A qualitative study of primary health care access, barriers and satisfaction among people with mental illness

Research has found that a substantial proportion of individuals with mental illness have high morbidity and mortality rates, and high under-diagnosis of major physical illnesses. Furthermore, people with a mental illness tend not to seek out or utilise health care services. The reasons for the negative attitudes and behaviour towards health care services among this population have not been investigated. This paper presents findings from a study that investigated the health care service needs of people with mental illness (n = 20), and views from health care providers (n = 16) regarding access to these services by people with a mental illness. Results indicated that psychiatric patients identified a range of barriers to their health care usage and low levels of health care satisfaction. These views were shared with health care professionals. Reasons for these findings and strategies to address these problems so that there is better access to health care services for people with mental illness are discussed.

Building collaborative partnerships: a key to increasing Indigenous Victorian peoples' access to country

This article reports on a qualitative research study undertaken with Indigenous government employees to explore ways in which Indigenous communities can access programs involving caring for Country' (knowledge, responsibility and inherent right to protect the traditional natural landscape) on their traditional land and, in so doing. improve their health. Factors that optimise such nature-based projects are the capacity of their intention to build relationships, consultation. transparency, consistency, education and training between Indigenous communities. government and the general public. Government agencies need to develop strategies where partnership and collaboration are effective with Indigenous communities and within the agencies themselves, in order to resolve controversial issues surrounding access to Country.

Using sister city relationships to access the Chinese market

Purpose – The purpose of this paper is to offer a new approach for small and medium enterprises (SMEs) in Australia to engage in sustainable trade with China through the use of Sister City relationships. The reason for writing this paper is to address this research gap with the aim of influencing government policy at the national and the local level.

Design/methodology/approach – The main methods used is a historical literature review, a critical review of the effectiveness of the Sister City relationships and an examination of a special Sister City relationship between Latrobe City in Australia and the Chinese city of Taizhou.

Findings – Throughout the course of the paper it was established that Sister City relationships had been insufficiently utilized as commercial facilitators and especially SMEs in regional Australia. This was especially evident in terms of trade relations with China.

Research limitations/implications – This conceptual paper will require further research at different levels. Future research should establish what Australian sister cities with China are actually doing and how a more focused relationship utilizing SMEs in their territory might be utilized. This is clearly a limitation with this conceptual paper, which it is hoped will be overcome with new research planned by the authors.

Practical implications – The practical implications emerging from this paper is that Sister City relationships can be refocused from their current role to becoming structurally integrated into trade facilitators for SMEs in pursuing trade with China. Most Sister City relationships do not have a trade focus in the first instance. As a result of this paper we are hoping that local government policy makers and state government trade facilitators will see Sister City relationships in a new light.

Originality/value – This paper brings to attention cases of Sister City relationships which have gravitated towards a trade focus (an exception like Latrobe City) in which results are already evident. A paper of this kind is directed at governments at all levels as well as SMEs who wish to work better with government.

Neighbourhood socioeconomic inequalities in food access and affordability

This study investigated whether the availability and accessibility of supermarkets and fruit and vegetable stores, and the availability, variety and price of foods within these stores, varied across areas of different levels of socioeconomic disadvantage in Melbourne, Australia. Data on food store locations, and food variety and price within stores were obtained through objective audits of 45 neighbourhoods of varying socioeconomic disadvantage. Geographical accessibility of healthy food stores was mostly better amongst those living in more advantaged neighbourhoods. Availability of healthy foods within stores only slightly favoured those in advantaged neighbourhoods. However food prices favoured those living in disadvantaged areas.

Fast food purchasing and access to fast food restaurants : a multilevel analysis of VicLANES

Background : While previous research on fast food access and purchasing has not found evidence of an association, these studies have had methodological problems including aggregation error, lack of specificity between the exposures and outcomes, and lack of adjustment for potential confounding. In this paper we attempt to address these methodological problems using data from the Victorian Lifestyle and Neighbourhood Environments Study (VicLANES) – a cross-sectional multilevel study conducted within metropolitan Melbourne, Australia in 2003.
Methods : The VicLANES data used in this analysis included 2547 participants from 49 census collector districts in metropolitan Melbourne, Australia. The outcome of interest was the total frequency of fast food purchased for consumption at home within the previous month (never, monthly and weekly) from five major fast food chains (Red Rooster, McDonalds, Kentucky Fried Chicken, Hungry Jacks and Pizza Hut). Three measures of fast food access were created: density and variety, defined as the number of fast food restaurants and the number of different fast food chains within 3 kilometres of road network distance respectively, and proximity defined as the road network distance to the closest fast food restaurant. Multilevel multinomial models were used to estimate the associations between fast food restaurant access and purchasing with never purchased as the reference category. Models were adjusted for confounders including determinants of demand (attitudes and tastes that influence food purchasing decisions) as well as individual and area socio-economic characteristics.
Results : Purchasing fast food on a monthly basis was related to the variety of fast food restaurants (odds ratio 1.13; 95% confidence interval 1.02 – 1.25) after adjusting for individual and area characteristics. Density and proximity were not found to be significant predictors of fast food purchasing after adjustment for individual socio-economic predictors.
Conclusion : Although we found an independent association between fast food purchasing and access to a wider variety of fast food restaurant, density and proximity were not significant predictors. The methods used in our study are an advance on previous analyses.

Energy-efficient medium access control in wireless sensor networks

Medium access control for wireless sensor networks has been an active
research area in the past decade. This chapter discusses a set of important medium access control (MAC) attributes and possible design trade-offs in protocol design, with an emphasis on energy efficiency. Then we categorize existing MAC protocols into five groups, outline the representative protocols, and compare their advantages and disadvantages in the context of wireless sensor network. Finally, thoughts for practitioners are presented and open research issues are also discussed.

When the whole 'bloke' thing starts to crumble : men's access to chronic illness (arthritis) self management programs

This thesis explores the issue of men's access to chronic illness self management programs from a social constructionist perspective. A combination of research methodologies was used; a quantitative analysis to confirm gender differences in levels and patterns of service use; a qualitative analysis to gain an increased understanding of the factors affecting men's access; and a trial to test the application of the research findings. The clients and services of Arthritis Victoria were chosen as the setting for this research. The quantitative analyses were conducted on contingency tables and odds ratios and confirmed that men were under-represented as service users. The analyses also identified gender differences in patterns of service use. The qualitative analysis was based on a series of in-depth, semi-structured interviews. It was undertaken from a grounded theory approach to allow for the development of theoretical explanations grounded in the data. It was found that men's decisions to access chronic illness self management programs were strongly influenced by dominant social constructions of masculinity which constrained help-seeking and health management behaviour. However, the restrictive influence of hegemonic masculinity was progressively undermined by the increasing severity of the chronic condition until a crisis point was reached in terms of the severity of the condition or its impact on lifestyle. This resulted in a reformulation or rejection of hegemonic masculinity. The described conceptual framework was consistent for men from diverse social groupings, although it appeared less prominent in both younger and older men, suggesting that dominant social constructions of masculinity have the greatest influence on health decisions during the middle stage of adulthood when work and family obligations are greatest. The thesis findings informed the development of some guiding principles for reviewing the structure and delivery of chronic illness self management services for men. The guiding principles will have direct application in the planning of Arthritis Victoria programs, and implications for other chronic illness self management programs in Australia, and also in Western countries with a similar health and sociocultural setting to Australia.

Reconceptualising access in education policy : method and mindset

Enhancing access to education and knowledge is a long-held principle enshrined in education policy. Access to education offers leverage for educational attainment and achievement, at the individual and social levels. In policy, the term equates with concepts of inclusion, social justice and equity. Over the last decades, as education policy has responded to global social, cultural and economic reforms, concepts such as access have also undergone revision. This article revisits the relationship between access, education and knowledgemaking, in order to clarify the meaning of access in current education policies by reevaluating how access is constructed in policy and how the concept associates with other aspects of education. The research examines the concept of access in order to improve the efficacy of policy, opening the way for more systematic and transparent policy analysis and policy making centred on defining and delineating conceptual meanings such as access, as a basis for more targeted policy. Using evidence-based policy research, the article proposes a research process model based on the hierarchy of abstraction, to show that education policy requires systematic examination of key concepts as a fundamental step towards more clearly defined policy postulates that recognise and deal with contextual complexity of education policy. Defining and delineating the meaning of concepts such as access can help in the way that education policy contributes to guiding innovative knowledge construction.

Variations in vascular access flows in haemodialysis can depend on needle orientation

Introduction: While using the Transonic Qc[TM] machine to assess access flow in arteriovenous fistulae (AVF), we observed that when compared to antegrade arterial needle insertion, retrograde arterial needle insertion could regularly produce lower access flow measurements. This study sought to explore this phenomenon.

Method: 23 patients entered and 20 finished the study. Patient selection criteria included: functioning AVF and an adequate AVF length for either retrograde or antegrade arterial needle insertion. After ensuring stable and similar blood pressures, 3 flow measurements were taken during the first 2 hours on the same dialysis day of 3 consecutive weeks using antegrade needle insertion then were repeated on 3 further consecutive weeks using retrograde insertion.

Results: Overall, access flows measured with retrograde insertion were significantly lower by a mean difference of 107.15 ml/min (57-484 ml/min) than the flows measured with antegrade needle placement. In 5/20, 3 recorded minimal difference and 2 had a higher access flows during retrograde insertion. No recirculation was observed during either antegrade or retrograde needle insertion. The paired t-test showed that there was significant difference between the antegrade versus retrograde mean measurements (p = 0.005).

Conclusion: Although the sample size is small and the number of measurements limited, we conclude that access flows may be greater with an antegrade arterial orientation compared to flows recorded with a retrograde orientation. The phenomenon behind this conclusion is yet to be investigated. We suggest that when using the Transonic Qc[TM] access measurement device the arterial needle should always be in the same direction for each measurement for each individual patient.

Investigations of access for people with disability and older people

The phenomenon of access was investigated in regard to people with disability and older people. Access is described as a journey which involves navigation of numerous access opportunities and barriers and achievement of an access goal. While differences existed, numerous access issues and solutions are relevant to the two groups.