypothesis. Instead it interviews the participants about their situations at work in their workplace, interprets natural interaction and creates a foundation for the development of theory informing workplace design, particularly theory that recognises the human nature of work and the need, as highlighted by several seminal researchers, for a greater understanding of how people manage and adapt in dynamic work environments.

Educating the public health workforce : issues and challenges

Background: In public health, as well as other health education contexts, there is increasing recognition of the transformation in public health practice and the necessity for educational providers to keep pace. Traditionally, public health education has been at the postgraduate level; however, over the past decade an upsurge in the growth of undergraduate public health degrees has taken place. Discussion: This article explores the impact of these changes on the traditional sphere of Master of Public Health programs, the range of competencies required at undergraduate and postgraduate levels, and the relevance of these changes to the public health workforce. It raises questions about the complexity of educational issues facing tertiary institutions and discusses the implications of these issues on undergraduate and postgraduate programs in public health. Conclusion: The planning and provisioning of education in public health must differentiate between the requirements of undergraduate and postgraduate students – while also addressing the changing needs of the health workforce. Within Australia, although significant research has been undertaken regarding the competencies required by postgraduate public health students, the approach is still somewhat piecemeal, and does not address undergraduate public health. This paper argues for a consistent approach to competencies that describe and differentiate entry-level and advanced practice.

Introduction to Public Health

"An Introduction to Public Health is about the discipline of public health and the nature and scope of public health activity set within the challenges of the twenty first century. It is an introductory text to the principles and practice of public health written in a way that is easy to understand. Of what relevance is public health to the many allied health disciplines who contribute to it? How might an understanding of public health contribute to a range of health professionals who use the principles and practices of public health in their professional activities? These are the questions that this book addresses. An Introduction to Public Health leads the reader on a journey of discovery that concludes with not only an understanding of the nature and scope of public health but the challenges that face the field into the future." Provided by publisher.

Social justice and high-quality human services : visioning the place of a contemporary professional association

The current world situation is plagued by “wicked problems” and a widespread sense of “things are going to get worse”. We confront the almost imponderable consequences of global habitat destruction and climate change, as well as the meltdown of the financial markets with their largely yet to be seen damage to the “real economy”. These things will have considerable negative impacts on the social system and people's lives, particularly the disadvantaged and socially excluded, and require innovative policy and program responses delivered by caring, intelligent, and committed practitioners. These gargantuan issues put into perspective the difficulties that confront social, welfare, and community work today. Yet, in times of trouble, social work and human services tend to do well. For example, although Australian Social Workers and Welfare and Community Workers have experienced phenomenal job growth over the past 5 years, they also have good prospects for future growth and above average salaries in the seventh and sixth deciles, respectively (Department of Education, Employment and Workplace Relations, 2008). I aim to examine the host of reasons why the pursuit of social justice and high-quality human services is difficult to attain in today's world and then consider how the broadly defined profession of social welfare practitioners may collectively take action to (a) respond in ways that reassert our role in compassionately assisting the downtrodden and (b) reclaim the capacity to be a significant body of professional expertise driving social policy and programs. For too long social work has responded to the wider factors it confronts through a combination of ignoring them, critiquing from a distance, and concentrating on the job at hand and our day-to-day responsibilities. Unfortunately, “holding the line” has proved futile and, little by little, the broad social mandate and role of social welfare has altered until, currently, most social programs entail significant social surveillance of troublesome or dangerous groups, rather than assistance. At times it almost seems like the word “help” has been lost in the political and managerial lexicon, replaced by “manage” and “control”. Our values, beliefs, and ethics are under real threat as guiding principles for social programs.

Health professional partnerships and their impact on Aboriginal health : an occupational therapist's and Aboriginal health worker's perspective

Objective: To describe the extent and nature of demonstrated professional partnerships between occupational therapists and Aboriginal health workers in rural and remote communities of North Queensland. The study identifies ways in which professional partnerships improve client services and enhance occupational therapy outcomes through exploring the aspects of communication, collaboration and bridging cultural boundaries.---------- Design: Data collected via in-depth, semistructured telephone interviews. ---------- Setting: Aboriginal and mainstream health and human service organisations in rural and remote North Queensland. Rural and remote areas were identified using the Accessibility and Remoteness Index of Australia codes. ---------- Participants: Seven participants working in rural and remote areas of North Queensland, comprising four occupational therapists and three Aboriginal health workers. All participants were female. ---------- Results: Participants identified five core themes when describing the extent and nature of professional partnerships between occupational therapists and Aboriginal health workers. Themes include: professional interaction; perception of professional roles; benefits to the client; professional interdependence; and significance of Aboriginal culture. According to participants, when partnerships between occupational therapists and Aboriginal health workers were formed, clients received a more culturally appropriate service, were more comfortable in the presence of the occupational therapist, obtained a greater understanding of occupational therapy assessment and intervention, and felt valued in the health care process. ---------- Conclusions: This study substantiates the necessity for the formation of professional partnerships between occupational therapists and Aboriginal health workers. The findings suggest that participation in professional partnerships has positive implications for occupational therapists working with Aboriginal clients and Aboriginal health workers in rural and remote regions of North Queensland.

The reliability of information on work-related injuries available from hospitalisation data in Australia

Objective: To examine the reliability of work-related activity coding for injury-related hospitalisations in Australia. Method: A random sample of 4373 injury-related hospital separations from 1 July 2002 to 30 June 2004 were obtained from a stratified random sample of 50 hospitals across 4 states in Australia. From this sample, cases were identified as work-related if they contained an ICD-10-AM work-related activity code (U73) allocated by either: (i) the original coder; (ii) an independent auditor, blinded to the original code; or (iii) a research assistant, blinded to both the original and auditor codes, who reviewed narrative text extracted from the medical record. The concordance of activity coding and number of cases identified as work-related using each method were compared. Results: Of the 4373 cases sampled, 318 cases were identified as being work-related using any of the three methods for identification. The original coder identified 217 and the auditor identified 266 work-related cases (68.2% and 83.6% of the total cases identified, respectively). Around 10% of cases were only identified through the text description review. The original coder and auditor agreed on the assignment of work-relatedness for 68.9% of cases. Conclusions and Implications: The current best estimates of the frequency of hospital admissions for occupational injury underestimate the burden by around 32%. This is a substantial underestimate that has major implications for public policy, and highlights the need for further work on improving the quality and completeness of routine, administrative data sources for a more complete identification of work-related injuries.