Using birthing kits to promote clean birth practices in Ethiopia

This article explores three NGO projects that assemble and distribute clean birthing kits in Ethiopia. It contrasts the government's health strategy that aims to increase skilled birth attendance, with local realities as most women in rural and remote settings give birth at home, often in unhygienic conditions, and without skilled assistance. Many health facilities are also unable to provide hygienic conditions for birthing women. The findings indicate that clean birth kits have assisted the NGOs to effectively promote clean delivery at home or in health facilities, and to encourage antenatal care, and early referral to emergency obstetric and new-born care.

The safety and effectiveness of different methods of ear wax removal: a systematic review and economic evaluation

Build-up of earwax is a common reason for attendance in primary care. Current practice for earwax removal generally involves the use of a softening agent, followed by irrigation of the ear if required. However, the safety and benefits of the different methods of removal are not known for certain.

Home delivery in Southern Lao PDR: challenges to achieving MDG 4 & 5 targets

This study investigated rural Lao PDR village women's views and experiences of recent, or impeding, childbirth to better understand barriers to maternity service usage. Lao PDR has the highest maternal mortality rate (MMR) in the South-East Asian region with very low utilization rates for skilled birth assistance and health sector delivery services. The study site, Sekong, a southern Lao province, was lowest in the country on virtually all indicators of reproductive and maternal health, despite several recent maternal health service interventions. The study's aim was to gain a fuller understanding of barriers to maternity services usage to contribute towards maternity services enhancement, and district and national policy-making for progressing towards 2015 MDG 4 & 5 targets. 

Process evaluation design and tools used in a kindergarten-based, family-involved intervention to prevent obesity in early childhood. The ToyBox-study

Process evaluation (PE) is used for the in-depth evaluation of the implementation process of health promotion programmes. The aim of the current paper was to present the PE design and tools used in the ToyBox-intervention. The PE design was based on a three-step approach, including the identification of ToyBox-specific PE elements (step 1), the development of PE tools and harmonization of procedures (step 2), and the implementation of PE using standardized protocol and tools across the intervention countries (step 3). Specifically, to evaluate the implementation of the intervention, teachers' monthly logbooks were recorded (dose delivered, fidelity, dose received); post-intervention questionnaires were completed by parents/caregivers and teachers (dose received); participation and attrition rates were recorded (recruitment, reach); and audit questionnaires and retrospective information on weather conditions were collected (physical and social environment within which the intervention was implemented). Regarding the teachers' training sessions, the researchers who performed the trainings completed evaluation forms and documented teachers' attendance after each training (dose delivered, fidelity, dose received) and teachers completed evaluation forms after each training (dose received). The PE performed in the ToyBox-intervention may contribute in the evaluation of its effectiveness, guide the revision of the intervention material and provide insights for future health promotion programmes and public health policy.

Responses of incubating hooded plovers (Thinornis rubricollis) to disturbance

Hooded Plovers (Thinornis rubricollis) and recreationists co-occur on the ocean beaches of southern Australia, and it has been suggested that disturbance of the breeding birds by humans constitutes a conservation problem. This study examines whether humans disturb incubating Hooded Plovers and places that disturbance in context with naturally occurring disturbances. Incubating Hooded Plovers encountered and responded to a variety of human and natural stimuli. The most common response involved leaving the nest for a period of time (an "absence"), and humans were responsible for 33.1% of time spent off nests. The response rates of incubating birds varied with the type of stimulus, with higher than expected response rates to two species of potentially predatory birds. About 17% of encounters with potential causes of disturbance occurred while birds were already responding to other disturbance, and this prolonged the return to the nest. Absences from the nest that were not apparently caused by disturbance were shorter and less frequent than those caused by external disturbance stimuli. Nest habitat influenced the response to encounters with humans, and on average foredune nests suffered the greatest decrease in attendance per encounter. This study has confirmed that human disturbance is more frequent than natural disturbances, and that humans decrease nest attendance substantially and more than any other source of disturbance.

Advance care planning for older people in Australia presenting to the emergency department from the community or residential aged care facilities

The purpose of this retrospective, cross-sectional study was to determine the prevalence of advance care planning (ACP) among older people presenting to an Emergency Department (ED) from the community or a residential aged care facility. The study sample comprised 300 older people (aged 65+ years) presenting to three Victorian EDs in 2011. A total of 150 patients transferred from residential aged care to ED were randomly selected and then matched to 150 people who lived in the community and attended the ED by age, gender, reason for ED attendance and triage category on arrival. Overall prevalence of ACP was 13.3% (n = 40/300); over one-quarter (26.6%, n = 40/150) of those presenting to the ED from residential aged care had a documented Advance Care Plan, compared to none (0%, n = 0/150) of the people from the community. There were no significant differences in the median ED length of stay, number of investigations and interventions undertaken in ED, time seen by a doctor or rate of hospital admission for those with an Advance Care Plan compared to those without. Those with a comorbidity of cerebrovascular disease or dementia and those assessed with impaired brain function were more likely to have a documented Advance Care Plan on arrival at ED. Length of hospital stay was shorter for those with an Advance Care Plan [median (IQR) = 3 days (2–6) vs. 6 days (2–10), P = 0.027] and readmission lower (0% vs. 13.7%). In conclusion, older people from the community transferred to ED were unlikely to have a documented Advance Care Plan. Those from residential aged care who were cognitively impaired more frequently had an Advance Care Plan. In the ED, decisions of care did not appear to be influenced by the presence or absence of Advance Care Plans, but length of hospital admission was shorter for those with an Advance Care Plan.

Formative feedback through summative tutorial-based assessments: the relationship to student performance

This paper investigates the effectiveness (measured using assignment and examination performance) of an assessment design incorporating formative feedback through summative tutorial-based assessments to improve student performance, in a second-year Finance course at an Australian university. Data was collected for students who were enrolled in an undergraduate Finance course and analyzed to ascertain performance improvements. The results indicate that there is a relationship between formative feedback through the use of summative tutorial-based assessments and student performance. Our empirical evidence enriches the extant literature surrounding the effectiveness of formative feedback through summative tutorial-based assessments and fosters an interest in assessment designs that provide formative feedback.

Review article: Emergency department data sharing to reduce alcohol-related violence: a systematic review of the feasibility and effectiveness of community-level interventions.

The present paper aims to review current evidence for the effectiveness and/or feasibility of using inter-agency data sharing of ED recorded assault information to direct interventions reducing alcohol-related or nightlife assaults, injury or violence. Potential data-sharing partners involve police, local council, liquor licensing regulators and venue management. A systematic review of the peer-reviewed literature was conducted. The initial search discovered 19,506 articles. After removal of duplicates and articles not meeting review criteria, n = 8 articles were included in quantitative and narrative synthesis. Seven of eight studies were conducted in UK EDs, with the remaining study presenting Australian data. All studies included in the review deemed data sharing a worthwhile pursuit. All studies attempting to measure intervention effectiveness reported substantial reductions of assaults and ED attendances post-intervention, with one reporting no change. Negative logistic feasibility concerns were minimal, with general consensus among authors being that data-sharing protocols and partnerships could be easily implemented into modern ED triage systems, with minimal cost, staff workload burden, impact to patient safety, service and anonymity, or risk of harm displacement to other licensed venues, or increase to length of patient stay. However, one study reported a potential harm displacement effect to streets surrounding intervention venues. In future, data-sharing systems should triangulate ED, police and ambulance data sources, and assess intervention effectiveness using randomised controlled trials that account for variations in venue capacity, fluctuations in ED attendance and population levels, seasonal variations in assault and injury, and control for concurrent interventions.

Social inclusion through cultural engagement among ethnic communities

This study analyzes arts attendance of six ethnic communities in Australia using social inclusion as a theoretical lens. Qualitative data from 20 interviews and 6 focus groups (N = 37) were examined. Respondents were from established (Italian, Greek), moderately established (Chinese, Vietnamese, Indian), and newly settled (African) communities. Four themes were identified that are linked to social inclusion: (a) social connectedness; (b) link with home culture; (c) link with host and other cultures; and (d) inclusive initiatives. All ethnic participants shared views on social connectedness; Vietnamese, Chinese, and Indian participants expressed a strong need to maintain links with their home culture and develop links with the host culture. Italian and Greek respondents focused on developing links with host and other cultures. African respondents wished to maintain home country links. The study advances arts marketing literature and cross-cultural marketing initiatives using a social inclusion lens to explain arts attendance by ethnic communities.

Teeth Tales: a community-based child oral health promotion trial with migrant families in Australia

OBJECTIVES: The Teeth Tales trial aimed to establish a model for child oral health promotion for culturally diverse communities in Australia. DESIGN: An exploratory trial implementing a community-based child oral health promotion intervention for Australian families from migrant backgrounds. Mixed method, longitudinal evaluation. SETTING: The intervention was based in Moreland, a culturally diverse locality in Melbourne, Australia. PARTICIPANTS: Families with 1-4-year-old children, self-identified as being from Iraqi, Lebanese or Pakistani backgrounds residing in Melbourne. Participants residing close to the intervention site were allocated to intervention. INTERVENTION: The intervention was conducted over 5 months and comprised community oral health education sessions led by peer educators and follow-up health messages. OUTCOME MEASURES: This paper reports on the intervention impacts, process evaluation and descriptive analysis of health, knowledge and behavioural changes 18 months after baseline data collection. RESULTS: Significant differences in the Debris Index (OR=0.44 (0.22 to 0.88)) and the Modified Gingival Index (OR=0.34 (0.19 to 0.61)) indicated increased tooth brushing and/or improved toothbrushing technique in the intervention group. An increased proportion of intervention parents, compared to those in the comparison group reported that they had been shown how to brush their child's teeth (OR=2.65 (1.49 to 4.69)). Process evaluation results highlighted the problems with recruitment and retention of the study sample (275 complete case families). The child dental screening encouraged involvement in the study, as did linking attendance with other community/cultural activities. CONCLUSIONS: The Teeth Tales intervention was promising in terms of improving oral hygiene and parent knowledge of tooth brushing technique. Adaptations to delivery of the intervention are required to increase uptake and likely impact. A future cluster randomised controlled trial would provide strongest evidence of effectiveness if appropriate to the community, cultural and economic context. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (ACTRN12611000532909).

Spirituality, religion, social support and health among older Australian adults

AIM: To examine the impact of perceived importance of spirituality or religion (ISR) and religious service attendance (RSA) on health and well-being in older Australians. METHODS: A cross-sectional survey of 752 community-dwelling men and women aged 55-85 years from the Hunter Region, New South Wales. RESULTS: Overall, 51% of participants felt spirituality or religion was important in their lives and 24% attended religious services at least 2-3 times a month. In univariate regression analyses, ISR and RSA were associated with increased levels of social support (P < 0.001). However, ISR was also associated with more comorbidities (incidence-rate ratio= 1.2, 95% confidence interval 1.08-1.33). There were no statistically significant associations between ISR or RSA and other measures such as mental and physical health. CONCLUSION: Spirituality and religious involvement have a beneficial impact on older Australians' perceptions of social support, and may enable individuals to better cope with the presence of multiple comorbidities later in life.

Young people's perceptions of the risks of methamphetamine use in Adelaide nightclubs: a quantitative study

Understanding young people’s perceptions of the risks associated with the use of methamphetamines is an important but under-researched area. Precisely how these young people use the space of Adelaide nightclubs, perceive such drug risks, employ risk management strategies and how these factors interact to influence their experience of methamphetamines in the nightclub is largely unknown. This article presents self-report data drawn from a sample of 457 young people who completed the Perception of Risk survey questionnaire while waiting to enter one of five key Adelaide nightclubs in 2010. Participants were examined in terms of gender, age, drug use history, motivations for nightclub attendance and frequency of nightclub attendance. Approximately one-fifth of the sample reported using methamphetamines (21.0 percent).Participants demonstrated a pattern of attendance at Adelaide nightclubs that reflects a broader understanding of the important role of the nightclub in their social lives, which for some also involves the use of methamphetamines. Specifically, participants’ motivations for ‘nightclubbing’ concern the consumption of leisure and are guided by social group membership, in which methamphetamine use is not prioritised, as evident in the development of knowledge and risk management strategies to ensure safe consumption in the club. Perceptions of risk reflect concern surrounding unregulated methamphetamine use, as well as gendered concerns linked to safety and the prevalence of alcohol misuse, violence, drink spiking, physical injury and sexual assault. These findings were consistent across the sample, suggesting a shift in youth nightclub culture that has numerous implications for understanding and reducing the use of methamphetamines and regulation of the night-time economy generally, which are discussed herein.