Concerns and worries in people living with inflammatory bowel disease (IBD): A mixed methods study.

OBJECTIVE: This mixed-methods study aimed to explore concerns and worries related to living with inflammatory bowel disease (IBD). METHODS: Overall, 294 patients with a clinically established diagnosis of IBD were enrolled in this cross-sectional study. Concerns and worries were measured with one open-ended question. Measures of anxiety and depressive symptoms and disease activity were also administered. A thematic analysis was conducted and thematic map created. Spearman's rho was used to identify univariate correlations between predictors and the main themes. Binary logistic regression was used to test the predictors of the main themes. RESULTS: Despite the majority of study participants being in IBD remission (74%, n=217), all but 11 reported significant IBD-related concerns. Twenty two percent reported symptoms of depression and 41% of anxiety. Four themes were identified: Quality of life (51%); Unpredictability (35%); Symptoms (34%) and Treatments (19%). Males and older people were less concerned about Quality of life (OR=.597, 95% CI: .363-.980 and OR=.980, 95% CI: .965-.995, respectively). Those in remission were less concerned about Symptoms (OR=.510, 95% CI: .281- .926) while those with longer disease duration worried more about the Symptoms (OR=1.035, 95% CI: 1.010-1.061). Males were less concerned about Treatments (OR=.422, 95% CI: .229-.777). CONCLUSION: IBD patients report significant disease-related concerns even when in remission. Further exploration of what predicts patient concerns may help in shaping health-care delivery so that it better addresses patient needs.

Claiming the (n)either/(n)or of 'third space': (re)presenting hybrid identity and the embodiment of mixed race

As a multiracial artist, I am interested in how people of mixed race have been represented in popular culture and how mixed race image-makers can redress popular representation and facilitate a movement beyond the dichotomy, which seeks to reduce us to the sum of our parts. In the footsteps of Evelyn Alsultany I advocate the creation of a new cartography—a space that is inclusive and beyond existing notions of race. To this end I embarked on a project of exploration of the representation of multiracial identity, drawing from Homi K. Bhabha’s notion of Third Space.

The recovery journey : employment support for people with depression and other mental illnesses

This paper presents the qualitative findings of a larger mixed method study aimed to articulate factors that clients and staff of the Disability Employment Network (DEN) identify in relation to re-engagement into the workforce. The DEN is a supported job training and employment program funded by the Australian Federal Government, established to assist clients with health disabilities, including mental health diagnoses, to seek and retain employment. Two DEN sites participated in the study (one regional and one metropolitan). Semi structured interviews and focus groups were undertaken with seven employment counsellors and 16 clients until data saturation occurred. Analysis of the narrative data identified two overarching emergent concepts articulated by clients and employment counsellors: employment enablers and employment barriers. The notion of recovery and re-engagement in the workforce in the context of mental illness is complex. The qualitative results of this study highlight the essential nature of supporting clients’ mental health and vocational needs concurrently through such means as service collaboration, vocational peer support and, importantly, provision of employment support congruent with phase of recovery.

Trust in mono-ethnic and mixed-ethnic association in Penang

Investigation into trust has become a topical issue in current social science research. This is, in large part, a result of a perception that trust in institutions has declined markedly in the past two decades. This paper investigates trust in some of Penang's civil associations as a way of measuring the health of social capital in Penang. It focuses on issues of trust and diversity since both are critical issues in Malaysian society in general and civil associations in particular. We began our analysis expecting higher forms of trust among members in the mono-ethnic associations, based on the power of bonding. However, findings from this study tend to suggest that rather than leading to lesser trust and infectiveness, involvement in mixed-ethnic associations have in fact generated higher trust among their members. These findings reveal an interesting corrective to more pessimistic view on the relationship between trust and diversity. Data from this study also provide important insight into how bridging between different people in associations marked by diversity can accentuate trust over and above the levels found in associations were bonding between like types is the dominant characteristic. The data also indicate that for both, mono-ethnic and mixed-ethnic associations, it is the extent of members' involvements in their associations that form trust and not vice versa.

Trust in mono-ethnic and mixed-ethnic associations in Penang

Investigation into trust has become a topical issue in current social science research. This is, in large part, a result of a perception that trust in institutions has declined markedly in the past two decades. This paper investigates trust in some of Penang’s civil associations as a way of measuring the health of social capital in Penang. It focuses on issues of trust and diversity since both are critical issues in Malaysian society in general and civil associations in particular. We began our analysis expecting higher forms of trust among members in the mono-ethnic associations, based on the power of bonding. However, findings from this study tend to suggest that rather than leading to lesser trust and infectiveness, involvement in mixed-ethnic associations have in fact generated higher trust among their members. These findings reveal an interesting corrective to more pessimistic view on the relationship between trust and diversity. Data from this study also provide important insight into how bridging between different people in associations marked by diversity can accentuate trust over and above the levels found in associations were bonding between like types is the dominant characteristic. The data also indicate that for both, mono-ethnic and mixed-ethnic associations, it is the extent of members’ involvements in their associations that form trust and not vice versa.

Building realities less limited than their own : young people practising same sex attraction on the internet

The internet has met with mixed community reactions, especially when the focus is on young people's internet use. There are those who fear that the internet will introduce undesirable people and information into the home, leaving the young vulnerable and exploited. Alternatively, there are others who argue that the exclusion of young people from the internet is one of many examples of the diminishing public space that is made available to young people in this post-modern world. In this article we focus on the internet use of one ‘space deprived’ group of marginalized young people, those who are same-sex attracted. Regardless of some important changes in Australian culture and law, these young people's opportunities to openly live their sexual difference remain restricted. In this article we are interested in exploring the role of the internet as a space in which some important sexuality work can be done. What we found was that the internet was providing young people with the space to practise six different aspects of their sexual lives namely identity, friendship, coming out, intimate relationships, sex and community.

The construction of the racially different indigenous offender

The over‐representation and increased growth of Indigenous offenders in all Western criminal justice systems is longstanding and undeniable. In 2006 Victoria’s Koori offenders were 12 times more likely to be sentenced to a custodial or community sanction than non‐Koori people. Similarly, in New Zealand, Maori men account for 50 percent of the prison population but only 12.5 percent of the general population. Yet, it was not until the 1990s that the issues of Indigenous over‐representation or expanding Indigenous offender populations began to be presented as a problem within the correctional literature. This paper will explore the parameters of these ‘problems’, and present the following three arguments: (1) the issues of over‐representation was constructed within the correctional literature as a symptom of the different nature of Indigenous offending; (2) the different nature of Indigenous offending was in turn constructed as a problem of race; and (3) this construction of Indigenous offending is consistent with the contemporary constitution of mainstream offending behaviour. In concluding, this paper will discuss the implications of the emergence and sustained production of this figure of the Indigenous offender in relation to the capacity of criminologists to reconceptualise Indigenous offending.

Bipolar missed states : the diagnosis and clinical salience of bipolar mixed states

Objective: To explore diagnostic and treatment issues concerning bipolar mixed states.

Method: Bipolar mixed states are described and concerns about diagnostic and treatment difficulties are summarized and discussed.

Result: Mixed states can present with equal admixtures of depressive or manic symptoms, or more commonly one component predominates. There is fair consensus, although little data, regarding the management of manic mixed states. However depressive mixed states are far more complex both in terms of recognition and management. People suffering from mixed states characteristically present with complaints of depression.

Conclusions: The boundaries between depressive mixed states and agitated depression are vague, yet carry substantial therapeutic implications. Bipolar mixed states are often difficult to treat, and tend to take much longer to settle than either pure mania or depression.  Furthermore there is data that treatment with antidepressants can worsen the course of mixed states. Hence missed diagnoses can potentially have negative clinical implications.  Therefore in this paper the clinical presentation, diagnosis and therapy of mixed states is reviewed with a view to improving management.

Presenting evidence-based health information for people with multiple sclerosis : the IN-DEEP project protocol

Background - Increasingly, evidence-based health information, in particular evidence from systematic reviews, is being made available to lay audiences, in addition to health professionals. Research efforts have focused on different formats for the lay presentation of health information. However, there is a paucity of data on how patients integrate evidence-based health information with other factors such as their preferences for information and experiences with information-seeking. The aim of this project is to explore how people with multiple sclerosis (MS) integrate health information with their needs, experiences, preferences and values and how these factors can be incorporated into an online resource of evidence-based health information provision for people with MS and their families.

Methods - This project is an Australian-Italian collaboration between researchers, MS societies and people with MS. Using a four-stage mixed methods design, a model will be developed for presenting evidence-based health information on the Internet for people with MS and their families. This evidence-based health information will draw upon systematic reviews of MS interventions from The Cochrane Library. Each stage of the project will build on the last. After conducting focus groups with people with MS and their family members (Stage 1), we will develop a model for summarising and presenting Cochrane MS reviews that is integrated with supporting information to aid understanding and decision making. This will be reviewed and finalised with people with MS, family members, health professionals and MS Society staff (Stage 2), before being uploaded to the Internet and evaluated (Stages 3 and 4).

Discussion - This project aims to produce accessible and meaningful evidence-based health information about MS for use in the varied decision making and management situations people encounter in everyday life. It is expected that the findings will be relevant to broader efforts to provide evidence-based health information for patients and the general public. The international collaboration also permits exploration of cultural differences that could inform international practice.

Economic implications of obesity among people with atherothrombotic disease

Objective: The purpose of this study was to ascertain the impact of obesity on the cost of disease management in people with or at high risk of atherothrombotic disease from a governmental perspective using a bottom-up approach to cost estimation. In addition, the aim was also to explore the causes of any differences found.

Method: The health-care costs of obesity were estimated from 2819 participants recruited into the nationwide Australian REACH Registry with established atherothrombotic disease or at least three risk factors for atherothrombosis. Enrollment was in 2004, through primary care general practices. Information was collected on the use of cardiovascular drugs, hospitalizations and ambulatory care services. Bottom-up costing was undertaken by assigning unit costs to each health-care item, based on Australian Government-reimbursed figures 2006-2007. Linear-mixed models were used to estimate associations between direct medical costs and body mass index (BMI) categories.

Results: Annual pharmaceutical costs per person increased with increasing BMI category, even after adjusting for gender, age, living place, formal education, smoking status, hypertension and diabetes. Adjusted annual pharmaceutical costs of overweight and obese participants were higher (7 (P0.004) and 144 (0.001), respectively) than those of the normal weight participants. This was due to participants in higher BMI categories receiving more pharmaceuticals than normal weight participants. There was no significant change across the BMI categories in annual ambulatory care costs and annual hospital costs.

Conclusion: In these participants with or at high risk of atherothrombotic disease, annual pharmaceutical costs were greater in participants of higher BMI category, but there was not such a gradient in the annual hospital or ambulatory care costs. The greater cardiovascular pharmaceutical costs for participants of higher BMI categories remained even after adjusting for a range of demographic factors and comorbidities. Our results suggest that these costs are explained by the higher number of drugs used among people with atherothrombotic disease. Further investigation is needed to understand the reasons for this level of drug use.

Finding a place for personal growth in an Australian community singing group for older people

As in many countries, Australia is faced with an aging population. This creates challenges for the maintenance of well-being which can be enhanced by active engagement in society. Music engagement encompasses a range of social participation and has the potential to recognise the contribution of older people to their local communities. Engagement in music by older people (50+) is positively related to individual and community well-being.  Music participation can contribute to a better quality of life, particularly in relation to health and happiness. The possible forms of music engagement are myriad.

This paper focuses on two members of a mixed voluntary singing group formed by older residents of an outer suburban community in Melbourne, Australia.  This study frames music as a positive way for older people to find a place for personal growth and fulfilment in a singing group. This phenomenological qualitative single case study focuses on two members of a small singing ensemble, the Skylarkers, formed to perform at retirement villages, nursing homes and facilities for senior citizens. In this study, data were gathered by interviews and analysed using interpretative phenomenological analysis.

Two significant themes emerged. The first concerned the nature of the choir and its fluid membership and notions of self-identity. The second theme concerns the validation offered to individual members by active music participation through which they gained a sense of purpose, fulfilment and personal growth. This emphasis is unusual in discussions of community music engagement that ordinarily identify the importance of social connections. Groups such as the Skylarkers provide a place for members to continue their active engagement with music performance and music learning.

What's important in defining quality of life for older people? An exploratory study of the views of older South Australians

Background
Cost-effectiveness analyses of interventions for older adults have traditionally focused on health status. There is increasing recognition of the need to develop new instruments to capture quality of life in a broader sense in the face of age-associated increasing frailty and declining health status, particularly in the economic evaluation of aged and social care interventions which may have positive benefits beyond health. 

Mechanisms underpinning use of new walking and cycling infrastructure in different contexts: mixed-method analysis

BACKGROUND: Few studies have evaluated the effects of infrastructural improvements to promote walking and cycling. Even fewer have explored how the context and mechanisms of such interventions may interact to produce their outcomes. METHODS: This mixed-method analysis forms part of the UK iConnect study, which aims to evaluate new walking and cycling routes at three sites - Cardiff, Kenilworth and Southampton. Applying a complementary follow-up approach, we first identified differences in awareness and patterns of use of the infrastructure in survey data from a cohort of adult residents at baseline in spring 2010 (n = 3516) and again one (n = 1849) and two (n = 1510) years later following completion of the infrastructural projects (Analysis 1). We subsequently analysed data from 17 semi-structured interviews with key informants to understand how the new schemes might influence walking and cycling (Analysis 2a). In parallel, we analysed cohort survey data on environmental perceptions (Analysis 2b). We integrated these two datasets to interpret differences across the sites consistent with a theoretical framework that hypothesised that the schemes would improve connectivity and the social environment. RESULTS: After two years, 52% of Cardiff respondents reported using the infrastructure compared with 37% in Kenilworth and 22% in Southampton. Patterns of use did not vary substantially between sites. 17% reported using the new infrastructure for transport, compared with 39% for recreation. Environmental perceptions at baseline were generally unfavourable, with the greatest improvements in Cardiff. Qualitative data revealed that all schemes had a recreational focus to varying extents, that the visibility of schemes to local people might be an important mechanism driving use and that the scale and design of the schemes and the contrast they presented with existing infrastructure may have influenced their use. CONCLUSIONS: The dominance of recreational uses may have reflected the specific local goals of some of the projects and the discontinuity of the new infrastructure from a satisfactory network of feeder routes. Greater use in Cardiff may have been driven by the mechanisms of greater visibility and superior design features within the context of an existing environment that was conducive neither to walking or cycling nor to car travel.

Development of a measure of health literacy for caregivers of people with cancer

Caregivers play a key role in supporting people with cancer. Little is known about challenges that caregivers might have when finding and understanding health information, making health-related decisions, and navigating the healthcare system. Using an innovative mixed-methods approach, the study developed and evaluated a tool to measure cancer caregiver health literacy.