Barriers to effective management of depression in general practice

Objective: The aim of this study was to investigate the effects of prior general practice training in mental health and practice location on general practitioner (GP) attitudes toward depression, self-confidence in assessing and treating depressed patients, identification of doctor, patient and practice barriers to the effective care of depressed patients in general medical practice and GP-reported current clinical practice.

Method: Fifty-two (out of 123) Divisions of General Practice that responded to an invitation to participate in the study distributed 608 anonymous surveys to a representative sample of GPs; 420 (69%) were returned. The questionnaire focused on current clinical practice, perceived barriers to care of depressed patients and doctors' self-efficacy for assessing and treating depressed patients. It also consisted of two scales, based upon previous research, designed to assess doctors' attitudes towards depression and depressed patients.

Results: General practitioners who had undertaken mental health education and training more often used non-pharmacological treatments (p = 0.00), as did female GPs (p = 0.00). Male GPs (p = 0.00) and those in rural settings (p = 0.01) more often prescribed medication for depression. Those without mental health training more often identified incomplete knowledge about depression as a barrier to its effective management (p = 0.00). Urban-based GPs (p = 0.04) and those with prior mental health training (p = 0.00) were more confident in the use of non-pharmacological treatments. Female GPs without mental health training were the least confident in the use of these methods (p = 0.01). Overall, GPs with mental health training were more positive in their attitudes toward depression and their treatment of these patients (p = 0.00). Female GPs appeared more positive in their attitudes toward depression than male GPs (p = 0.01), although the results were not entirely consistent.

Conclusions: Participation in mental health training by GPs appears to be related to their attitudes toward depressed patients and to their confidence and abilities to diagnose and manage the common mental disorders effectively.

Combating homophobia : preliminary results of a school-based program to reduce discrimination against same-sex attracted youth

Two key determinants of mental health are (a) freedom from discrimination and (b) social connectedness. Same-sex attracted youth who are subjected to violence and discrimination, or who experience homophobia in their everyday lives are at greater risk of mental health problems, including suicidal thoughts and behaviours. As one of the most significant sites of homophobia is the school, a 6-week school-based program designed to help students explore their attitudes to gays and lesbians was developed, called “Pride & Prejudice”. In order to evaluate the usefulness of the program, students’ attitudes were measured before and after their participation. Variables assessed were: beliefs about gender roles, social desirability, attitudes to gay men and lesbians, social connectedness, self-esteem, and attitudes to race. Attitudes towards gay men held by students were significantly more positive after the program, and the level of attendance during the program significantly predicted > this change. A significant positive change also occurred in attitudes towards lesbians. Process evaluation showed that students generally viewed the program positively. From this preliminary data, it can be concluded that school-based programs delivered to individual classes in which students are given the opportunity to explore their attitudes towards lesbians and gay men are likely to lead to a significant reduction in homophobia. Health-promoting schools now have available to them an effective tool for promoting opportunities for students to reflect on their attitudes towards gay men and lesbians, and other aspects of “social diversity”. It is hoped that school-wide implementation of such a program will eventually lead to a reduction in the discrimination same-sex attracted youth often experience (either directly, or indirectly), and improve the social-connectedness of all students.

Vietnamese-born health professionals : negotiating work and life in rural Australia

Introduction: Australia is a culturally diverse nation due to migrants from a wide variety of countries creating a multicultural society. The health professions are highly valued by the younger generation of overseas-born migrants who have acculturated into Australian society; many have chosen health care as their profession in Australia. However, most migrants settle in metropolitan areas and young health professionals may find working in rural or remote Australia culturally and professionally highly challenging. The present study of migrant health professionals examined the life experiences and acculturation strategies of Vietnamese-born health professionals working and living in rural Australia. Objectives: The two main study objectives were to: (1) examine aspects of the acculturation of overseas-born and Australian-trained health professionals in the Australian health discourse; and (2) identify key coping strategies used by them when in working in the rural context.

Methods: Six overseas-born, Australian-trained health professionals were invited to participate in this qualitative study using a snowball sampling technique. The participants were all born in Vietnam and had experienced working in rural Australia. They included three medical doctors, a dentist, a physiotherapist and a nurse. The interviews were recorded and four participants also provided additional written responses to some of the open-ended interview questions. The interview data were transcribed and later coded for thematic analysis. Topics and themes that emerged focused on the issues and strategies of acculturation to the rural health context.

Results: The study showed that the acculturation process was affected by the participants’ views about and attitudes towards working in an Australian rural context. The study identified these essential strategies used by the participants in adapting to a new workplace: collaborating, distancing, adjusting, repairing, and accommodating.

Conclusion: The study provides insights into the lives of these health professionals in a rural context, and particularly their experience of cultural shock and the coping strategies they may use. A need is identified for a larger study to inform recruitment and retention of these health professionals to rural Australia, and to assist universities to prepare such students and their clinical supervisors for rural placements.

Migrant youth, cultural identity and media representation

The current social climate of heightened intercultural tensions in culturally pluralist societies such as Australia highlights the need to develop a more nuanced understanding of the complex cultural adjustment processes  encountered by migrant youth in developing and articulating a sense of  national belonging, To this end, this chapter examines migrant settlement experiences as a 'process by which individuals and groups ... maintain their cultural identity while actively participating in the larger societal framework' (Karac 2001). Research into these critical aspects of integration and  acculturation examines identity formation as a cultural process of  renegotiating individual and group identity, and focuses on concepts of belonging, recognition and self-respect (Berry '997). While cultural factors are considered critical indicators of successful integration into the host community, insufficient research has been conducted into the particular processes of group and individual identity formation that take place amongst migrant youth. In the case of Australia, this process has been made  particularly difficult for some cultural groups due to the contemporary resurgence of populist and exclusionary discourses of national identity. In such a context, the construction of identity amongst migrant youth is all the more challenging, especially when this process exhibits notions of dual attachment, hybridity and difference. For migrant youth, the engagement with different social institutions such as family, school and wider societal networks often affects the processes of identity 'formation that are inherently  dynamic and 'necessarily multiple and fluid' (Noble & Tabar 2002, pp.I28). Negotiating life in-between cultures, youths from migrant backgrounds experience identity construction as a highly contested territory.

Cultural identity is a central issue for immigrants, regardless of how much time has elapsed since leaving their country of origin. This issue is particularly salient for first- and second-generation1 migrant youth, who negotiate identity space comfortably alongside, in opposition to, or more commonly, somewhere in between, their immigrant parents' conceptions of culture and the receiving culture in which they live. Unlike their native peers,  the children of immigrants arc exposed to intra-ethnic and inter- ethnic   dynamics and experiences in their journey towards cultural identity formation. These experiences are complex and diverse, and are navigated within multi- layered ethnic, racial, familial, gendered, socioeconomic and educational  contexts.

The chapter begins by providing theoretical frameworks for conceptualising  cultural diversity and cultural identity. It then examines how migrant youth  negotiate cultural identity in the public realms of family networks and school  environments and how these translate into key educational and behavioural  outcomes. It will draw on some qualitative snapshots as a way of illustrating  shifting migrant youth attitudes towards society, school and culture.

Why there is reason to remain sceptical of Durston's scepticism

In this reply I argue that Durston's defence of his argument from the complexity of history ought to be unacceptable to the theist as it undermines not only common theistic attitudes towards God, such as gratitude and praise, but also the rationality of our ordinary moral practices.

Declining participation in computing education : an Australia perspective on the "gender and lT" problem

Participation in post-compulsory computing education has declined over recent years, both in the senior years of secondary school and at university. This trend has been observed in most developed countries, despite reported and projected skills shortages in Information Technology (IT) industries. Within the computing education enrollment mix, girls and women continue to be under-represented and recent years have seen female participation fall even more rapidly than that of males. This article reports on findings of an Australian study which explored secondary school students’ beliefs about and attitudes towards computing education and careers in IT. Factors that might discourage girls in particular from pursuing post-compulsory computing education and careers are discussed, along with broader implications for school education in an era when information and communication technologies are an integral part of our daily lives. Findings include the persistence among both boys and girls of inaccurate and outdated views of the field of IT and low expectations of both school IT curricula and pedagogy in terms of their relevance and interest for students. Many of the issues identified as discouraging students in general from pursuing computing education appear to have a greater discouraging effect on girls, and this is compounded by stereotypical views of the field as male-dominated and unwelcoming to women and girls.

Intersection of autonomy and social control : negotiating teenage motherhood

Contrary to popular belief, teenage mothers are a declining proportion of birthing women; however they receive much negative public attention. Of particular public concern is the high cost of supporting teenage mothers, in terms of financial, health and welfare resources. Historically, the typical founding mother of white Australia was single, but post-war changes in the family structure incorporated the expectation that children be born into two-parent households with the male as the breadwinner. Policy changes in the seventies saw the introduction of the Sole Parents Pension which meant that many birthing teenage women could choose to keep their infants rather than have a clandestine adoption or an enforced marriage. The parenting practices of teenage mothers have been criticised for being less than optimal, and mother and child are reported as being disadvantaged cognitively, psychosocially, and educationally. One widespread nursing service which provides support for new mothers in Victoria is the Maternal and Child Health Service; however, teenage mothers appear reluctant to use such services. Why this should be so became an important question for this research, since little is known about the parenting practices of teenage mothers. This study therefore sought to explore mothering from the perspective of five sole supporting teenage mothers each of whom had a child over six months of age. The research methodology took an interpretive ethnographic approach and was guided by feminist principles. The data were collected through repeated interviewing, participant observation, informal discussions with key informants, field notes and journalling. Data analysis was aided by the use of the software, program NUD-IST. It was found that the young women in this study each chose to give birth with full realisation that their existence was dependent on the Welfare State. Unanticipated, however, were the many structural barriers which made their lives cataclysmic, but these reinforced their determination to prove themselves worthy and capable mothers. The young women negotiated motherhood through a range of social supports and through maternal practice. Unquestionably, their social dependency on the welfare system forced them into marginal citizen status. Moreover, absolute and intrinsic poverty levels were experienced, brought about by inadequate welfare payments. Formal support agencies, such as the Maternal and Child Health nurses were rarely approached to provide childrearing support beyond the initial months following birthing, since the teenagers' basic needs such as shelter, food and clothing took precedence over their parenting needs. Additionally, some nurses were perceived to hold judgmental attitudes towards teenage mothers. It was far easier to forestall confrontation with nurses and the other 'older' women clientele by avoiding them. Thus XI they turned to charitable agencies who provided a safety net in the form of emergency supplies of money, food, or equipment. Informal networks of friends provided alternative modes of support when family help failed to materialise. The children, however, provided the young women with an opportunity to transform their lives by breaking free of the past, and by creating a new, mature existence for themselves. Despite being abandoned by family, friends, lovers and society, in the privacy and isolation of their own homes, they attempted to provide a more nurturing environment for their children than they themselves had received. Each bestowed unconditional maternal love on the child and were rewarded through the pleasures of watching their children grow and develop into worthwhile individuals. The children became the focus of their attention and their reason for living. In the course of their welfare dependency, the young women became public property, targets of surveillance, and were subjected to stigmatising and condescending public attitudes wherever they went. In this way, it was evident that they were an oppressed group, but each found ways of resisting. Rather than focussing on their oppressive or disabling lives, or dwelling on their disadvantaged status, the young women sought their identities as mature women through motherhood and by demonstrating that they could do this important job well. Through motherhood their lives had meaning and a sense of purpose. The thesis concludes that motherhood in the teenage years is difficult. However, if appropriate supports are made available, teenage mothers need be no different from non-teenage mothers. But with state resources shrinking, and their own resources limited, teenage mothers are disadvantaged. In some ways, this study showed that all levels of support were inadequate, although those provided through the charitable organizations were seen to be the most appropriate. This reflects the current policy of economic rationalism adopted by most Western liberal democracies in the 1980s and 1990s and no less by the former Keating Labor Government in Australia.

Computing in a social context : gender difference in participation

The thesis reviews the literature relating to girls and computing within a framework which is structured around three specific questions. First, are there differences between girls and boys in their participation in class computing activities and/or in non-class computing activities? Second, do these differences in participation in computing activities have broader implications which justify the growing concern about the under-representation of girls? Third, wahy are girls under-represented in these activities? Although the available literature is predominantly descriptive, the underlying implicit theoretical model is essentially a social learning model. Girl's differential participation is attributed to learned attitudes towards computing rathan to differences between girls and boys in general ability. These attitudes, which stress the masculine, mathematical, technological aspects of computing are developed through modelling, direct experience, intrinsic and extrinsic reinforcement and generalisation from pre-existing, attitudes to related curriculum areas. In the literature it is implicitly assumed that these attitudes underlie girl's decisions to self-select out of computing activities. In this thesis predictions from a social learning model are complemented by predictions derived from expectancy-value, cognitive dissonance and self-perception theories. These are tested in three separate studies. Study one provides data from a pretest-posttest study of 24 children in a year four class learning BASIC. It examines pre- and posttest differences between girls and boys in computing experience, knowledge and achievement as well as the factors relating to computing achievement. Study two uses a pretest-posttest control group design to study the gender differences in the impact of the introduction of Logo into years 1, 3, 5 and 7 in both a coeducational and single-sex setting using a sample of 222 children from three schools. Study three utilises a larger sample of 1176 students, drawn from three secondary schools and five primary schools, enabling an evaluation of gender differences in relation to a wide range of class computing experiences and in a broader range of school contexts. The overall results are consistent across the three studies, supporting the contention that social factors, rather than ability differences influence girls' participation and achievement in computing. The more global theoretical framework, drawing on social learning, expectancy-value, cognitive dissonance and self-perception theories, provides a more adequate explanation of gender differences in participation than does any one of these models.

Tariff protection and politics : Castlemaine 1870-1901

This study, set within the contextual background of Victorian politics, ‘seeks to identify the economic, political and social implications of tariff protection for the Castlemaine region from 1870-1901. The introduction of the Victorian tariff in 1865 precipitated a reversal of earlier attitudes towards protection by politicians and their constituents. Reasons are sought for changes in the perceptions of the Castlemaine electorate and its political representatives towards the tariff between 1870 and Federation. An examination has been made of the role of the tariff in the creation of employment in the region’s primary and secondary industries together with its influence on politicians, primary and secondary industry leaders and workers. Also explored is the relative impact of the tariff on the economic performance of Castlemaine industries, whether producing for export or domestic markets.

Perceptions and experiences of taking oral hypoglycaemic agents among people of Pakistani and Indian origin : qualitative study

Objective:  To explore British Pakistani and British Indian patients’ perceptions and experiences of taking oral hypoglycaemic agents (OHAs).
Design : Observational cross sectional study using in-depth interviews in English or Punjabi.
Setting and participants : 32 patients of Pakistani and Indian origin with type 2 diabetes, recruited from primary care and community sources in Edinburgh, Scotland.
Results : Respondents reported complex and ambivalent views about OHAs, which reflected their ambivalent attitudes towards Western drugs in general. Respondents considered OHAs to be an important part of the diabetic regimen because they perceived British healthcare professionals to be competent and trustworthy prescribers, and they considered the medicines available in Britain to be superior to those on the Indian subcontinent. Despite this, some respondents made deliberate efforts to reduce their tablet intake without being advised to do so. Reasons for this included perceptions that drugs worked by providing relief of symptoms and concerns that OHAs could be detrimental to health if taken for long periods, in conjunction with other drugs, or without traditional foods.
Conclusions : British Pakistani and Indian patients’ perceptions of their OHAs may partly derive from popular ideas about drugs on the Indian subcontinent. Cultural factors need to be understood and taken into consideration to ensure that these patients are given appropriate advice and to avoid unnecessary changes to prescriptions.

A note on work-related values, budget emphasis and managers’ organisational commitment

Managers’ work-related values (WRVs) have important implications for designing appropriate management accounting systems (MAS) in organisations. This paper examines the effect of the interaction between managers’ WRV for innovation and budget emphasis (an integral part of MAS) on their organisational commitment. The sample consisted of 109 managers from production, marketing and support departments within Australian manufacturing firms. Hypotheses were tested using both quantitative and qualitative data collected by a questionnaire survey and post-survey interviews. The results indicate that the adoption of low budget emphasis led to high organisational commitment when managers’ WRV for innovation was high, but not when managers’ WRV for innovation was low. The results also indicate that marketing managers held higher WRV for innovation than production managers. The post-survey interviews provide further insight into how a more customer- and competitor-focused subculture of marketing managers and a more technical- and efficiency-focused subculture of production managers may promote the difference in their WRV for innovation, and affect their attitudes towards budget emphasis. The findings of the study have implications for design of performance evaluation systems for managers in functionally differentiated organisations.

'Rushing behind the wheel' : investigating the prevalence of 'drug driving' among club and rave patrons in Melbourne, Australia

The paper reports the findings of survey research recently completed in Melbourne, Australia, among a sample of 455 club and rave festival patrons. This research aims to provide a clearer account of the prevalence of drug driving within such settings in Melbourne, as well as identifying relevant ‘predictors’ of this drug driving. Just under half of the sample (48%) indicated that they had driven a motor vehicle within four hours of consuming an illicit substance at least once in the past year; 22% of respondents reported driving while ‘knowingly intoxicated’ in the previous year. Fifteen percent reported such behaviour ‘several times’ or more in this time. Relatively permissive attitudes towards drug driving, coupled with higher than average prevalence of drug driving in one's peer group, were found to be significant predictors of drug driving. So too was the reported frequency of the use of cannabis and ecstasy, and the propensity to use these substances in ‘rave’ and ‘party’ settings. Given the levels of drug driving revealed in this study, the paper closes with a series of recommendations regarding the design and delivery of more effective anti-drug-driving strategies within rave and club settings.

EDRMS implementation in the Australian public sector

Sad stories about EDRMS implementation failure are often told among records managers. An EDRMS project, like any other IS implementation, will need key ingredients to be successful. This paper reveals these components of a successful EDRMS implementation from the findings of a Web-based survey on the perspectives of records managers in the three levels of the Australian public sector. It also uncovers these organisations’ attitudes towards digital  recordkeeping initiatives and an insight on their EDRMS projects.

Dancing with death : the grey area between suicide related behavior, indifference and risk behaviors of heroin users

Suicide-related behavior (SRB) among heroin users is a complex and multifaceted continuum, including such fringe areas as indifference and "risky" behavior. The article investigates the nuances and intersections of SRB, using qualitative semi-structured interviews with 60 regular heroin users recruited primarily from syringe programs in Geelong, Australia. Twenty-eight percent of interviewees reported a previous suicide attempt and 45% reported serious consideration of it. Types of SRB reported included: Suicide attempts, instrumental suicide-related behaviors, suicidal ideation, indifference and risk-taking thoughts and behaviors. Heroin users engage in much behavior which inhabits a grey area of SRB. The use of a nomenclature which addresses the elements of lethality and intent improves the ability of research to properly define and categorize SRB in drug-using populations. But the categories should not be overinclusive; indifferent attitudes towards death and risk-taking behaviors can sometimes be a functional response to the risk environment of heroin users.

Understanding anxiety and depression : a dimensional and categorical approach

Three studies were conducted to understand the strong relationship between anxiety and depression. Common indicators of each disorder including critical attitudes towards self and others, negative childhood experiences, low social support and use of emotion as a coping strategy were found. Another important finding is that unremitted anxiety leads to depression in approximately 50% of cases. Implications of these findings for intervention and treatment were presented.