Problem-based learning and masculinities : unique opportunities for Mr. Fix It? Well, maybe

I watched a smoker of 30 years being admitted to the Coronary Care unit following an acute Myocardial Infarction (heart attack). The message from the male clinician was simple, accurate, but somewhat behaviourist: " the death of part of your heart muscle is the result of your smoking, if you don’t stop smoking the damage will continue and you will die." A global, proactive and humanistic consultation demonstrating an understanding of the man’s addiction to a legal and accessible drug and illuminating prevention strategies may have been more appropriate. Maybe the interaction was about competing masculinities, the risk taker and the problem solver. The irony? As I left the hospital that night I observed the same clinician strategically positioned in a secluded hospital doorway drawing heavily on a cigarette. Hypocrite? No, invincible late 20’s male? Maybe. Smoking was someone else’s problem – at least today.

In my 16 years as a clinician such scenarios are common. Clinical practice based predominantly on problem solving potentiates hegemonic masculine approaches to treating men in clinical practice, often justified by limited health resources and increasing patient acuity. Ironically, Problem-based Learning (PBL) curriculums commonly used in health sciences higher education encourages, nurtures and rewards such problem solving approaches. As a teaching academic with current clinical practice it occurs to me that health science education and PBL has an opportunity if not obligation to empower clinicians to establish holistic approaches to male health presentations.

This paper explores the interconnections of Problem-based Learning (PBL) curriculums, health promotion, male nurses’ health-related behaviours and the implications and specificities of masculinity. The pilot study offers an insight into the perceptions of three male nurses that completed undergraduate nursing studies in PBL curriculums. The data obtained introduces some connections that could be illuminated by further research.

University campus settings and the promotion of physical activity in young adults: lessons from research in Australia and the USA

Describes the decreasing prevalence of physical activity participation over the young adult years and the patterns of difference in the physical activity habits of young men and young women. Physical activity habits during the young adult years are likely to be important influences on habitual physical activity during overall adult life and, consequently, have significant implications for long-term health outcomes. Tertiary-education campuses are settings where there exist important yet partially neglected opportunities to influence the physical activity habits of young adults. Uses examples from Australia and the USA are used to characterise relevant contextual and practical aspects of the campus setting and the physical activity promotion opportunities that it may provide. Reviews findings from two campus-based physical activity intervention studies. In conclusion, identifies a set of issues that require further research.

School, parent, and student perspectives of school drug policies

Background: Schools use a number of measures to reduce harmful tobacco, alcohol, and drug use by students. One important component is the school's drug policy, which serves to set normative values and expectations for student behavior as well as to document procedures for dealing with drug-related incidents. There is little empirical evidence of how policy directly or indirectly influence students' drug taking. This study compares how effectively schools communicate school drug policies to parents and students, how they are implemented, and what policy variables impact students' drug use at school and their perceptions of other students' drug use at school.

Methods: Data were obtained from 3876 students attending 205 schools from 2 states in the United States and Australia, countries with contrasting national drug policy frameworks. School policy data were collected from school personnel, parents, and students.

Results: Schools' policies and enforcement procedures reflected national policy approaches. Parents and students were knowledgeable of their school's policy orientation.

Conclusions: When delivered effectively, policy messages are associated with reduced student drug use at school. Abstinence messages and harsh penalties convey a coherent message to students. Strong harm-minimization messages are also associated with reduced drug use at school, but effects are weaker than those for abstinence messages. This smaller effect may be acceptable if, in the longer term, it leads to a reduction in harmful use and school dropout within the student population.

Prevalence of genital human papillomavirus DNA in a sample of senior school-aged women in the Australian Capital Territory

Background: A strong association between persistent infection with oncogenic types of human papillomavirus (HPV) and cervical cancer is well established. Small numbers of international studies examining adolescent HPV infection and the risk factors associated are published, but there is currently no evidence on the prevalence and risk factors for HPV in an Australian, sexually active female adolescent population. Methods: To provide prevalence and risk factors for HPV in a female sexually active, senior high school population in the Australian Capital Territory (ACT), a convenience sample of 161, 16–19-year-old females attending a senior high school was evaluated. The sample formed part of a larger sample recruited for a study of sexually transmitted infections and blood-borne viruses in senior high school students. A clinical record was used to collect information about sexual and other risk behaviours, while self-collected vaginal swabs were tested for HPV DNA detection and genotyping using polymerase chain reaction. Results: The prevalence of HPV DNA in this sample overall was 11.2%, with multiple genotypes in 38%. No statistically significant associations were found between HPV DNA and the number of male partners, age of coitarche, time since first sexually active, condom use, smoking or alcohol intake. Conclusions: This is the first Australian study that has examined the prevalence and risk factors for genital HPV in this demographic group. The prevalence of HPV infection is slightly lower than reported in similar age groups overseas and is lower than other Australian studies in older women and those attending sexual health centres. Of HPV-positive young women, high-risk genotypes were found in over half, with more than one-third of HPV existing as multiple genotypes. Large community-based prevalence studies are needed to guide the development of recommendations for the vaccination of young women against HPV and to support other health promotion initiatives.

Teaching literacy in the new media age through the arts

Many school literacy practices often ignore youths' creativity in the 'new media age'. School curricula often do not acknowledge the range of skills adolescents acquire outside formal education. Youths' new multi- modal social and cultural practices - as they fashion themselves creatively in multiple modes as different kinds of people in 'New Times' - points to the liberating power of new technologies that embrace their imagination and creativity. In two middle years classes, adolescents' creativity was recognised and validated when they were encouraged to re-represent curricular knowledge through multi-modal design (New London Group 1996). The results suggest the changed classroom habitus produced new and emergent discursive and material practices where creativity emerges as capital in an economy of practice. Recommendations are put forth for schools to recognise adolescents' creativity - that often manifests itself through their cultural and social capital resources - as they integrate and adapt to the new affordances acquired through their out-of-school literacy practices.

Wait no more : the use of private dental services by welfare recipients in Australia

Dental services in Australia are available both privately and publicly. However, access to public dental services, like access to public hospital services for non-urgent treatment, is subject to a considerable waiting period. Moreover, access to public dental services is restricted to certain categories of welfare beneficiaries who qualify for a health care card. Because of the waiting time for public treatment, there is a frequent call for more public dental resources. This paper addresses the issue of what the waiting time for public dental services represents. One view largely confirmed by our research is that state governments are using the waiting time as a way of trying to push more and more people into the private sector. We find that more and more health care card holders are using the
private sector for dental services.

Area variation in recreational cycling in Melbourne : a compositional or contextual effect?

Objective: To examine whether compositional and/or contextual area characteristics are associated with area socioeconomic inequalities and between-area differences in recreational cycling.

Setting: The city of Melbourne, Australia.

Participants: 2349 men and women residing in 50 areas (58.7% response rate).

Main outcome measure: Cycling for recreational purposes (at least once a month vs never).

Design: In a cross-sectional survey participants reported their frequency of recreational cycling. Objective area characteristics were collected for their residential area by environmental audits or calculated with Geographic Information Systems software. Multilevel logistic regression models were performed to examine associations between recreational cycling, area socioeconomic level, compositional characteristics (age, sex, education, occupation) and area characteristics (design, safety, destinations or aesthetics).

Results: After adjustment for compositional characteristics, residents of deprived areas were less likely to cycle for recreation (OR 0.66; 95% CI 0.43 to 1.00), and significant between-area differences in recreational cycling were found (median odds ratio 1.48 (95% credibility interval 1.24 to 1.78). Aesthetic characteristics tended to be worse in deprived areas and were the only group of area characteristics that explained some of the area deprivation differences. Safety characteristics explained the largest proportion of between-area variation in recreational cycling.

Conclusion: Creating supportive environments with respect to safety and aesthetic area characteristics may decrease between-area differences and area deprivation inequalities in recreational cycling, respectively.

Contemporary PE reform in China : teachers' talk

Among the many changes occurring across Chinese society in the early phase of Y2K is the construction and implementation of a new physical education (PE) curriculum. Not unlike recent changes in Australia, New Zealand and the UK, this process has seen a heightening of the profile of health. Presented within a wider framework for making the school curriculum more relevant, PE is more closely aligned with China's emerging health concerns around young people. Foremost here are burgeoning social anxieties about decreased levels of physical activity, dietary practices, risk-taking tendencies, and a general decline of social cohesion/connection across the profile of contemporary youth. This paper reports on a study undertaken to explore the experiences of Chinese PE teachers as they engage with the new curriculum.

The data reveals a number of structural, personal and cultural factors that work against teachers taking up the opportunities presented in the new curriculum. Prominent here are; low professional status, an expanding generation gap, lack of training and the grip of deeply rooted cultural values. Juxtaposed against the like experiences of PE teachers in Australia and the UK the paper concludes with practical recommendations for nurturing curriculum change in China.

General practitioner and the control of sexually transmissible infections

Sexually transmissible infections (STIs), one of the major preventable health problems affecting the Australian population, are often asymptomatic and, if undetected, can cause sub-fertility, infertility and chronic morbidity. In addition to these significant and costly consequences, STIs increase the risk of transmission of HIV. Given that 80% of Australian patients attend their General Practitioner (GP) each year, GPs are well placed to have a significant impact on STI transmission by diagnosing and treating both asymptomatic and symptomatic disease. Good professional practice would suggest that all GPs will undertake certain actions when they are consulted by a patient who either has symptoms of an STI or who appears to be at risk of acquiring an STI. This expectation is based on the premise that all GPs share the same detailed knowledge of STI risk factors and symptoms. It assumes that they will have no difficulty in eliciting such information from the patient, that the patient will comply with STI testing and treatment and that the patient will return for follow-up, to ensure that they and their sexual partners have been adequately treated. Given the constraints of the real world in which general practice exists, the sensitive nature of sexual health, and the stigma associated with STIs, there are many barriers to achieving such an outcome. My own previous research has highlighted some of the difficulties experienced by GPs in the area of STI control. This study has used data from four different sources (policy and stakeholder documents, literature, key informant interviews and my own past research) to examine ideal practice and actual practice in the prevention and treatment of STIs. A number of discrepancies were identified, and from these arose a series of recommendations for ways of making STI control in general practice less complex. To ensure that the results of the study were firmly embedded in the reality of general practice, comments on the recommendations were sought from GPs employed in a variety of practice settings, including those with low STI caseloads. These comments were used to modify the recommendations to ensure they would offer a practical and effective contribution to STI control in Victoria.

Lesbian and gay experiences of primary care in one borough in North London, UK

This paper reports the findings of a research study which explored the experiences of lesbians and gay men in relation to primary care services in general practice in a multiracial borough in North London, UK. The research took a qualitative approach and used several methods including a literature review, interviews with stakeholders (n = 6), focus group discussions (n = 27) and completion (n = 42) of a survey distributed to lesbians and gay men locally. The process facilitated the development of a grounded theory. The important themes to emerge were finding a GP and coming out, sexual health issues, mental health issues and communication with the GP. Given the high level of mobility among this population, there were problems in maintaining continuity of care, and a lack of protocols to facilitate the sharing of knowledge between patients and practitioners while reducing reliance on heterosexual assumptions. There were clear differences between the treatment of women and men in relation to sexual health, and neither approach could be said to be patient centred or inclusive of diversity of need. The fact that many informants accessed alternative sources of healthcare indicated that they were concerned to promote and maintain their health and wellbeing in a holistic manner. The lack of transparent protocols within general practice inhibited some informants from being as open and honest about their sexuality with their GPs as they were with their families or their employers. The findings highlight (1) the need for organisational development within primary care to improve sensitivity to the needs of lesbians and gay men; (2) the value of research to engage with the social experiences of lesbians and gay men; (3) the importance of engaging with the differing experiences of lesbians and gay men in relation to sexual health concerns.

Participation, relational justice and social identity in cervical cancer screening

Extending existing health literature by drawing on social and community psychology, this thesis represents the first attempt to explore the conceptualisation of 'participation' in cervical cancer screening. Quantitative and qualitative findings suggested that women's experiences of 'patient participation' and 'voice opportunity' were important and related to various social processes and variables in this health context. Using four case studies, the professional portfolio demonstrates a biopsychosocial approach to assessment and intervention as used by a provisional health psychologist working with clients with intellectual disabilities in order to promote sexual health.