A qualitative examination of the experience of 'depression' in hospitalized medically ill patients

Background: Research into depression in the medically ill has progressed without sufficient attention being given to the validity, in this group, of the taxonomic categories. We aimed to describe, using qualitative interviews, the experience of 'being depressed', separating experiences that are unique to depression from experiences that are common to being ill and in hospital.
Method: Forty-nine patients hospitalized for medical illness underwent a 30-min interview in which they were asked to 'Describe how you have been unwell and, in particular, how that has made you feel.' From the transcripts, a 'folk' taxonomy was constructed using a phenomenological framework involving four steps: frame elicitation to identify the important themes, componential analysis to systematically cluster the attributes into domains, a comparison of the experiences of patients screening depressed and  not-depressed, and a theoretical analysis comparing the resulting taxonomy with currently used theoretical constructs.
Results: Experiences common to all patients were being in hospital, being ill or in pain, adjusting to not being able to do things, and having time to think. In addition, all participants described being depressed, down or sad. Patients who were identified by screening as being depressed described unique experiences of depression, which included 'having to think about things' (a forceful intrusive thinking), 'not being able to sleep', 'having to rely on others', 'being a burden' to others (with associated shame and guilt), feelings of 'not getting better' and 'feeling like giving up'. Theoretical analysis suggested that this experience of depression fitted well with the concept of demoralization described by Jerome Frank.
Conclusions: Demoralization, which involves feelings of being unable to cope, helplessness, hopelessness and diminished personal esteem, characterizes much of the depression seen in hospitalized medically ill patients

Reading practices experienced by preschool children in areas of disadvantage

The purpose of this survey investigation was to gain insight into the different home literacy practices of preschool children in some disadvantaged areas across the state of Victoria, Australia. Findings indicate that parents read to their children regularly from a young age, found libraries easy to access and use, and have children who enjoy books and paper and pencil activities. However, more than half of them found there was not enough information available to support them in their child's literacy development. It is argued here that such information should be made available as a matter of some urgency and be distributed through libraries.

The value of community-based monitoring in marine protected areas

There is an increasing realisation of the importance of community or volunteer collected data for management programs that are otherwise limited by the availability of funds or resources. However, there are concerns regarding the reliability of scientific data collected by inexperienced people. We investigated the potential for community-based monitoring in Victoria’s newly established system of Marine Protected Areas. The main objectives for the study were to 1) develop a template for the scientific monitoring of marine habitats suitable for community groups, 2) assess data quality and data integrity collected by community volunteers and 3) determine a sustainable model for ongoing community participation in monitoring marine habitats. Three different habitats (subtidal, intertidal, and seagrass) were investigated and data collected by volunteers across these habitats was compared to that collected by scientists. Reliability of data collected by volunteers was dependent on habitat type and the type of measurement the volunteers were required to make. Qualitative estimates made by volunteers were highly variable across all three habitat sites, compared to quantitative data collection. Subtidal monitoring had the greatest inaccuracy for data collection, whereas intertidal reef monitoring was most reliable. Sustainability of community-based monitoring programs is dependent on adequate training for volunteers and the development of partnerships to foster greater community engagement.

Community group volunteer perceptions and awareness of Victorian marine protected areas

In 2004, a Community Based Monitoring (CBM) program for Victoria’s Marine National Parks and Marine Sanctuaries was developed. A key performance area for Victoria’s Marine Protected Area (MPA) Management Strategy is community engagement. This program was developed to incorporate the key performance principles of community education, participation and engagement. CBM involves scientific protocols to monitor different habitat types in a MPA. As part of the CBM project, perceptions and values of MPAs were investigated through a pilot survey of 125 community group volunteers from 4 volunteer groups. Surveys were sent to all community group members which included participants and non-participants in the CBM program. Questions sought qualitative and quantitative information, focusing on personal values of MPAs. The surveys included questions associated with CBM, MPA management and environmental issues affecting the marine environment. Responses from the pilot study indicated that 50% of the volunteers participated in CBM to learn more about scientific research, and 30% wanted to work close to nature. This pilot study will form the basis of a larger-scale study to investigate community group perceptions of MPAs and identifying how to maintain volunteer enthusiasm, interest and motivation in a CBM program.

Novel and effective treatment modality for medically unexplained symptoms

Medically unexplained symptoms (MUS) confound physicians, and the incidence and prevalence of these conditions is poorly documented.  This is not least due to the complex nature of MUS and mimicry of morbidity with conditions that have common clinical assessment and treatment modalities, e.g. migraine headaches which stress headaches commonly are misdiagnosed as.  Effective treatment modalities for MUS have been more or less non-existent.  In the following we present a modality for the assessment, diagnosis and treatment of MUS that in our experience leads to cure, at least in better than half of these cases measured in terms of allowing the individual back to work.  These results are at least twice as high as those described hitherto (see below), and yet, our treatment modality is beset with many obstacles, not the least of which is the intrasigence of a system that will not and/or can not understand why this modality is so much better than what they are able to offer.  The most importance obstacle is financing, as this modality requires long term and committed financing to work.  The economic implications of not dealing with these issues are described.

Rethinking policies for the retention of allied health professionals in rural areas : a social relations approach

Objective: Retaining allied health professionals in rural areas is a recognised problem. Generally the literature has concentrated on three elements: practitioner needs, community needs and organisational needs. There has been little attempt to focus other types of social relations in which health practitioner retention and recruitment takes place. The aim of this paper is to question the present dominant hierarchical approach taken in relation to the retention of allied health professionals in rural localities.

Methods: The data derives from a survey in Southwest Victoria, Australia. The sample was purposive rather than representative as it was intended to be exploratory in nature rather than definitive.

Results: The data indicates that there is a greater tendency for allied health professionals in private practice to be retained in rural areas than those in the public sector.

Conclusion: The paper concludes by raising some questions about the pertinence of present models for regional health initiatives since they are locked into a bureuacratic model where relationships are hierarchical and asymmetrically controlled.

Total arsenic accumulation in yabbies (Cherax Destructor Clark) exposed to elevated arsenic levels in Victorian gold mining areas, Australia

Arsenic is a proven carcinogen often found at high concentrations in association with gold and other heavy metals. The freshwater yabby, Cherax destructor Clark (Decapoda, Parastacidae), is a ubiquitous species native to Australia's central and eastern regions, with a growing international commercial market. However, in this region of Australia, yabby farmers often harvest organisms from old mine tailings dams with elevated environmental arsenic levels. Yabbies exposed to elevated environmental arsenic were found to accumulate and store as much as 100 μg/g arsenic in their tissues. The accumulation is proportional to the concentration of arsenic in the sediment and is high enough to be of concern for people who eat the yabbies. A comparison of arsenic levels in wild and lab-fed animals also was performed. Although there was no significant difference in the level of arsenic in the various organs of the wild animals, the animals purchased from a yabby farm showed a significantly higher arsenic concentration in their hepatopancreas (3.7 ± 0.9 μg/g) compared to other organs (0.6–1.8 μg/g). Furthermore, after a 40-d exposure to food containing 200 to 300 μg/g inorganic arsenic, arsenate (As[V])-exposed animals showed a significant increase in tissue-specific arsenic accumulation, whereas arsenite (As[III])-exposed animals showed a lower, nonsignificant increase in As uptake, primarily in the hepatopancreas. These results have important implications for yabby growers and consumers alike.

Ecosystem conservation in multi-tenure reserve networks : the contribution of land outside of publicly protected areas

Multi-tenure reserve networks have been developed as a mechanism to improve cross tenure management and protection of biodiversity, but also as a means of accounting for biodiversity assets managed for conservation outside of protected areas on public land. We evaluated the contribution of multi-tenure reserve networks to enhancing the comprehensiveness and representativeness of ecosystems in publicly protected areas, using three Australian case studies. All networks contributed to enhancing comprehensiveness and representativeness, but this contribution varied between networks and between components of those networks. Significantly, components on private land and "other public land" in all three networks greatly enhanced the protection of some ecosystems at a subregional scale. The Grassy Box Woodlands Conservation Management Network, in particular made a substantial contribution to conservation, with most components protecting remnants of an endangered and under-represented ecosystem. Multi-reserve conservation networks not only act to protect threatened and under-reserved ecosystems, but they also provide a mechanism to account for this protection. Thus, multi-tenure reserve networks have the potential to provide increased knowledge and understanding to conservation planning decision making processes.

Future landscapes in South-eastern Australia : the role of protected areas and biolinks in adaptation to climate change

The extent and rapidity of global climate change is the major novel threatening process to biodiversity in the 21 st century. Globally, numerous studies suggest movement of biota to higher latitudes and altitudes with increasing empirical -evidence emerging. As biota responds to the direct and consequent effects of climate change the potential to profoundly affect natural systems (including the reserve system) of south-eastern Australia is becoming evident. Climate change is projected to accelerate major environmental drivers such as drought, fire and flood regimes. Is the reserve system sufficient for biodiversity conservation under a changing climate? Australia is topographically flat, biologically mega-diverse with high species endemism, and has the driest and most variable climate of any inhabited continent. Whilst the north-south orientation and aftitude gradient of eastern Australia's forests and woodlands provides some resilience to projected climatic change, this has been eroded since European settlement, particularly in the cool-moist Bassian zone of the south-east. Following settlement, massive land-use change for agriculture and forestry caused widespread loss and fragmentation of habitats; becoming geriatric in agricultural landscapes and artificially young in forests. The reserve system persists as an archipelago of ecological islands surrounded by land uses of varying compatibility with conservation and vulnerable to global warming. The capacity for biota to adapt is limited by habitat availability. The extinction risk is exacerbated. Re-examination of earlier analysis of ecological connectivity through biolink zones confirms biolinks as an appropriate risk management response within a broader suite of measures. Areas not currently in the reserve system may be critical to the value and ecological function of biological assets of the reserve system as these assets change. Ecological need and the rise of ecosystem services, combined with changing socio-economic drivers of land-use and social values that supported the expansion of the reserve system, all suggest biolink zones represent a new, necessary and viable multi-functional landscape. This paper explores some of the key ecological elements for restoration within biolink zones (and landscapes at large) particularly through currently agricultural landscapes.