The value of asthma camps for young people in Victoria, Australia

Purpose: This paper investigates the impact of the Asthma Foundation of Victoria's educational camp program on children's knowledge of asthma and its management, their feelings about asthma, and their attitudes toward physical and social activities. Parents' observations of changes in their child's behaviour and attitudes are also reported.

Design and methods: This research was descriptive and applied. It used questionnaires at four stages (directly pre- and post- camp, three-four months and ten-15 months post-camp) of an asthma education camp program to assess child asthma knowledge levels. At three months post-camp, parental observations of children's attitudes and behaviours were assessed using a questionnaire. Children's feelings toward asthma were also assessed using a questionnaire pre- and post-camp.

Results: The children surveyed displayed a better knowledge of asthma and how to manage their condition immediately after the camp. This knowledge tended to return to pre-camp levels after ten months. The children also reported less anxiety and fear about their illness, a greater sense of wellbeing, and more confidence in participating in a whole range of physical and social activities. Many parents also noted positive changes in their children in terms of activities and asthma management at three months post-camp.

Clinical implications: Although there were limitations to sustaining knowledge gained in the asthma camping program, the camping experience provided a benefit for children in terms of promoting their mental and social wellbeing. When readers consider modernising asthma education (eg shorter camps, education in everyday social settings such as schools), they need to consider retaining the key ingredients of the more traditional camping program that supports good asthma management, wellbeing and social participation.

Weighing it up : thinking about the implications of school based obesity prevention initiatives

In this paper we explore the tensions that exist between two health promotion discourses prevalent in school based Health Education. We use one example from a widely used curriculum resource and one classroom episode to explore discourses related to obesity prevention, often described as an obesity epidemic by media and health professionals alike. Our argument is that these discourses work to produce the 'unhealthy other' that everyone is then in danger of becoming and in the process produce moral judgements and reinforce stereotypes about overweight and obese people. In so doing they run counter to health education and other discourses that seek to promote self-esteem and body acceptance in students no matter what their shape and size.

Are parental concerns about children's inactivity warranted, and are they associated with a supportive home environment?

This paper explores parental concern about children's activity levels and whether parents who are concerned about their child's activity provide a supportive environment, a sample of 615 parents of 5-6-year-old children and 947 parents of 10-12-year-old children completed a questionnaire. Just over 50% of parents reported they were concerned their child was not getting enough activity. Children of concerned parents were less active than those whose parents were not concerned. These findings suggest that parents who are concerned about their child's physical activity levels provided a less supportive environment for physical activity than parents who are not concerned. The challenge for public health will be to harness parental concerns and translate them into action.

Barriers to care for depressed older people : perceptions of aged care among medical professionals

The current study evaluated barriers to detection of depression among older people. Focus groups were conducted with 21 professional carers, 4 nurses, 10 general practitioners, and 7 aged care managers. The results demonstrated that care for older people is primarily focused on physical care. Further, staff resources, a lack of continuity of care, multiple co-morbidities, reluctance by older people to discuss depression, negative attitudes among carers, as well as a lack of skills all contributed to a failure to detect and treat depression. The implications of these findings for training programs for professional carers are discussed.

Partnerships and place : mobilising resources from outside

Partnerships facilitate sharing of resources and can create outcomes that are more than the sum of partners’ contributions. The concept of partnership has entered policy rhetoric and is urged as good practice, sometimes along with consideration of place. For example, Mears et al’s recent academic critique of health policy holds that modern health systems should have a sense of place and be partnership orientated, as well as being primary care based and pragmatic in adopting effective practice. It is easy to regard partnership as unequivocally a good thing, however this is a simplistic view that ignores issues such as power imbalances, self-seeking behaviour of partners and the often complex, resource intensive and sensitive process required to establish and sustain partnerships. Rural communities tend to have fewer resources available for the provision of services such as health and education than their metropolitan counterparts, and so could be expected to benefit from partnerships with outside services and resource providers. Factors such as distance and lack of power in many professional and political domains imply that rural communities are also more likely to encounter barriers in establishing and maintaining partnerships with metropolitan based partners.

There is a growing literature on the composition and outcomes of partnerships in a variety of contexts and settings, including rural place-based communities, but relatively little about the partnership process. Understanding this process is a key step in designing policy at the system level and in developing and maintaining partnerships at the grass roots level. This paper makes a contribution to this gap by presenting lessons from the analysis of rural-urban partnerships around health services for two rural Tasmanian communities.

Factors affecting the offer of pulmonary rehabilitation to patients with chronic obstructive pulmonary disease by primary care professionals : a qualitative study

Aim: To explore health professionals’ experiences of barriers and facilitators to referring patients for pulmonary rehabilitation in a primary care setting.

Background: Pulmonary rehabilitation involves a multidisciplinary teamwork approach to improving
the quality of life for people with chronic obstructive pulmonary disease. This study aimed to find out about health care professionals’ experiences when referring patients. Reports suggest that a health care professional’s attitude towards a treatment affects the willingness of patients to accept advice.

Methods: Five focus group interviews were undertaken with 21 health professionals from North Midlands, UK. Data were analysed using a thematic analysis drawing on the techniques of grounded theory.

Findings: Chronic disease management has been delegated to Practice Nurses in many cases leaving some nurses feeling unsupported and some General Practitioners feeling deskilled. Problems with communication, a lack of adequate and timely local service provision, a difficult referral process, time pressures and lack of information were barriers to health care professionals making an offer of pulmonary rehabilitation. An explanatory model is proposed to describe how addressing barriers to referral may improve health care professionals views about pulmonary rehabilitation and therefore may mean that they present it in a more positive manner.

Sporting clubs, alcohol and young people : enduring tensions and emerging possibilities

This paper examines data from a research project that investigated the cultural drivers of drinking in 14-24 year-old Australians, funded by Drinkwise Australia and the Department of Health and Ageing. At the same time that we were working on this project a moral panic about young people, risk and binge drinking had once more energised public debate. Prominent here was the highly politicised imputation of a strategic taxation levy on ready to drink products (alcopopos). This qualitative, interview-based project examined two separate but related aspects of young people's alcohol use: the roles played by sporting clubs, as community hubs, in shaping young people's use of alcohol: and young people's drinking biographies over different phases of their lives. This paper will focus on the sporting club study to discuss issues related to the positioning and serving of alcohol in the relation to young people. As part of the study, we conducted interviews with club administrators and young people in a range of sporting clubs. Insights from the study give rise to the potential for clubs to play an active and influential role in helping young people create positive/responsible approaches to alcohol consumption.

The epidemiology workforce : are we planning for the future?

Epidemiology has a central role in public health practice, education and research, and is arguably the only discipline unique to public health. A strong perception exists among epidemiologists in Australia that there is a substantial shortage in epidemiological capacity within the health workforce and health research, and that there are few graduates with sufficient high-level epidemiological training to fill the educational and leadership roles that will be essential to building this capacity. It was this concern that led the Australasian Epidemiological Association (AEA)--the peak professional body for epidemiologists in Australia and New Zealand--to convene a working group in 2007 to assess and address these concerns. This article summarises the key training challenges and opportunities discussed within this group, and the larger organisation, with the intention of stimulating greater public debate of these issues.

Women's views and outcomes of an educational intervention designed to enhance psychosocial support for women during pregnancy

Background: Identification of psychosocial issues in pregnant women by screening is difficult because of the lack of accuracy of screening tools, women's reluctance to disclose sensitive issues, and health care practitioner's reluctance to ask. This paper evaluates if a health professional education program, a new (ANEW) approach, improves pregnant women's ratings of care and practitioner's listening skills and comfort to disclose psychosocial issues.

Methods: Midwives and doctors from Mercy Hospital for Women, Melbourne, Australia, were trained from August to December 2002. English-speaking women (< 20 wks' gestation) were recruited at their first visit and mailed a survey at 30 weeks (early 2002) before and after (2003) the ANEW educational intervention. Follow-up was by postal reminder at 2 weeks and telephone reminder 2 weeks later.

Results: Twenty-one midwives and 5 doctors were trained. Of the eligible women, 78.2 percent (584/747) participated in a pre-ANEW survey and 73.3 percent (481/657) in a post-ANEW survey. After ANEW, women were more likely to report that midwives asked questions that helped them to talk about psychosocial problems (OR 1.45, CI 1.09–1.98) and that they would feel comfortable to discuss a range of psychosocial issues if they were experiencing them (coping after birth for midwives [OR 1.51, CI 1.10–2.08] and feeling depressed [OR 1.49, 1.16–1.93]; and concerns relating to sex [OR 1.35, CI 1.03–1.77] or their relationships [OR 1.36, CI 1.00–1.85] for doctors).

Conclusions: The ANEW program evaluation suggests trends of better communication by health professionals for pregnant women and should be evaluated using rigorous methods in other settings.

Developing the whole child? Tensions between sport and study in Australian independent schools

This paper reports on a research project that set out to examin the relationship between students' involvement in school co-curricular activities and their academic performance.  The warrant for the study emerges out of consistent claims made about the provision of co-curricular, naming sporting, activities and the development of a more rounded and successful student.  The primary question being asked here was: 'Are student's academic performances, as measured by their results for tertiary entrance in their final year of school, improved or reduced by their participation in co-curricular activities?'  The study used a mix of quantitative and qualitative methods to interrogate this relationship.

History of contact and change in the Goroka Valley, Central Highlands of New Guinea, 1934-1949

The thesis traces the interaction of the Goroka Valley people with European and coastal New Guinean intruders during the pacification stage of contact and change. In this 15 year period the people moved from a traditional subsistence culture to the threshold of a modern, European-influenced technological society. The contact experiences of the inhabitants of the Valley and the outsiders who influenced them are examined, using both oral and documentary sources. A central theme of this study is the attempts by Europeans and their coastal New Guinean collaborators to achieve the pacification of a people for whom warfare has been described as 'the dominant orientation'. The newcomers saw pacification as being inextricably linked with social, economic and religious transformation, and consequently it was pursued by patrol officers, missionaries and soldiers alike. Following an introductory chapter outlining the pre-contact and early-contact history of the Goroka Valley people, there is a discussion of the causes of tribal fighting in Highlands communities and two case studies of violent events which, although occurring beyond the Goroka Valley, had important consequences for those who lived within its bounds. The focus then shifts to the first permanent settlement of the agents of change -initially these were coastal New Guinean evangelists and policemen - and their impact on the local people. A period of consolidation is then described, as both government and missions established a permanent 'European presence in the Valley'. This period was characterised by vigorous pacification coupled with the introduction of innovations in health and education, agriculture, technology, law and religion. The gradual transformation of Goroka Valley society as a result of the people's interaction with the newcomers was abruptly accelerated in 1943, when many hundreds of Allied soldiers occupied the Valley in anticipation of a threatened Japanese invasion. Village life was disrupted as men were conscripted as carriers and labourers and whole communities were obliged to grow food to assist the Allied war effort. Those living close to military airfields-and camps were subject to Japanese aerial attacks and the entire population was exposed to an epidemic of bacillary dysentery introduced by the combatants. However the War also brought some positive effects, including paradoxically, the almost total cessation of tribal fighting, the construction of an ail-weather airstrip at Goroka which ensured its future as a town and administrative and commercial centre, and the compulsory growing of vegetables, coffee, etc, which laid the foundations for a cash economy and material prosperity. The final chapter examines the aftermath of military occupation, the return of civil administration and the implementation of social and economic policies which brought the Goroka Valley people into the rapid-development phase of contact. By 1949 Gorokans were ready to channel their aggressive energies into commercial competitiveness and adopt a cash-crop economy, to accept the European rule of law, to take advantage of Western innovations in medicine, education, transport and communications, to seek employment opportunities at home and in other parts of the country and to modify their primal world view with European religious and secular values. A Stone Age people was in process of being transformed into a modern society.

Factors influencing the impact of secondary exposure to trauma

The research found significant relationships between secondary exposure to client trauma and symptoms associated with secondary traumatic stress and vicarious trauma in a sample of community mental health clinicians. The research supports developmental conceptualisations of the relationships between these constructs and burnout, and identifies potential individual vulnerability and protective factors. The portfolio explores the impact of childhood maltreatment from an attachment theory perspective. Four clinical cases are presented illustrating the clinical relevance of the impact of childhood maltreatment and attachment disturbance, and the complexities associated with current attachment classification systems and differential diagnosis.