Rural youth and multimedia: an interagency approach.

The 10MMM multimedia project began in late 2002 in a rural region of  western Victoria and has now entered its second stage. It is an interagency initiative intended to decrease the social isolation of rural young people and stimulate the expression of youth 'voice' and leadership using multimedia tools. As the process of working with rural young people unfolds over time, it provides an opportunity for ongoing reflection on the extent to which the project can become truly driven by young people, and whether it can enable them to take a stronger leadership role in their rural communities.

Overcoming systematic rural poverty : lessons from the Yunnan Upland Management Program

Sustainable poverty alleviation means more than the relief of poverty. It means attention to the systemic foundation of poverty and enhancement of local community and household capacity for self-reliance to sustain the improvement. This thesis assesses the record left behind by the Yunnan Upland Management Program (YUM) among rural households in remote and isolated southwestern China. Poverty is many faced and cannot be resolved without the active participation of the victims.

Community water fluoridation : is it still worthwhile

Community Water Fluoridation (CWF) is the adjustment of fluoride concentration in community drinking water to a level that confers optimal protection from dental caries (Truman et al 2002). It is supported by many authorities as the single most effective public health measure for reducing dental caries (DHS 2007). It has consistently been shown to be effective in reducing the prevalence and severity of dental caries in populations following its introduction (NHMRC 1999). The most dramatic reductions (50-60%) were demonstrated in the earlier studies although more recent research has still shown reductions of between 30 and 50% (Truman et al 2002). Despite the strong scientific evidence for its beneficial effects and safety the issue of the appropriateness of CWF is often the focus of public debate. Proponents argue that it reduces dental caries. is safe and cost effective. and that it provides significant benefits to all social classes (Slade et al 1995: Slade et a 1996: Spencer et al 1996). Opponents question its efficacy and safety and argue that its addition to community water supplies is unethical mass medication (Colquhoun 1990: Diesendorf 1986: Diesendorf et al 1997).

More recently, however, there have been important questions raised regarding the continuing benefit of CWF over and above that produced by the widespread use of other sources of fluoride (toothpaste. mouth rinses. varnish and other professionally applied fluorides). Generally, dental caries has declined steeply in the last thirty years and many have observed that dental caries has also reduced in parts of Australia and other countries where there has never been CWF or where it has ceased. It has been suggested that because of the current low population levels of dental caries and the increase in alternate sources of fluoride, CWF no longer offers the benefits it may have in the past. Given this notion, together with the concerns of a minority subgroup of the population regarding the safety of CWF, it is valuable to examine current evidence to answer the question: Is there still a role for CWF in Australia?

This paper will firstly examine the history of water fluoridation and its mechanisms of action. Secondly. trends in dental decay experience over the last three decades with particular emphasis on social and geographical inequities in Australia will be described. We also review the current state of scientific evidence for the benefits of CWF including the contribution it makes to the reduction of oral health inequalities. In light of this we will provide a response to the question posed above.

'Girls talking about girls' issues' : the importance of girls-only health and physical education in promoting well-being

Recognition of the important role schools play in the promotion of student well-being can be seen in the growing number of policies and programs being implemented in schools across Australia. This paper reports on some initial data from focus group interviews with Year 9 and 10 girls involved in the pilot of a health and physical activity intervention designed to connect them to their local community and reconnect them with their school and their peers. The aim of the program was to build connectedness and resilience by engaging young women in non-traditional physical activities whilst providing them with a sound understanding of health issues relevant to adolescent girls. Situated in a relatively isolated rural community 200 kilometres south-east of Melbourne the program was overwhelmingly delivered by regional and local agencies in conjunction with the local secondary school. The intervention was built on a partnerships model designed with the purpose of increasing participation and access for young women whilst building a sustainable program run in partnership between the school and local agencies and services. The initial data from this pilot indicates the program is having a positive impact on the young women's sense of self and their bodies, their relationships with their peers and in reducing bullying behaviour amongst the girls. However, the data raises some important questions around the adequacy of school-based health education, and the sustainability of approaches designed to be delivered by outside agencies rather than classroom teachers.

Study of relationships between colonial women and black Australians

The study is concerned with the history of black and white women in Australia during the colonial period. Particular emphasis is on the variety of cross-cultural relationships which developed between women during that time. As a starting point, male frontier violence is discussed and compared with the more moderate approach taken by women faced with threatening situations. Among Europeans, women are revealed as being generally less racist than men. This was a significant factor in their ability to forge bonds with black women and occasionally with black men. The way in which contacts with Aborigines were made is explored and the impact of them on the women concerned is assessed, as far as possible from both points of view. Until now, these experiences have been omitted from colonial history, yet I believe they were an important element in racial relations. It will be seen that some of these associations were warm, friendly and satisfying to both sides, and often included a good deal of mutual assistance. Others involved degrees of exploitation. Both are examined in detail, using a variety of sources which include the works of modern Aboriginal writers. This study presents a new aspect of the female experiences which was neglected until the emergence of the feminist historians in the 1960’s. It properly places women, both black and white, within Australian colonial history.

Structure of unemployment in country Victoria

Investigates the extent of structural unemployment in country Victorian regions through analysing labour force statistics by region, industry, age, gender and occupation. It was found that female workers in country Victoria and the young are the most likely to be structurally unemployed. There are indications that the structural unemployment problem is getting worse despite the continued fall in the unemployment rate.

A virtual clinic : telemetric assessment and monitoring for rural and remote areas

This article reports the establishment of a pilot ‘virtual clinic’ in a rural region of Victoria, Australia. Using low-cost videophones that work across ordinary phone lines, together with off-the-shelf (mostly automatic) clinical tools, local volunteers have been trained to mediate a virtual consultation between simulated patients and local GPs. This system has the potential to save long trips into town by such patients since the traditional ‘home visit’ is not feasible, as well as to provide regular home monitoring for those with chronic conditions. This in turn should impact favourably on ambulance deployment, sometimes enabling patients to avoid going to hospital or allowing them to come home sooner than otherwise would be the case, and generally to offer a sense of medical security to those living in isolated regions.

Prevalence of psychological distress, anxiety and depression in rural communities in Australia

Objective: To describe the prevalence of psychological distress, depression and anxiety in three Australian rural settings and to identify the levels of risk by gender and age.

Design and setting: Three cross-sectional surveys in the Greater Green Triangle area covering the south-east of South Australia (Limestone Coast), and south-west (Corangamite Shire) and north-west (Wimmera) of Victoria.

Participants: A total of 1563 people, aged 25–74 years, randomly selected from the electoral roll.

Main outcome measures: Psychological distress assessed by the Kessler 10, and anxiety and depression assessed by the Hospital Anxiety and Depression Scale.

Results: The prevalence of psychological distress was 31% for both men and women with two-thirds reporting moderate and one-third high levels of psychological distress. The prevalence of depression and anxiety was approximately 10%. The highest rate of psychological distress, anxiety and depression occurred in the 45–54 years age group. There were no consistent gender or area differences in the prevalence of psychological distress, depression or anxiety.

Conclusions: A third of the rural population reported psychological distress, with the highest prevalence observed in middle-aged men and women. Thus, health professionals should attend not only to physical health, but also to mental health status in this age group. It is also important to target prevention strategies at the 20% who reported moderate levels of psychological distress in order to prevent the development of more serious conditions.

Checks and cheques : implementing a population health and recall system to improve coverage of patients with diabetes in a rural general practice

Identification of all diabetic patients in the population is essential if diabetic care is to be effective in achieving the targets of the St Vincent Declaration.¹ The challenge therefore is to establish population based monitoring and control systems by means of state of the art technology in order to achieve quality assurance in the provision of care for patients with diabetes. ^2,3 Disease management receives extensive international support as the most appropriate approach to organising and delivering healthcare for chronic conditions like diabetes.⁴ This approach is achieved through a combination of guidelines for practice, patient education, consultations and follow up using a planned team approach and a strong focus on continuous quality improvement using information technology. ^5,6 The current software (Medical Director) could not easily meet these requirements which led us to adopt a trial of Ferret. In designing this project we used change management⁷ and the plan, do, study, act cycle⁸ illustrated in Diagram 1.

Adapting to rural communities by overseas-born health professionals

Introduction
As with other multicultural nations, cultural diversity is a prominent feature of Australian society that leads to intercultural awareness and respect through citizen interactions. While this enriching multicultural interaction is clearly seen in big cities like Sydney and Melbourne, it can be very different in the Australian rural context. Living in an isolated rural area is challenging for health professionals who were brought up in urban areas, particularly those born overseas as they experience two types of cultural and social adaptation: urban into rural and native culture into new culture.

As a result of workforce shortages, many overseas trained health professionals are recruited to work in Australia, particularly in rural areas. This has given rise to various initiatives and strategies developed to support and assist these health professionals in their dual cultural and social adaptation. These include University Departments of Rural Health and Rural Clinical Schools programs as well as the Rural Workforce Agencies. However, these programs do not extend to those health professionals who were born overseas and trained in Australia as they are ‘Australian graduates’. In this paper we argue that in ways similar to those born and trained overseas, overseas-born Australian-trained health professionals may require additional support during the acculturation process and making the transition to working in rural communities.

Aim
The aim of this study is to examine some aspects of the acculturation of overseas-born Australian trained health professionals working in rural areas. This study seeks to understand the particular issues that emerge as a result of cultural difference in order to propose strategies that may more adequately prepare these Australian graduates for their rural health experience.

Method
Six overseas-born Australian-trained health professionals were invited to participate in this qualitative study using snowball sampling. The interviews were recorded with the approval of the participants. The interview data were transcribed as raw data and later coded for thematic analysis, which includes topics and themes arising from the raw data as well as from the interview questions with a focus on issues and strategies of acculturation into a rural health context.

Results/conclusion
There were different factors which facilitated or hindered the acculturation of overseas-born health professionals into a rural workforce such as professional isolation, cultural shock, family pressure, and cultural identity. The acculturation process was also affected by the quality of their perceived ‘social and cultural capital’. Different coping strategies were employed to deal with the changes in a new rural environment. The paper discusses some implications of this study with focus on how to improve the living and working conditions of overseas-born Australian-trained health professionals in order to attract them to rural Australia.

Comparison of the work of psychologists in rural and urban settings : implications for professional training

To compare the work practices and training needs of rural and urban psychologists, 774 surveys were sent to psychologists throughout Australia. The psychologists were selected from the Australian Psychological Society (APS) Directory of Psychologists, 1992- 1993. A total of 86 rural psychologists and 282 urban psychologists responded to the survey. The survey comprised of four sections with questions asking respondents their demographic and employment background, past and current training activities, work experience, and relations with community. Results showed that the decision to practice and remain in a rural area was influenced by psychologists’ childhood experience and professional training in a rural setting, A substantial proportion of rural psychologists (28%) had been working in rural practice for five years or less. These rural psychologists were identified as a group that had a demographic and training profile more similar to urban psychologists than their rural colleagues. The employment conditions and training background of rural and urban psychologists were similar, though rural psychologists were more likely to be working in private practice and have undertaken their studies in a rural setting. Rural and urban psychologists rated their undergraduate and postgraduate training in psychology as only somewhat adequate. Training in rural health and community issues received the lowest ratings from both groups of psychologists. The work practices of rural and urban psychologists were also similar. There were some differences in the demographic profile of the client groups seen by the two groups. Rural psychologists reported the type of relations with their communities that are conducive to rural practice. The main evidence of this was that rural psychologists were collaborating with the natural helpers of their communities, and expressed willingness to formally train natural helpers to assist in the provision of psychological services. There were several conclusions drawn from this study. The first conclusion was that rural psychologists with urban demographic and training backgrounds are a group that is likely to migrate from rural practice to urban practice, Secondly, training needs to be specialised for rural practice if there is to be an improvement in the number of psychologists practicing in rural settings. Thirdly, rural psychologists were conducting the type of relations with their communities that are important to the requirements of rural practice.

Rural women's self-management of arthritis

Assesses the relevance of self-management for rural women suffering arthritic conditions, by identifying factors that enabled or constrained their ability to self-manage, and by discerning differences between women in terms of their capacities to utilise self-management. A typology was developed identifying four different groups of rural women: unconstrained, passive, determined, and marginalised; therefore highlighting the ways in which different types of women are enabled or constrained in their self-management.

Wool industry : a decade of turbulence : an examination of some of the factors contributing to the crisis within Australia's wool industry, and the resulting economic, social and demographic effects on a small isolated rural community

A central issue of this thesis has been an examination of the effects that the current wool crisis has had on the Balmoral district, an area almost solely devoted to the production of wool and wool sheep. Examines the methods being utilised to try to alleviate some of these effects.

Water savings or water efficiency? Water-use attitudes and behaviour in rural and regional areas

Drought conditions in southwest Victoria, as in other regions of Australia and around the world, have caused the need to reduce water consumption to ensure security of supply into the future. To develop effective water-saving behaviour change strategies, an understanding of people's attitudes to the behaviour, including barriers stopping them from adopting the behaviour, is required. Thus, this paper explores the water-use behaviours and attitudes of rural and regional urban water users in southwest Victoria. A conceptual model of the factors impacting on water use of these users, including drivers and barriers to water saving, is developed. The factors that appear to impact on water-use behaviour not previously identified included the source of water supply (groundwater versus surface water), previous experience with water shortages and trust in the water authority and government. Also, a difference in the drivers for water saving was found, with farmers wanting to be 'water efficient' to keep their business viable and productive, while hobby farmers and residential users were 'saving water' for more altruistic reasons. These findings have implications for development of demand management strategies in this, and other, rural and regional areas. However, the conceptual model has to be tested to determine if it truly reflects factors influencing water-saving behaviour in rural and regional areas.