Closure of the Challinor Centre II: An extended report on 95 individuals after 12 months of community living

As part of an institutional closure programme, 95 individuals with an intellectual disability were relocated to community-based group homes. Each individual was assessed 6 months prior to the relocation and then again after 1, 6, and 12 months of community living. Assessments involved ratings of adaptive and maladaptive behaviour, choice-making, and life circumstances. The group means comparing institution to community ratings showed improvements in adaptive functioning but no significant change in maladaptive behaviour. There were also improvements in life circumstances and increased opportunities for choice-making following relocation to the community. These outcomes suggest that relocation to the community was associated with a more active and normalised lifestyle than experienced in the institutional setting.

Communicating with the community about grieving: A description and review of the foundations of a broken leg analogy of grieving

With loss permeating the lives of all people throughout the entire life span and its potential for serious long-term deleterious effects, providing effective care for those experiencing situations of loss would be an important element of any preventive community-based mental health promotion approach. The low use of mental health services by those confronted with loss, and the lack of such services in many areas, makes it imperative to enhance the competency of the broader community to provide appropriate care during times of loss. Contributory to such care is a sound knowledge of the literature concerning loss and grieving. The broken leg analogy of grief presented in this article integrates the traditional and emerging grief theories and empirical evidence into an analogy of grieving that can be easily communicated to the general community, is relevant to many losses. and vet upholds the differing positions concerning grieving held by various schools of psychiatric thought.

Managing strategic challenges in community sector organisations

Like those in other sectors, managers in community-based organisations face an uncertain and challenging future. Research and writing about the community sector (non-government, notjor-profit, or third seclOr) has canvassed a wide range of issues. A selective review of the recent literature reveals the breadth of research interest in the challenges facing community sector managers. While some reflection on the implications for managers of current economic and social policy contexts is crucial for this sector, research effort needs to be focused on understanding how third sector managers construe their current strategic challenges and the strategies they use to address them A small sample ofmanagers working in a regional area in South East Queensland was asked to identify current strategic concerns related to the future viability of their organisations. The key issues raised by managers are compared with the issues raised in the research literature. Results -to date indicate that managers' concerns are reflected in the research literature, but that managers are also concemed about the current trends in social policy towards collaboration, amalgamation, and pannership. Implications of these findings for managers operating in this sector are discussed.

Perceived social support in a large community sample - Age and sex differences

Background. The positive health and wellbeing effects of social support have been consistently demonstrated in the literature since the late 1970s. However, a better understanding of the effects of age and sex is required. Method. We examined the factor structure and reliability of Kessler's Perceived Social Support (KPSS) measure in a community-based sample that comprised younger and older adult cohorts from the Australian Twin Registry (ATR), totalling 11,389 males and females aged 18-95, of whom 887 were retested 25 months later. Results. Factor analysis consistently identified seven factors: support from spouse, twin, children, parents, relatives, friends and helping support. Internal reliability for the seven dimensions ranged from 0.87 to 0.71 and test-retest reliability ranged from 0.75 to 0.48. Perceived support was only marginally higher in females. Age dependencies were explored. Across the age range, there was a slight decline (more marked in females) in the perceived support from spouse, parent and friend, a slight increase in perceived relative and helping support for males but none for females, a substantial increase in the perceived support from children for males and females and a negligible decline in total KPSS for females against a negligible increase for males. The perceived support from twin remained constant. Females were more likely to have a confidant, although this declined with age whilst increasing with age for males. Conclusions. Total scores for perceived social support conflate heterogeneous patterns on sub-scales that differ markedly by age and sex. Our paper describes these relationships in detail in a very large Australian sample.

The performance of community organisers in promotion of community forestry in Leyte Province, Phillipines

A study was conducted to assess the role and effectiveness of community organisers in supporting the development of people’s organisations in achieving community-based forest management objectives in Leyte Province Philippines. Community organisers were found to be effective in forming people’s organisations (POs), motivating people to participate in voluntary activities organised by POs and encouraging cohesiveness among PO members. Community organisers manage to raise the level of environmental awareness and knowledge of members of people’s organisations, develop leadership interest and skills, create various livelihood opportunities and provide direction and facilitate the establishment of large tree plantations. However, the short duration of community organisers’ contracts (typically two years) is insufficient to establish mature and cohesive POs prepared to assume management on their own, including the management of tree plantations. Further, lack of training and funding support, low wages, delayed payment of salaries and limited time to work with people’s organisations, as well as the pressure to produce tangible outputs such the establishment of large tree plantations, prevents them from placing greater emphasis on the development and empowerment of the people.

Exploring the feasibility and acceptability of using internet technology to promote physical activity within a defined community

ISSUE ADDRESSED: To explore the feasibility of using the Internet and e-mail to promote physical activity in a defined community. METHODS: An online survey was conducted through a community-based Internet Service Provider (ISP). ISP clients were recruited via electronic newsletter and direct e-mail. Data were collected on preferred sources of assistance for physical activity advice and stage of motivational readiness for physical activity. RESULTS: Valid surveys were completed by 797 (9% response rate). Participants were: 55% men; 56% aged >45 years; 57% worked full time; mean BMI was 28+/-8. Thirty-six per cent were in the early stages of motivational readiness for physical activity. More than 70% were somewhat to extremely interested in having access to a physical activity website. CONCLUSION: Promoting physical activity via the Internet and e-mail is feasible and appealing to some people. Expanding the reach, appeal and use of this technology to deliver physical activity programs will be a challenge.

Health-protective behaviours and risk of fall-related hip fractures: a population-based case-control study

Background: fall-related hip fractures are one of the most common causes of disability and mortality in older age. The study aimed to quantify the relationship between lifestyle behaviours and the risk of fall-related hip fracture in community-dwelling older people. The purpose was to contribute evidence for the promotion of healthy ageing as a population-based intervention for falls injury prevention. Methods: a case-control study was conducted with 387 participants, with a case-control ratio of 1:2. Incident cases of fall-related hip fracture in people aged 65 and over were recruited from six hospital sites in Brisbane, Australia, in 2003-04. Community-based controls, matched by age, sex and postcode, were recruited via electoral roll sampling. A questionnaire designed to assess lifestyle risk factors, identified as determinants of healthy ageing, was administered at face-to-face interviews. Results: behavioural factors which had a significant independent protective effect on the risk of hip fracture included never smoking [adjusted odds ratio (AOR): 0.33 (0.12-0.88)], moderate alcohol consumption in mid- and older age [AOR: 0.49 (0.25-0.95)], not losing weight between mid- and older age [AOR: 0.36 (0.20-0.65)], playing sport in older age [AOR: 0.49 (0.29-0.83)] and practising a greater number of preventive medical care [AOR: 0.54 (0.32-0.94)] and self-health behaviours [AOR: 0.56 (0.33-0.94)]. Conclusion: with universal exposures, clear associations and modifiable behavioural factors, this study has contributed evidence to reduce the major public health burden of fall-related hip fractures using readily implemented population-based healthy ageing strategies.

10,000 Steps Rockhampton: A Whole Community Approach to Increasing Levels of Physical Activity

10,000 Steps Rockhampton is a multi-strategy health promotion program which aims to develop sustainable community-based strategies to increase physical activity.The central coordinating focus of the project is the use of pedometers to raise awareness of and provide motivation for physical activity, around the theme of '10,000 steps/day - Every step counts.' To date, five key strategies have been implemented: (1) a media-based awareness raising campaign; (2) promotion of physical activity by health professionals; (3) improving social support for physical activity through group-based programs; (4) working with local council to improve environmental support for physical activity; and (5) establishment of a ‘micro-grants’ fund to which community groups could apply for assistance with small, innovative physical activity enhancing projects. Strategies were introduced on a rolling basis beginning in February 2002 with 'layering' of interventions designed to address the multi-level individual social and environmental determinants of physical activity. The project was quasi-experimental in design, involving collection of baseline and two year follow-up data from community based surveys in Rockhampton and in a matched regional Queensland town. In August 2001,the baseline CATI survey (N=1281)found that 47.9% of men and 33.0% of women were meeting the national guidelines for physical activity. In August 2002, a smaller survey (N=400) found an increase in activity levels among women (39.7% active) but not in men (48.5%). Data from the two year follow up survey, to be conducted in August 2003, will be presented, with discussion of the major successes and challenges of this landmark physical activity intervention. Acknowledgement: This project is supported by a grant from Health Promotion Queensland

Building Community Coalitions for the Promotion of Physical Activity: 10,000 Steps Rockhampton

The 10,000 Steps Rockhampton project is a multi-strategy community-wide, physical activity intervention based on the simultaneous implementation of five strategies, each identified as 'best practice' for the promotion of physical activity. Several community partners were engaged to develop and implement the strategies during the first eighteen months of the project. These included: the local media (TV, newspaper and radio); the local Division of General Practice and other health professional groups; the Heart Foundation and ‘Just Walk It’; the local council; and several large worksites. A local physical activity task force was also formed to administer a 'micro-grants' scheme, and to guide the development of community based strategies. The presentation will focus on the critical elements involved in developing and maintaining relationships with community partners. These include identification and ‘courting’ of potential partners, strategies for keeping them engaged, and the challenges of maintaining the balance between ‘top-down’ (evidence-based) and ‘bottom-up’ (community-driven) strategies. Data on implementation and uptake of the key strategies will also be presented. These include: 1) process data on the number of health

Sudden death in psychiatric patients

Background The present study investigated histories of prior psychiatric treatment in cases of sudden death reported to the coroner Methods A matching survey linked the register of deaths reported to the coroner with a comprehensive statewide psychiatric case register covering both inpatient and community-based services. Results Sudden death was five times higher in people with histories of psychiatric contact. Suicide accounted for part of this excess mortality but deaths from natural causes and accidents were also elevated. Schizophrenic and affective disorders had similar suicide rates. Comorbid substance misuse doubled the risk of sudden death in affective and schizophrenic disorders. Conclusions The rates of sudden death are sufficiently elevated to raise questions about current priorities in mental health care. There is a need both for greater attention to suicide risk, most notably among young people with schizophrenia, to the early detection of cardiovascular disorders and to the vigorous management of comorbid substance misuse.

Methadone maintenance treatment reduces heroin injection in New South Wales prisons

The purpose of this study was to examine whether methadone maintenance treatment reduces injecting risk behaviour land therefore transmission of blood-borne viral infections) among prisoners in New South Wales (NSW), using comparison of retrospective reports of drug use in prisons for people who received standard drug treatment, time-limited methadone treatment and methadone maintenance treatment, The setting for the study was the NSW prison system. One hundred and eighty-five injecting drug users who had been recently released from NSW prisons were recruited in 1993, Self-reported drug use and injecting risk behaviour were compared in inmates who received standard drug treatment (counselling), time-limited methadone treatment and methadone maintenance treatment. HIV status was determined by serology, Intervention comprised high and low dose methadone treatment and counselling. The groups were similar in terms of most basic demographic characteristics but subjects who had been maintained on methadone reported a significantly lower prevalence of heroin injection, syringe sharing and scored lower on an HIV Risk-taking Behavioural Scale than subjects who received standard drug treatment and time-limited methadone treatment, This study suggests that methadone treatment is associated with reduced injecting risk behaviour in prison with adequate (greater than 60 mg) dose and duration in treatment. These treatment conditions are known to increase effectiveness in community-based methadone programmes. Prospective studies are required to evaluate the effectiveness of methadone programmes in the prevention of HIV and other blood-borne viral infections among IDU prisoners.

Suicide and recency of health care contacts - A systematic review

Background Many countries have set targets for suicide reduction, and suggested that mental health care providers and general practitioners have a key role to play. Method Asystematic review of the literature. Results Among those in the general population who commit suicide, up to 41% may have contact with psychiatric inpatient care in the year prior to death and up-to 9% may commit suicide within one day of discharge. The corresponding figures are I I and 4% for community-based psychiatric care and 83 and 20% for general practitioners. Conclusions Among those who die by suicide. contact with health services is common before death. This is a necessary but not sufficient condition for clinicians to intervene. More work is needed to determine whether these people show characteristic patterns of care and/or particular risk factors which would enable a targeted approach to be developed to assist clinicians in detecting and managing high-risk patients.

Changes in cigarette smoking among adults in 35 populations in the mid-1980s

Objective-To examine changes in the prevalence of cigarette smoking in 35 study populations of the World Health Organisation's MONICA Project. Design-Data from two independent, community-based surveys conducted, on average, five years apart. Setting-Geographically defined populations in 21 countries mainly in eastern and western Europe. Subjects-Randomly selected men and women aged 25-64 years. Numbers of participants in each study population ranged from 586 to 2817 in each survey. Main outcome measures-Changes in proportions of current smokers, ex-smokers, and never-smokers by age and sex using data collected by standardised methods. Results-Among men, smoking prevalence decreased in most populations, by three to four percentage points over five years. In Beijing, however, it increased in all age groups-overall by 11 percentage points. Among women there were increases in smoking in about half the populations. The increases were mainly in the age group 35-54 years and often in those populations where smoking prevalence among women has been relatively low. Conclusions-Smoking initiation by middle-aged women in parts of southern and eastern Europe and among men of all ages in Beijing is a matter of concern. The various public health measures that have helped to reduce smoking among men in developed countries should be vigorously extended to these other groups now at growing risk of smoking-related disease.