Converting potential organ donors : a situational analysis of Australian physicians

This theory-building research suggests that the key to unlocking Australia's potential organ donor pool is to reduce the ethical ambiguity and legal uncertainty plaguing physicians' interepretation of the patients's best interests standard. This may generate a greater acceptance of organ donation as part of end-of-life patient care amongst our physicians.

Delayed allegations of sexual abuse, complainant credibility and juror verdict

This study investigated laypersons' perceptions of memory evidence in a mock childhood sexual abuse trial. Results indicated that delay, memory type (continuous vs. recovered) and the nature of the alleged sexual assault (penetrative vs. fondling) influenced both how witnesses were perceived and the outcome of the trial.

Physical activity, sedentary behaviour and depression among socio-economically disadvantaged women

Promoting physical activity, particularly for leisure and transport, could be an important aspect in preventing depression amongst women living in disadvantaged neighbourhoods. Furthermore, including some aspect of social physical activity and reducing time spent in sedentary behaviours may further reduce risk of depression.

Child maltreatment in stepfamilies : the impact of mother's dating behaviour

This thesis explored the relative utility of evolutionary and ecological theories to understand under which conditions children in non-biological families are most at risk of childmaltreatment.  The study revealed that single-mothers have complex needs and stressors, which may increase their vulnerability and impact on decisions made in selection of partners.

Association between sexual behavior and cervical cancer screening

Background: Not much is known about whether women who follow Pap testing recommendations report the same pattern of sexual behavior as women who do not.
Methods: Data come from part of a larger population-based computer-assisted telephone survey of 8656 Australians aged 16–64 years resident in Australian households with a fixed telephone line (Australian Longitudinal Study of Health and Relationships [ALSHR]). The main outcome measure in the current study was having had a Pap test in the past 2 years.
Results: Data on a weighted sample of 4052 women who reported sexual experience (ever had vaginal intercourse) were analyzed. Overall, 73% of women in the sample reported having a Pap test in the past 2 years. Variables individually associated with Pap testing behavior included age, education, occupation, cohabitation status, residential location, tobacco and alcohol use, body mass index (BMI), lifetime and recent number of opposite sex partners, sexually transmitted infection (STI) history, and condom reliance for contraception. In adjusted analyses, women in their 30s, those who lived with their partner, and nonsmokers were more likely to have had a recent Pap test. Those who drank alcohol at least weekly were more likely to have had a recent test than irregular drinkers or nondrinkers. Women with no sexual partners in the last year were less likely to have had a Pap test, and women who reported a previous STI diagnosis were more likely to have had a Pap test in the past 2 years.
Conclusions: There are differences in Pap testing behavior among Australian women related to factors that may affect their risk of developing cervical abnormalities. Younger women and regular smokers were less likely to report a recent test. Screening programs should consider the need to focus recruitment strategies for these women.

Health satisfaction and perceived control : investigating subjective wellbeing homeostasis

Through an investigation of relationships between subjective wellbeing, health satisfaction and perceived control, the thesis contributes to a greater understanding of the psychological adaptation processes of individuals experiencing back pain. Risk factors to subjective wellbeing are also identified, thus presenting opportunities to provide assistance before the onset of psychopathology.

Clarifying the Effort-Reward Imbalance Model : the role of personality

The thesis aimed to identify the sources of stress experienced by a sample of Australian police officers. It was guided by the Effort-Reward Imbalance Model, augmented with Type A personality components. The findings support the research model and suggest that interventions to reduce stress should focus on reward and recognition.

Consumer-citizens of China : the role of foreign brands in the imagined future China

This book presents a comprehensive examination of Chinese consumer behaviour and challenges the previously dichotomous interpretation of the consumption of Western and non-Western brands in China.

Perceived discrimination and stigmatisation against severely obese women : age and weight loss make a difference

Aims: Patients’ perceptions about weight-related stigma and discrimination were assessed in 2 groups of patients, obese and laparoscopic adjustable gastric banding (LAGB).

Methods: Seven focus group sessions were held including a total of 32 women, 8 obese (body mass index 35+) and 24 who had lost 50% of excess weight following bariatric surgery. During the sessions, participants were asked to consider their experiences in situations including general, family, friends, work place, medical, and educational settings.

Results: Whilst perceptions of discrimination and stigmatisation were common and affected many life situations, they were less prevalent than previous reports. It appeared that it was not the frequency or number of events which affected an individual but the intensity of the experience. Younger women reported greater discrimination than older women and felt the social consequences of obesity to a greater extent. Older women were more concerned about the consequences of being overweight on their health.

Conclusions: Women who had lost weight considered that aspects of their own behaviours when obese contributed to their experiences of discrimination and stigmatisation. Perceptions of discrimination and stigmatisation appear to be influenced by age and current weight status.

A preliminary investigation of adult defence style and physiological reactivity to infant distress signals

Species whose offspring require extended care-giving ought to be predisposed to being biologically responsive to their infant's signalling. This paper examined the interplay between biological and psychological aspects of adult response to an infant's distress. HR (heart rate) and GSR (galvanic skin response) were recorded continuously, while 50 adults listened to white noise and an infant cry audio recording. Participants completed the defence style questionnaire and the state trait anxiety inventory. HR acceleration occurred in response to the control sound, while HR decelerated in response to the infant cry. GSR responsiveness was positively correlated with immature and neurotic defence styles. When controlling for other variables, immature defence was a unique and independent predictor of GSR change in response to infant distress. Defence demonstrated a stronger relationship than self-reported anxiety, than that with physiological responsiveness. Employing defence mechanisms appears to reduce an individual's perceived anxiety, though it has little effect on physiological arousal levels.

Critical evaluation of the nursery role hypothesis for seagrass meadows

The vast majority of published papers concerning seagrass meadows contain statements to the effect that seagrass beds serve as important nurseries for many species. We reviewed more than 200 papers that were relevant to the nursery role hypothesis. We used both vote counting and meta-analytic techniques to evaluate whether the body of previous studies that report seagrass meadows to be nursery grounds actually contain data that support this proposition. We restricted our analyses to papers that compared seagrass beds to other habitats, and examined data on a variety of well-studied species concerning their density, growth, survival and migration to adult habitat. Within this group of papers, we considered potential factors that could influence the nursery function (e.g. location, or laboratory vs field studies). We also evaluated case histories of well-documented large-scale seagrass losses on the nursery function. Major results were consistent with the expectations that abundance, growth and survival were greater in seagrass than in unstructured habitats. Abundance data also suggested that seagrass beds in the Northern Hemisphere might be more important as nursery areas than those in the Southern Hemisphere. Surprisingly, few significant differences existed in abundance, growth or survival when seagrass meadows were compared to other structured habitats, such as oyster or cobble reefs, or macroalgal beds. Nor were there decreases in harvests of commercially important species that could clearly be attributed to significant seagrass declines in 3 well-studied areas. However, there were decreased abundances of juveniles of commercially important species in these areas, suggesting a strong link between seagrass abundance and those of juvenile finfish and shellfish. One important implication of these results is that structure per se, rather than the type of structure, appears to be an important determinant of nursery value. Clearly, more rigorous studies that test all aspects of the nursery role hypothesis are clearly needed for seagrass meadows as well as other structured habitats. The results of such studies will allow better decisions to be made concerning the conservation and restoration of marine habitats.

You kind of want to fix it don’t you? Exploring general practice trainees’ experiences of managing patients with medically unexplained symptoms

Background
Much of a General Practitioner’s (GP) workload consists of managing patients with medically unexplained symptoms (MUS). GP trainees are often taking responsibility for looking after people with MUS for the first time and so are well placed to reflect on this and the preparation they have had for it; their views have not been documented in detail in the literature. This study aimed to explore GP trainees’ clinical and educational experiences of managing people presenting with MUS.
Method
A mixed methods approach was adopted. All trainees from four London GP vocational training schemes were invited to take part in a questionnaire and in-depth semi-structured interviews. The questionnaire explored educational and clinical experiences and attitudes towards MUS using Likert scales and free text responses. The interviews explored the origins of these views and experiences in more detail and documented ideas about optimising training about MUS. Interviews were analysed using the framework analysis approach.


Results

Eighty questionnaires out of 120 (67 %) were returned and a purposive sample of 15 trainees interviewed. Results suggested most trainees struggled to manage the uncertainty inherent in MUS consultations, feeling they often over-investigated or referred for their own reassurance. They described difficulty in broaching possible psychological aspects and/or providing appropriate explanations to patients for their symptoms. They thought that more preparation was needed throughout their training. Some had more positive experiences and found such consultations rewarding, usually after several consultations and developing a relationship with the patient.
Conclusion
Managing MUS is a common problem for GP trainees and results in a disproportionate amount of anxiety, frustration and uncertainty. Their training needs to better reflect their clinical experience to prepare them for managing such scenarios, which should also improve patient care.

The burden of neck pain: its meaning for persons with neck pain and healthcare providers, explored by concept mapping

PURPOSE: To empirically define the concept of burden of neck pain. The lack of a clear understanding of this construct from the perspective of persons with neck pain and care providers hampers adequate measurement of this burden. An additional aim was to compare the conceptual model obtained with the frequently used Neck Disability Index (NDI). METHODS: Concept mapping, combining qualitative (nominal group technique and group consensus) and quantitative research methods (cluster analysis and multidimensional scaling), was applied to groups of persons with neck pain (n = 3) and professionals treating persons with neck pain (n = 2). Group members generated statements, which were organized into concept maps. Group members achieved consensus about the number and description of domains and the researchers then generated an overall mind map covering the full breadth of the burden of neck pain. RESULTS: Concept mapping revealed 12 domains of burden of neck pain: impaired mobility neck, neck pain, fatigue/concentration, physical complaints, psychological aspects/consequences, activities of daily living, social participation, financial consequences, difficult to treat/difficult to diagnose, difference of opinion with care providers, incomprehension by social environment, and how person with neck pain deal with complaints. All ten items of the NDI could be linked to the mind map, but the NDI measures only part of the burden of neck pain. CONCLUSION: This study revealed the relevant domains for the burden of neck pain from the viewpoints of persons with neck pain and their care providers. These results can guide the identification of existing measurements instruments for each domain or the development of new ones to measure the burden of neck pain.

Assessing adult adjustment to relationship separation : the Psychological Adjustment to Separation Test (PAST)

Relationship separation is associated with substantial adult adjustment problems. The Psychological Adjustment to Separation Test (PAST) was developed as a self-report measure of 3 key dimensions of separation adjustment problems: lonely negativity, ex-partner attachment and coparenting conflict. Two independent samples (n = 219 and n = 169, respectively) of recently separated adults, 60% of whom had children, completed the PAST and other measures of general adjustment. Exploratory and confirmatory factor analyses demonstrated a replicable 3-factor structure, with each factor showing satisfactory test–retest and internal reliability and good convergent and discriminant validity. The PAST meets initial criteria for a potentially useful new measure of adult separation adjustment.