Experiences of racism, racial/ethnic attitudes, motivated fairness and mental health outcomes among primary and secondary school students

While studies investigating the health effects of racial discrimination for children and youth have examined a range of effect modifiers, to date, relationships between experiences of racial discrimination, student attitudes, and health outcomes remain unexplored. This study uniquely demonstrates the moderating effects of vicarious racism and motivated fairness on the association between direct experiences of racism and mental health outcomes, specifically depressive symptoms and loneliness, among primary and secondary school students. Across seven schools, 263 students (54.4% female), ranging from 8 to 17 years old (M = 11.2, SD = 2.2) reported attitudes about other racial/ethnic groups and experiences of racism. Students from minority ethnic groups (determined by country of birth) reported higher levels of loneliness and more racist experiences relative to the majority group students. Students from the majority racial/ethnic group reported higher levels of loneliness and depressive symptoms if they had more friends from different racial/ethnic groups, whereas the number of friends from different groups had no effect on minority students' loneliness or depressive symptoms. Direct experiences of racism were robustly related to higher loneliness and depressive symptoms in multivariate regression models. However, the association with depressive symptoms was reduced to marginal significance when students reported low motivated fairness. Elaborating on the negative health effects of racism in primary and secondary school students provides an impetus for future research and the development of appropriate interventions.

Working with people who have killed: The experience and attitudes of forensic mental health clinicians working with forensic patients

Forensic mental health (FMH) clinicians sometimes feel unsupported and unprepared for their work. This article explores their experiences of working in a FMH setting in Australia. The research examined the clinical context of clinicians working with forensic patients (FP), particularly those individuals who have killed while experiencing a mental illness. A qualitative, exploratory design was selected. Data were collected through focus groups and individual interviews with hospital and community-based forensic clinicians from all professional groups: psychiatric medicine, social work, psychology, mental health nursing, occupational therapy, and psychiatric service officers. The main themes identified were orientation and adjustment to FMH, training in FMH, vicarious traumatization, clinical debriefing and clinical supervision, and therapeutic relationships. Participants described being frustrated and unsupported in making the transition to working with FP and felt conflicted by the emotional response that was generated when developing therapeutic relationships. Recommendations include the development of programmes that might assist clinicians and address gaps in service delivery, such as clinical governance, targeted orientation programmes, and clinical supervision.

Should I and Can I?: a mixed methods study of clinician beliefs and attitudes in the management of lifestyle risk factors in primary health care

Background
Primary health care (PHC) clinicians have an important role to play in addressing lifestyle risk factors for chronic diseases. However they intervene only rarely, despite the opportunities that arise within their routine clinical practice. Beliefs and attitudes have been shown to be associated with risk factor management practices, but little is known about this for PHC clinicians working outside general practice. The aim of this study was to explore the beliefs and attitudes of PHC clinicians about incorporating lifestyle risk factor management into their routine care and to examine whether these varied according to their self reported level of risk factor management.

Methods
A cross sectional survey was undertaken with PHC clinicians (n = 59) in three community health teams. Clinicians' beliefs and attitudes were also explored through qualitative interviews with a purposeful sample of 22 clinicians from the teams. Mixed methods analysis was used to compare beliefs and attitudes for those with high and low levels of self reported risk factor management.

Results
Role congruence, perceived client acceptability, beliefs about capabilities, perceived effectiveness and clinicians' own lifestyle were key themes related to risk factor management practices. Those reporting high levels of risk factor screening and intervention had different beliefs and attitudes to those PHC clinicians who reported lower levels.

Conclusion
PHC clinicians' level of involvement in risk factor management reflects their beliefs and attitudes about it. This provides insights into ways of intervening to improve the integration of behavioural risk factor management into routine practice.

An examination of stakeholder attitudes and understanding of therapeutic jurisprudence in a mental health court

Mental health courts represent a key component of contemporary responses to mental illness and disability in the criminal justice system, and yet there is uncertainty about how these courts should balance their punishment and treatment roles. This paper reports an analysis of interviews with court professionals which considers their understanding of the rationale underpinning an Australian mental health court, its effectiveness in achieving its criminal justice and clinical goals, and of broader notions of therapeutic jurisprudence. This reveals considerable support for diversionary mental health court programs of this type and professional confidence that this type of program is effective. However, the analysis also highlights conflict in the practice frameworks of the different professional groups who regularly contribute to the operations of the court. Suggestions to enhance service delivery are offered.

Health extension workers' and mothers' attitudes to maternal health service utilization and acceptance in Adwa Woreda, Tigray Region, Ethiopia.

BACKGROUND: The maternal health system in Ethiopia links health posts in rural communities (kebeles) with district (woreda) health centres, and health centres with primary hospitals. At each health post two Health Extension Workers (HEWs) assist women with birth preparedness, complication readiness, and mobilize communities to facilitate timely referral to mid-level service providers. This study explored HEWs' and mother's attitudes to maternal health services in Adwa Woreda, Tigray Region. METHODS: In this qualitative study, we trained 16 HEWs to interview 45 women to gain a better understanding of the social context of maternal health related behaviours. Themes included barriers to health services; women's social status and mobility; and women's perceptions of skilled birth attendant's care. All data were analyzed thematically. FINDINGS: There have been substantial efforts to improve maternal health and reduce maternal mortality in Adwa Woreda. Women identified barriers to healthcare including distance and lack of transportation due to geographical factors; the absence of many husbands due to off-woreda farming; traditional factors such as zwar (some pregnant women are afraid of meeting other pregnant women), and discouragement from mothers and mothers-in-law who delivered their children at home. Some women experienced disrespectful care at the hospital. Facilitators to skilled birth attendance included: identification of pregnant women through Women's Development Groups (WDGs), and referral by ambulance to health facilities either before a woman's Expected Due Date (EDD) or if labour started at home. CONCLUSION: With the support of WDGs, HEWs have increased the rate of skilled birth attendance by calling ambulances to transfer women to health centres either before their EDD or when labour starts at home. These findings add to the growing body of evidence that health workers at the community level can work with women's groups to improve maternal health, thus reducing the need for emergency obstetric care in low-income countries.

A public health intervention to change knowledge, attitudes and behaviour regarding alcohol consumption in pregnancy

Aim. To evaluate the effectiveness of a public health intervention aimed at changing knowledge, attitudes and behaviour. Methods. A non-blinded parallel group randomised controlled trial of pregnant women over 18 years of age. Women were recruited in the second trimester and assigned to one of two treatment groups. Both groups completed an initial questionnaire assessing knowledge, attitudes, and practices relating to alcohol consumption during pregnancy. The intervention group then received a mocktail recipe booklet and participants were asked to share the information with their partner. The control group received standard antenatal care. A follow-up questionnaire was conducted four weeks post birth. Primary outcome measures were a knowledge score of the health risks associated with alcohol consumption during pregnancy and an attitude score toward drinking during pregnancy. Secondary outcome measures included whether or not the woman and her partner abstained from drinking. Ethical approval was granted by the Women’s and Children’s Health Network and the University of South Australia. Results. A total of 161 participants were recruited at baseline (intervention = 82, control = 79) and 96 participants completed the trial (intervention = 49, control = 47). The findings suggest that the mocktail booklet was effective at improving knowledge (p<0.001; effect size 0.80) and improving attitudes towards drinking during pregnancy (p=0.017; effect size 0.43) in the intervention group compared to the control group. Although women in the intervention group were 30% more likely to abstain from drinking than in the control group (RR=1.3, 95% CI 0.97 – 1.75), this result was not statistically significant (p=0.077). Conclusions. Knowledge regarding the effects of alcohol consumption as well as attitudes towards drinking significantly improved as a result of a mocktail recipe booklet. Improving knowledge and changing attitudes has the potential to change health behaviour. Therefore, this intervention may reduce the percentage of women who continue to drink alcohol while they are pregnant and improve outcomes for infants and children.

Access and attitude of rural allied health professionals to CPD and training

Continuing professional development (CPD) activities for allied health professionals are becoming mandatory as a means for professionals to maintain accreditation or skills. To access CPD activities, rural allied health professionals have the added costs of travel, accommodation and information technology access. It is assumed that health professionals in rural areas want access to training and CPD. In 2003, a survey of allied health professionals was carried out in Southwest Victoria, Australia, with the aim of identifying access and attitudes to CPD. Results showed that allied health professionals in Southwest Victoria were highly qualified, wished to access CPD more than four times a year and were prepared to spend a mean rate of $1000 (1300) per annum on CPD activities.

Community attitudes towards the early detection of cancer in Victoria, Australia

Objectives: To describe people's attitudes towards early detection of cancer.

Methods: We conducted a telephone survey of Victorian adults aged 18+ years, during April-May 2005, using a market research company.

Results: 1,502 (41%) people participated; 80% of respondents believed that detecting cancer early meant that treatment saved lives most of the time or always; 88% believed finding cancer early enabled more effective treatment most of the time or always; and 70% indicated they would want to be tested for a cancer even if no treatment were available.  Two-thirds or more of adults considered survival would be very much improved by early detection for breast, melanoma and prostate cancers; 49% for bowel cancer, and 30% for lung cancer.

Conclusions and Implications : Community support for the early detection of cancer was evident even in the absence of effective treatment.  There was a lower perceived survival benefit for the early diagnosis of bowel cancer or melanoma.  An education campaign is required that focuses on the gains associated with early detection and benefits of screening for bowel cancer.

Stigmatization of patients with AIDS : understanding the interrelationships between Thai nurses' attitudes towards HIV/AIDS, drug use and commercial sex

There is currently a scarcity of research on the nature of HIV/AIDS stigma within the Thai health context. This is problematic given the negative role of stigma in hindering the provision of patient care and treatment. This study used a mixed-method approach to investigate the interrelationships between the stigma of HIV/AIDS and the stigmas relating to its various modes of disease transmission including injection drug use (IDU). Twenty interviews were conducted with trainees and qualified nurses from a Bangkok college. Participants were presented with vignettes describing a hypothetical person varying in disease diagnoses (AIDS, leukemia, no disease) and co-characteristics (IDU,  commercial sex (CS), blood transfusion, no co-characteristic). Using a Q-sort task, participants arranged the vignettes along a bipolar scale according to their willingness to interact with the persons, and were asked to explain their decisions. Univariate and multivariate regression analyses showed that IDU, AIDS, and CS were all individually stigmatizing. Strong interactions were found between the stigmas of HIV/AIDS, IDU, and CS. Interview data also showed clear biases toward patients according to their IDU and CS habits. The findings  suggest that addressing these co-stigmas could be vital to the success of efforts aimed at reducing the disease stigma of HIV/AIDS.

Nurses´ attitudes to single checking medications : before and after its use

We report nurses' attitudes towards the single checking of medications before and after the implementation of this procedure in an acute health-care setting. Data from a pre-implementation survey confirmed that some nurses held strong views against single checking. Following this survey, the hospital's medication administration policy was revised, a single checking resource manual was developed, 1–2 h nurse education sessions were held, the competencies of nurses to single check and to administer medications were assessed, and single checking was successfully piloted before hospital-wide implementation. Data from a survey conducted 18 months after the implementation indicated that nurses welcomed the single checking medication procedure, felt more confident using single checking and perceived that it made them more accountable for administering medications. The findings provide evidence that nurses' attitudes to single checking change remarkably in favour of its use with education and experience using this procedure.

Demographic differences in usage and attitudes to milk

Declining milk consumption is a potential public health problem because milk provides nutrients that are not abundant in other foods. Identification of the factors that may influence milk consumption may lead to development of interventions to promote more healthful behaviours.

Attitudes and beliefs about food appear to be strong predictors of dietary behaviour. The objective of this study was to survey a random sample of consumers in regard to their milk consumption and attitudes and beliefs about milk. Two telephone surveys were conducted one year apart. The questionnaire included attitude items that reflected the main themes of consumers' interest in milk.

The respondents' attitudes were complex and were related to demographics and milk consumption. In general, people's concerns about milk related to what was important in their lives; what threatened them physically and emotionally. Women held more positive attitudes, but they were concerned about the fat content of milk. Men were less aware of milk's nutritional benefits and, as a result, were less appreciative of its value.

The findings from this investigation provide an opportunity to develop appropriate public health initiatives to promote the consumption of high calcium foods and to address the barriers to drinking milk. Nutrition communications in collaboration with other health agencies and the milk industry could support these initiatives.

Sustainability and health : supporting global ecological integrity in public health

Radical changes in the biosphere and human interaction with the environment are increasingly impacting on the health of populations across the world. Diseases are crossing the species barrier, and spreading rapidly through globalized transport systems. From new patterns of cancer to the threat of global pandemics, it is imperative that public health practitioners acknowledge the interdependence between the sustainability of the environment and the sustainability of the human species.* Why are issues of global and local sustainability of increasing importance to the public's health?* Why do issues of sustainability require new practices within the professions of public health?* How can future and current public health practitioners develop those new practices?Drawing on scientific evidence of global and local environmental changes, Sustainability and Health offers a thorough background and practical solutions to the overlapping issues in environment and health. It examines potential and existing responses to global and local environment and health issues, involving individuals, community, industry and government. The authors introduce a range of emerging conceptual frameworks and theoretical perspectives, link IT and epidemiology and explain how scoping can link program design, delivery, data collection and evaluation in projects from their very beginning. Public health practitioners need to be able to manage health issues that cut across environmental, economic and social systems and to develop the capacity for leadership in facilitating change. Incorporating learning activities, readings, international case studies and an open learning approach, this is a valuable resource for students of public and environmental health, as well as medical, environmental and health science professionals.

Wellbeing of Australians : carer health and wellbeing

This Report concerns the subjective wellbeing of carers in Australia. It is the product of a partnership between Carers Australia, Australian Unity, and Deakin University. All three partners were involved in all stages of the project as planning the logistics, designing the questionnaire and composing the report. Data analysis was undertaken by Deakin University while the logistics of questionnaire mailout was managed by Australian Unity and Carers Australia. The actual mailing took place from each of the state/territory Carers Associations, who used their own databases to print and affix the addresses of their members to the envelopes. Three major outcome measures have been used. The first is the Personal Wellbeing Index, which is our standard measure of wellbeing. The Index score is the average level of satisfaction across seven aspects of personal life – health, personal relationships, safety, standard of living, achieving in life, community connectedness, and future security. The other two outcome measures are sub-scales taken from the Depression, Anxiety, and Stress Scale (Lovibond and Lovibond, 1995). This is a very well regarded scale and the sub-scales of Depression and Stress have been used for this study. A total of 10,939 questionnaires were distributed and 4,107 were returned in time for processing. This constitutes a 37.6% response rate.