An `upside-down` view of rural health care

Access to high quality health care services plays an important part in the health of rural communities and individuals. This fact is reflected in efforts by governments to improve the quality of such services through better targeting of funds and more efficient management of services. In Australia, the difficulties experienced by rural communities in attracting and retaining doctors has long been recognized as a contributing factor to the relatively higher levels of morbidity and mortality in rural areas. However, this paper, based on a study of two small rural communities in Australia, suggests that resolving the health problems of rural communities will require more than simply increasing the quality and accessibility of health services. Health and well-being in such communities relates as much to the sense of community cohesion as it does to the direct provision of medical services. Over recent years, that cohesion has diminished, undermined in part by government policies that have fuelled an exodus from small rural communities to urban areas. Until governments begin to take an 'upside-down' perspective, focusing on building healthy communities rather than simply on building hospitals to make communities healthy, the disadvantages faced by rural people will continue to be exacerbated.

Why primary health care offers a more comprehensive approach to tackling health inequities than primary care.

As governments attempt to focus more intently on how to deal with alarming measures of health disadvantage and inequities, a reformist gaze seems to have settled on the primary care sector. Simultaneously, in literature about this area, whether intended or not, primary health care and primary care are terms that are increasingly interchanged. This article argues that the slippage in language is counter-productive, first because it disguises the transformative potential of strategies and approaches that can make the fundamental changes necessary to improve health status, and second because the structures and practices of the primary care sector are not necessarily compatible with notions of comprehensive primary health care. There is much to be lost if primary health care and health promotion are disguised as primary care, and not understood for their capacity to make a difference to health inequities although of course in some circumstances, comprehensive primary health care is interdependent with services provided by primary care. In this article, characteristics of primary care and primary health care are juxtaposed to show that if the strengths and limitations of each model are understood, they can be mobilised in collaborative partnerships to deal more effectively with health inequities, than our system has so far been able to do.

Population based intervention to change back pain beliefs and disability : three part evaluation

Objective To evaluate the effectiveness of a population based, state-wide public health intervention designed to alter beliefs about back pain, influence medical management, and reduce disability and costs of compensation. Design Quasi-experimental, non-randomised, non-equivalent, before and after telephone surveys of the general population and postal surveys of general practitioners with an adjacent state as control group and descriptive analysis of claims database. Setting Two states in Australia Participants 4730 members of general population before and two and two and a half years after campaign started, in a ratio of2:1:1; 2556 general practitioners before and two years after campaign onset. Main outcome measures Back beliefs questionnaire, knowledge and attitude statements about back pain, incidence of workers' financial compensation claims for back problems, rate of days compensated, and medical payments for claims related to back pain and other claims. Results In the intervention state beliefs about back pain became more positive between successive surveys (mean improvement in questionnaire score 1.9 (95% confidence interval 1.3 to 2.5), P<0.001 and 3.2 (2.6 to 3.9), P < 0.001, between baseline and the second and third survey, respectively). Beliefs about back pain also improved among doctors. There was a clear decline in number of claims for back pain, rates of days compensated, and medical payments for claims for back pain over the duration of the campaign. Conclusions A population based strategy of provision of positive messages about back pain improves population and general practitioner beliefs about back pain and seems to influence medical management and reduce disability and workers' compensation costs related to back pain.

Leadership for socially just schooling: more substance and less style in high-risk, low-trust times?

This article argues that radical shifts in school governance arising from wider social, political, and economic relations toward what are described as high-risk and low-trust societies challenge past notions of leadership. I explore the tensions between the pluralism of postmodernist thinking and modernist notions of social justice that produce "predicaments" for school leaders through a series of paradoxes of educational management around centralized decentralization, markets and management, new educational professionalism, parental choice and community participation, and between the substance and style of leadership. The values underpinning the corporatization of public and private life most evident in education do not provide a satisfactory grounding for effective school leadership.

Euthanasia: why it doesn`t matter (much) what the doctor thinks and why there is no suggestion that doctors should have a duty to kill

A major reason that The Netherlands has taken a different approach to the rest of the world on such a fundamental moral issue is that the courts and legislature in that country have accorded the interests of doctors a cardinal role in the euthanasia debate. This article argues that the interests of doctors are of only incidental and peripheral relevance in relation to the moral status of euthanasia. The moral status of euthanasia has little to do with the
preparedness ofdoctors to administer the lethal injection or their general attitude towards the practice. Euthanasia is principally about the interests of the patient and the impact that the practice may have on the community in general, not preserving the conscience or improving the working life ofdoctors.

Integrating highlights for more complete sports video summarization

Summarization is an essential requirement for achieving a more compact and interesting representation of sports video contents. We propose a framework that integrates highlights into play segments and reveal why we should still retain breaks. Experimental results show that fast detections of whistle sounds, crowd excitement, and text boxes can complement existing techniques for play-breaks and highlights localization.

Promise more, leave less

Following Kim and Ritter (1999) who find that earnings forecasts provide more accurate valuations of IPOs, this paper analyses whether the owners of companies seeking to list will leave less money on the table if positive dividend per share (DPS) yield forecasts are made in the prospectus. Our findings indicate that DPS yield forecasts by directors of Industrial company IPOs have been an important ingredient in the amount of money left on the table. A similar result is found for Limited Liability IPOs and those that do not offer options to subscribers to buy more shares. The offer of an operational dividend reinvestment plan in the prospectus does not appear significant in reducing the amount of money left on the table.

The indigenous art market: a roadmap to a more equitable and efficient system

The Indigenous art market plays a significant role both in promoting appreciation for the accomplishments of Aboriginal culture and within broader concepts of the export of a national culture.[1] Despite the growth in status and impact of Indigenous art over the past decade, very little scholarship or resources exist to assist their development and analyse their impact on economic or social wellbeing. This paper canvasses new ways of operating the Indigenous art market to better support emerging and established artists in a globalised economy and suggests that there is a pressing need for future research to develop a new framework for its operation.

Mystery and movement: doing more with dominoes

John Gough explains how to turn an ordinary set of dominoes into games of mystery, movement and strategy.

More? You want more?..of course I do! Transsexualism and birth certificates-changing records or attitudes?

In 2004, the Victorian Government enacted legislation allowing people treated for transsexualism to correct the record of their sex on the Register of Births, Deaths and Marriages and obtain a new certificate reflecting their contemporaneous circumstances. It was the last of all the States and Territories to do so.

The legislation gave effect to some important changes to the law and was generally couched in terms more sensitive than those already in place in the other jurisdictions. In the view of the author, however, its proponents failed to both understand the import of the expert medical evidence adduced in, and to implement the common law position enunciated by, the Family Court in Re Kevin (validity of marriage of transsexual) [2001] FamCA 1074 and subsequently confirmed on appeal two years later by the Full Court.

The author argues that, while a welcome improvement to the human rights record of successive Victorian Governments, the result is still a largely disappointing piece of legislation. Rather than being truly 'beneficial' to all who need security of their personal identities, it perpetuates some of the very worst discrimination directed at people with transsexualism and their families by continuing to portray them as psychologically deluded rather than physiologically atypical and denying a small number of them their rights on the basis of legal reasoning which is no longer regarded as tenable. She asserts the legislation serves as a clear demonstration that prejudices and misconceptions about transsexualism stilI abound and explains much more is needed if real human rights, acceptance and freedom from discrimination are to be eventually obtained by those affected by the phenomenon.

Indirect approaches to obesity: are they likely to be more successful than 'direct' behavioural interventions?

The article comments on the paper of Manfred Müller and Sandra Danielzik about the indirect approaches to obesity. They are looking for alternatives that are both insighful and well-grounded in experience of single or multiple behavioral interventions on obesity prevalence. The author suggested various approaches including community capacity, counter commercialism, cultural change and contagion creation.

Is more better? The relationship between outcomes achieved by problem gamblers and the number of counselling sessions attended

This paper addresses the question of how much intervention is necessary for the effective treatment of problem gambling by exploring the relationship between the number of counselling sessions attended and the degree of problem resolution achieved for 613 individuals who attended problem gambling counselling services in Victoria. While those who achieved partial or full resolution of presenting problems attended more sessions than those who finished counselling with their problems still unresolved, problems were typically reported as being resolved in fewer than five sessions. It is concluded that for some problem gamblers a relatively brief intervention may be sufficient.

Is vascularity more evident after exercise? Implications for tendon imaging

OBJECTIVE. The objective of our study was to investigate the effect of activity on tendon vascularity in 17 abnormal patellar tendons.

CONCLUSION. Tendon vascularity is significantly increased by activity (p < 0.001). From this finding, we infer that imaging abnormal tendons with color Doppler sonography to detect neovascularization may be most useful after the patient exercises. Investigations to determine how much activity is necessary to ensure maximal vascularity is detected by Doppler sonography are required.