The adjustment of children of Australian Vietnam veterans: is there evidence for the transgenerational transmission of the effects of war-related trauma?

Objective: The presence of posttraumatic stress disorder (PTSD) in trauma survivors has been linked with family dysfunction and symptoms in their children, including lower self-esteem, higher disorder rates and symptoms resembling those of the traumatized parent. This study aims to examine the phenomenon of intergenerational transfer of PTSD in an Australian context.

Method: 50 children (aged 16–30) of 50 male Vietnam veterans, subgrouped according to their fathers' PTSD status, were compared with an age-matched group of 33 civilian peers. Participants completed questionnaires with measures of self-esteem, PTSD symptomatology and family functioning.

Results: Contrary to expectations, no significant differences were found between the self-esteem and PTSD symptomatology scores for any offspring groups. Unhealthy family functioning is the area in which the effect of the veteran's PTSD appears to manifest itself, particularly the inability of the family both to experience appropriate emotional responses and to solve problems effectively within and outside the family unit.

Conclusion: Methodological refinements and further focus on the role of wives/mothers in buffering the impact of veterans' PTSD symptomatology on their children are indicated. Further effort to support families of Veterans with PTSD is also indicated.

Returning to work: exploring the experiences of women with acute coronary syndromes

Aims: The aim of this study was to explore the transition experiences of Australian women in resuming paid employment after an acute coronary syndrome (ACS) event. Background: Until recently cardiovascular research has focused predominantly on men but this is changing and research exploring women’s experiences of ACS has increased. Despite knowing that many women do not resume paid employment following an ACS event, little is known about the experience of those women who do, even though it is understood that returning to the previous level of employment after an ACS event is a positive outcome. Design: An exploratory qualitative approach underpinned by naturalistic inquiry was undertaken. Methods: A purposive sample of seven women who had experienced their first ACS event 12 months ago was selected. Each woman was interviewed using a semi–structured format and their interviews were transcribed verbatim. Thematic analysis of the transcript set and conceptual mapping were employed to formulate key themes. Findings: All women (mean age 52.6 years) resumed paid employment at various stages during their recovery, but reported similar transition processes. Three key themes representing this process were identified: primary motivation; influence through guidance and support; and resuming paid employment. Conclusions: Study findings revealed that these women required substantial support from family, friends and employers, with ongoing guidance from health professionals to return to paid work. The time frames for their return varied and some modified their roles within the workforce to enable them to return to paid work. However, formal cardiac rehabilitation did not appear to have a significant impact on these participants' decisions to return to work. They felt that more information about this decision may have been helpful if given at the time of cardiac rehabilitation.

Symptoms, ill-health and quality of life of the members of a Porton Down veterans' support group

Background There has been a Human Volunteer Programme at the British chemical weapons research facility at Porton Down since the First World War, in which some of the participants were exposed to chemical warfare agents.

Aim To identify any striking specific morbidity patterns in members of the Porton Down Veterans Support Group (PDVSG).

Methods A self-completed postal questionnaire was prepared including health immediately after the visits to Porton Down, subsequent diagnoses and hospital admissions, symptoms in, and after, the first 5 years after the visits, fatigue symptoms and current quality of life, measured using the SF-36.

Results Responses were received from 289 of 436 (66%). Results reported here relate to 269 male respondents of mean age 66.8 years. Sixty-six per cent reported their first visit to Porton Down in the 1950s. The most common diagnoses or hospital admissions reported were diseases of the circulatory system. In the first 5 years after their visits the most common symptoms were headache, irritability or outbursts of anger and feeling un-refreshed after sleep. In the later period, most common symptoms were fatigue, feeling un-refreshed after sleep and sleeping difficulties. Sixty-five per cent met the definition for a case of ‘fatigue’. Current quality of life dimensions were consistently lower than age-specific estimates from general population samples.

Conclusions Members of the PDVSG responding to this survey reported poorer quality of life than the general population. Despite there being no clear pattern of specific morbidities, we cannot rule out ill-health being potentially associated with past experience at Porton Down

Organizational factors associated with decreased mortality among veterans affairs patients with an ICU stay

In-hospital mortality rates associated with an ICU stay are high and vary widely among units. This variation may be related to organizational factors such as staffing patterns, ICU structure, and care processes. We aimed to identify organizational factors associated with variation in in-hospital mortality for patients with an ICU stay. This was a retrospective observational cross-sectional study using administrative data from 34 093 patients from 171 ICUs in 119 Veterans Health Administration hospitals. Staffing and patient data came from Veterans Health Administration national databases. ICU characteristics came from a survey in 2004 of ICUs within the Veterans Health Administration. We conducted multilevel multivariable estimation with patient-, unit-, and hospital-level data. The primary outcome was in-hospital mortality. Of 34 093 patients, 2141 (6.3%)died in the hospital. At the patient level, risk of complications and having a medical diagnosis were significantly associated with a higher risk of mortality. At the unit level, having an interface with the electronic medical record was significantly associated with a lower risk of mortality. The finding that electronic medical records integrated with ICU information systems are associated with lower in-hospital mortality adds support to existing evidence on organizational characteristics associated with in-hospital mortality among ICU patients.

Experiences of Australian professional female tennis players returning to competition from injury

Background: This study examined the experiences of professional female tennis players returning to competition from injury.

Methods: In a study commissioned by Tennis Australia, 55 Australian professional female tennis players responded anonymously to a questionnaire developed for the purposes of this study. The questionnaire consisted of open and closed questions that assessed a player’s attribution style, the occurrence and effect of minor and major injuries, frequency and type of treatment sought, attitudinal chances following injury and preventative injury factors.

Results: The quantitative and qualitative analyses of participants’ responses revealed players generally displayed an internal attribution style with the majority of minor injuries involving lower limb injuries (attributed to playing on hard surfaces). Players reported these injuries were addressed in a variety of ways including self-treatment. The majority of severe injuries were upper limb/shoulder and these were generally treated at tournament sites with some requiring surgery.

Conclusions: Players adopted a range of measures to assist recovery from severe injury including the services of health professionals. In further findings, a player’s attribution style was not a predictive variable, except in terms of the number of tournaments missed for minor injuries. Implications of the study’s results and future research directions for cross-cultural studies are highlighted.

Borrowings; or ways of making poetry by taking, working and returning: a study in creative practice

The collaborative poetry project ‘Borrowings’ investigates and theorises some of the processes of poetic composition. Two collaborators, by making use of incepts from each other's work, have generated new poems by exploring the nature of intertextual genesis. This paper presents key ideas generated by this activity and, in doing so, applies Deleuze's analysis of games to its consideration of the nature of poetic composition, along with his contention that ‘[t]o pass to the other side of the mirror is to pass from the relation of denotation to the relation of expression … It is to reach a region where language no longer has any relation to that which it denotes’. The project explores some of the ways in which poetry makes ‘sense’, both to the writer and reader; as well as questioning the extent to which poetry depends on its author's ‘decision’ about what to write. It also teases out some of the implications for how we understand authorship if authorial decisions may be generated by incepts of one kind or another that occur to the poet apparently randomly, or may be given to them by a line or phrase that they encounter while reading. This paper's ultimate wager, and one put to the test in the project itself, is that limitation has an expansive effect on the generation of creative work.

Returning to co-residence: the experiences of young adults and parents

This thesis focused on family members’ experiences when a young adult returns home. Findings revealed that both young adults and parents come to accept the change in living arrangement, accommodate each other in the parental home and also appreciate how doing so enables them to advance in various life domains.

Returning a dislocated child's body to the scene of a crime

The 'Event' considered here is my 'abduction' as a child by my parents out of the Netherlands as part of the post war European migration to Australia in the 1950s. The migrant exists in many ways in-between cultures and this also holds for the migrant child. This event created a traumatic split in me as an eight year old boy. It was one that occurred to many children of migrants who left Europe post WWII. The migration in turn engaged with an unspoken racist complicity with Australia's 'White Australia Policy'. The 'white' Dutch were a good fit for this migration and thus the focus here applies to both 1950s Australia and the Netherlands. This article deals with how I expressed the two aspects of dislocation and racism made evident by this event through my art in a collaborative exhibition The Unwanted Land (see Figure 1). As this art is primarily visual, I have included a photo gallery of 28 images at the end of this text to reference and support this discussion.

‘You just accept’: Australian parents’ and young adults’ feelings towards returning to co-residence

Drawing on a qualitative study of Australian families who returned to co-residence, this article focuses on the ways young adults and their parents come to accept the change in their living arrangement after time spent apart. Findings from in-depth interviews suggest that young adults  experience mixed feelings about returning home on the pathway to eventual acceptance, whereas  parents appear to be more accepting of the living arrangement from the outset. The current study  also revealed that, although parents and their young adult offspring may have different degrees of acceptance, family members generally appreciated how the other member of their dyad felt  towards the return. This acceptance meant that the return to co-residence proceeded and, in turn,  engendered mutual benefits for both young adults and their parents.

Vulnerability at the end of life: Australian veterans requiring home-based palliative care

In Australia, veterans are a vulnerable group, because of ageing, and high rates of chronic or life-threatening illnesses and poor mental health .This retrospective pilot study explored the home-based palliative care needs of veterans as they face the end of their life, compared to non-veterans. Medical records of ten deceased veterans and ten non-veterans in a home-based palliative care service were analyzed both for demographic data, and qualitative content. Veterans had significantly more comorbidities and were older at death. Qualitative data indicated common concerns, including the role of families and practical aspects of care. Some differences were found between veterans and non-veterans in their end-of-life care requirements. More awareness of veterans’ status may assist in care more tailored to their specific needs.