The early postnatal period : exploring women's views, expectations and experiences of care using focus groups in Victoria, Australia

Background: There is growing evidence from Australia and overseas that the care provided in hospital in the early postnatal period is less than ideal for both women and care providers. Many health services face increasing pressure on hospital beds and have limited physical space available to care for mothers and their babies. We aimed to gain a more in-depth understanding of women's views, expectations and experiences of early postnatal care.

Methods: We conducted focus groups in rural and metropolitan Victoria, Australia in 2006. Fifty-two people participated in eight focus groups and four interviews. Participants included eight pregnant women, of whom seven were pregnant with their first baby; 42 women who were in the postpartum period (some up to twelve months after the birth of their baby); and two partners. All participants were fluent in English. Focus group guides were developed specifically for the study and explored participants' experiences and/or expectations of early postnatal care in hospital and at home, with an emphasis on length of hospital stay, professional and social support, continuity of care, and rest. Discussions were audio-taped and transcribed verbatim. A thematic network was constructed to describe and connect categories with emerging basic, organizing, and global themes.

Results: Global themes that emerged were: anxiety and/or fear; and the transition to motherhood and parenting. The needs of first time mothers were considered to be different to the needs of women who had already experienced motherhood. The women in this study were generally concerned about the safety of their new baby, and lacked confidence in themselves as new mothers regarding their ability to care for their baby. There was a consistent view that the physical presence and availability of professional support helped alleviate these concerns, and this was especially the case for women having a first baby.

Conclusion: Women have anxieties and fears around early parenting and their changing role, and may consider that the physical availability of professional care providers will help during this time. Care providers should be cognisant of these potential issues. It is crucial that women's concerns and needs be considered when service delivery changes are planned. If anxiety around new parenting is a predominant view then care providers need to recognise this and ensure care is individualised to address each woman's/families particular concerns.

Habitual fish consumption does not prevent a decrease in LCPUFA status in pregnant women (the Seychelles Child Development Nutrition Study)

Information on the status of long-chain polyunsaturated fatty acids (LCPUFAs) in pregnancy and breast milk in very high fish-eating populations is limited. The aim of this study was to examine dietary intake and changes in fatty acid status in a population of pregnant women in the Republic of Seychelles. Serum docosahexaenoic acid (DHA) decreased significantly between 28-week gestation and delivery (n=196). DHA status did not correlate significantly with length of gestation and was not associated with self-reported fish intake, which was high at 527 g/week. In breast milk, the ratio of DHA to arachidonic acid (AA) was consistent with those observed in other high fish-eating populations. Overall the data suggest that high exposure to LCPUFAs from habitual fish consumption does not prevent the documented decrease in LCPUFA status in pregnancy that occurs as a result of foetal accretion in the third trimester of pregnancy.

Women's views of postnatal care in the context of the increasing pressure on postnatal beds in Australia

Background : Despite limited evidence evaluating early postnatal discharge, length of hospital stay has declined dramatically in Australia since the 1980s. The recent rising birth rate in Victoria, Australia has increased pressure on hospital beds, and many services have responded by discharging women earlier than planned, often with little preparation during pregnancy. We aimed to explore the views of women and their partners regarding a number of theoretical postnatal care ‘packages’ that could provide an alternative approach to early postnatal care.

Methods : Eight focus groups and four interviews were held in rural and metropolitan Victoria in 2006 with participants who had experienced a mix of public and private maternity care. These included 8 pregnant women, 42 recent mothers and 2 male partners. All were fluent in English. Focus groups explored participants’ experiences and/or expectations of early postnatal care in hospital and at home and their views of alternative packages of postnatal care where location of care shifted from hospital to home and/or hotel. This paper describes the packages and explores and describes what ‘value’ women placed on the various components of care.

Findings : Overall, women expressed a preference for what they had experienced or expected, which may be explained by the ‘what is must be best’ phenomenon where women place value on the status quo. They generally did not respond favourably towards the alternative postnatal care packages, with concerns about any shorter length of hospital stay, especially for first time mothers. Women were concerned about the safety and wellbeing of their new baby and reported that they lacked confidence in their ability to care for their baby. The physical presence and availability of professional support was seen to alleviate these concerns, especially for first time mothers. Participants did not believe that increased domiciliary visits compensated for forgoing the perceived security and value of staying in hospital. Women generally valued staying in hospital for the length of time they felt they needed above all other factors.

Key conclusions and implications for practice : Women were concerned about shortened postnatal length of hospital stay and these concerns must be considered when changes are planned in maternity service provision. Any moves towards shorter postnatal length of stay must be comprehensively evaluated with consideration given to exploring consumer views and satisfaction. There is also a need for flexibility in postnatal care that acknowledges women's individual needs.

A status report on women academic accountants in Australia

This paper reports the findings of a survey of the attributes, career satisfactions and aspirations of Australian Academic Women Accountants (AAWA). The survey sought information about personal characteristics, institutional role expectations and perceptions of gender-related issues involving recruitment, promotion and retention of AAWAs. The data provide not only an interesting insight into respondents' perceptions of a career in academic accounting, but also a comparative measure against which future progress of AAWAs can be evaluated. The paper makes suggestions for facilitating the career paths of AAWAs at both institutional and individual levels.

Severely compromised quality of life in women and those of lower socioeconomic status waiting for joint replacement surgery

Objective
To determine health-related quality of life (HRQOL), psychological distress, physical function, and self efficacy in persons waiting for lower-limb joint replacement surgery.

Methods
A total of 214 patients on a waiting list for unilateral primary total knee or hip replacement at a large Australian public teaching hospital completed questionnaires after entry to the list. HRQOL and psychological distress were compared with available population norms.

Results
Average HRQOL was extremely poor (mean ± SD 0.39 ± 0.24) and much lower (>2 SD) than the population norm. Near death-equivalent HRQOL or worse than death-equivalent HRQOL were reported by 15% of participants. High or very high psychological distress was up to 5 times more prevalent in the waiting list sample (relative risk 5.4 for participants ages 75 years and older; 95% confidence interval 3.3, 9.0). Women had significantly lower HRQOL, self efficacy, and physical function scores than men. After adjusting for age and sex, significant socioeconomic disparities were also found. Participants who received the lowest income had the poorest HRQOL; those with the least education or the lowest income had the highest psychological distress. Low self efficacy was moderately associated with poor HRQOL (r = 0.49, P < 0.001) and more strongly associated with high psychological distress (r = -0.55, P < 0.001).

Conclusion
Patients waiting for joint replacement have very poor HRQOL and high psychological distress, especially women and those from lower socioeconomic backgrounds. Lengthy waiting lists mean patients can experience extended and potentially avoidable morbidity. Interventions to address psychological distress and self efficacy could reduce this burden and should target women and lower socioeconomic groups.

Socioeconomic influences on women's eating behaviours

This thesis investigated the socioeconomic influences on women's eating behaviours. Results showed that women of low socioeconomic position not only perceived higher direct financial costs as a predominant barrier for consuming a healthy diet, but also a number of indirect or non-financial cost factors such as the perceived additional time costs involved in preparing and cooking healthy foods.

Nutrient and phytoplankton status of Lakes Purrumbete and Bullen Merri, western Victoria

The thesis investigates two adjacent volcanic maar lakes, with differences in chemical and biological properties. Lake Bullen Merri a brackish, phosphorous-limited lake that suffers from nuisance algal blooms and Lake Purrumbete a fresh, nitrogen-limited lake with diverse phytoplankton assemblage. Nutrient fluxes for both lakes are dominated by internal cycling.

Societal constructions of the psycho-legal notion of mental impairment in Victoria

This thesis explored the factors relevant to decision-making when the defence of mental impairment is raised in Victoria. Findings indicate that disorder type, crime outcome, and the relationship between victim and offender were significantly associated with verdict decisions, while offender gender did not play a significant role in responsibility decisions. The portfolio discusses the role of co-morbid psychopathology in the assessment and treatment of veterans with chronic PTSD by presenting four case histories.

The legal response to problem gambling in Victoria

The thesis analyses judgments from the higher criminal courts in Victoria involving problem gamblers charged with serious crimes, investigates actions brought by gamblers against gaming establishments in the civil courts and examines the legislation governing gambling in Victoria and the effectiveness of recently introduced harm minimisation measures.

Personal, social and environmental correlates of healthy weight status amongst mothers from socioeconomically disadvantaged neighborhoods : findings from the READI study

Background

Socioeconomically disadvantaged mothers are at high risk of obesity, yet the aetiology of obesity in this group remains poorly understood. The aim of this study was to examine the perceived personal, social and physical environmental factors associated with resilience to obesity among mothers from socioeconomically disadvantaged neighbourhoods.
Methods

Survey data were provided by a cohort of 1840 women aged 18-46 years with dependent children (aged 0-18 years) from 40 urban and 40 rural socioeconomically disadvantaged neighbourhoods across Victoria, Australia. Mothers responded to a number of questions relating to personal, social and environmental influences on their physical activity and eating habits. Mothers' weight status was classified as healthy weight (BMI: 18.5-24.99), overweight (BMI: 25-29.99) or obese (BMI: 30+).
Results

Mothers' weight status was bivariably associated with factors from all three domains (personal, social and physical environmental). In a multivariable model, mothers' perceived ability to make time for healthy eating (OR = 1.34) and physical activity (OR = 1.11) despite family commitments, and the frequency with which families ate healthy low-fat foods with mothers (OR = 1.28) remained significantly positively associated with healthy weight status. The frequency with which families encouraged eating healthy low-fat foods remained negatively associated (OR = 0.81) with weight status; ie greater encouragement was associated with less healthy weight status.
Conclusions

Drawing on the characteristics of mothers resilient to obesity might assist in developing intervention strategies to help other mothers in socioeconomically disadvantaged neighbourhoods to manage their weight. Such strategies might focus on planning for and prioritising time for healthy eating and physical activity behaviours, and including family members in and encouraging family mealtimes.

Sociodemographic and behavioural correlates of weight status among women with children living in socioeconomically disadvantaged neighbourhoods

Objective: To investigate sociodemographic and behavioural characteristics associated with weight status among women with children living in socioeconomically disadvantaged neighbourhoods.
Methods and procedures: A total of 1680 women aged 18–46 years, living in socioeconomically disadvantaged neighbourhoods with dependent children (aged 0–18 years), provided self-report data on height and weight and a range of sociodemographic and behavioural (for example, dietary intake, physical activity and time spent sitting) characteristics.
Results: Half of the women were classified as having a healthy weight (body mass index=18.5–25). Bivariable ordinal logistic regression analyses indicated that a healthy weight status was associated with a range of sociodemographic and behavioural characteristics. In a multivariable model, a healthy weight status among women was associated with being younger and unmarried, speaking a language other than English at home, having a medium or high level of education, and a partner with a high level of education, having a high household income, spending more time engaged in leisure-time physical activity and less time spent sitting, and having a lower consumption of soft drink.
Discussion: The present findings highlight that a considerable proportion of women with children living in disadvantaged neighbourhoods manage to maintain a healthy weight. Acknowledging the cross-sectional nature of this study, strategies aimed at helping women with children in socioeconomically disadvantaged areas to maintain their weight should focus on increasing physical activity, and reducing sitting time and soft drink consumption.