Long-term outcomes of genetic counseling in women at increased risk of developing hereditary breast cancer Information,

This multicenter study evaluated the impact of genetic counseling in 218 women at risk of developing hereditary breast cancer. Women were assessed prior to counseling and 12-month post-counseling using self-administered, mailed questionnaires. Compared to baseline, breast cancer genetics knowledge was increased significantly at follow-up. and greater increases in knowledge were associated with educational level. Breast cancer anxiety decreased significantly from baseline to follow-up, and these decreases were associated with improvements in perceived risk. A significant decrease in clinical breast examination was observed at the 12-month follow-up. Findings suggest that women with a family history of breast cancer benefit from attending familial cancer clinics as it leads to increases in breast cancer genetics knowledge and decreases in breast cancer anxiety. The lowered rates of clinical breast examination indicate that the content of genetic counseling may need to be reviewed to ensure that women receive and take away the right message. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.

Telemedicine and developing countries - successful implementation will require a shared approach

Telemedicine is often proposed as a solution to certain health-care problems in the developing world. There seems to be little published experience on which to make judgements. A literature search revealed 39 articles, of which only two related to any kind of direct clinical work; most of them were review articles or editorials. The majority of the work reported was educational in nature, and there has been little clinical experience. It seems probable that telemedicine can help with the education of health-care workers and patients; it seems likely that it could bring major benefits to the organization of health-care. Without proper trials, it will be impossible to determine the place of health-care in the developing world. Trials are the only way in which rational decisions can ultimately be reached regarding whether scarce resources should be devoted to telemedicine in developing countries, or whether they should be employed in more conventional health-care measures whose outcomes are known to be cost-effective.

An analysis of why telehealth systems in Australia have not always succeeded

Telehealth programmes are rather similar to humans in the way that they are planned, develop, grow and ultimately die or disappear. To achieve good life expectancy for a telehealth programme there appear to be three major needs: nurturing, which includes the provision of money, ideas, education, training and innovation; experience, which involves an integrated management process, the achievement of long and wide patterns of usage, the development of updated policies and procedures and the involvement of multiple disciplines; success, which involves evidence of outcomes, evaluation and research, and, most important, the sharing of information through scientific and popular press publications, and conferences and collaborations with internal and external groups. The future of telehealth in Australia is at a watershed. There are now a substantial number of programmes, and there has been a large amount of financial and human investment in telehealth around the nation. There is, however, no forum for national leadership, no national association and little support at federal government level.

Client resistance in outreaching social work in Hong Kong

This paper reports the survey findings of a study on the outreaching social workers' perceptions of client resistance. In light of their social work practice 10th youth-at-risk in Hong Kong, resistance is generally recognised as a natural phenomenon in the counselling process and to a certain extent, is an obstacle to engaging in purposeful worker-client relationship as well as effecting behavioural changes. On Pipes and Davenport's (1990) classification, the respondents were more likely to classify client resistance as innocuous behaviours like missing appointments and refusing to discuss problems than disarming and proactive behaviours. The implications of these findings are discussed.

The game of leapfrog and the Internet: Developing countries and the information-divide

Recent rapid advances in communication technology have changed global structural patterns and produced new concepts and poles of dynamism in international relations. One such technology, which is increasingly causing a mixed reaction across international boundaries, is that of the Internet. For the first time in history the emergence of the Internet has produced an anarchic power that is capable of influencing individuals, societies and governments on a scale previously unimaginable.

Tracks of Change - the changing value commitments of non-profit organisations

If nonprofit organisations are moving towards more market oriented ways of operating, is this changing the traditional meanings and value of commitments associated with their activities? This article discusses the findings of a research project conducted by the University of Queensland into the impact that changes in government policies are having on the community services sector, in particular disability services. The values and belief systems traditionally associated with the sector were found to be fundamentally unaltered.

A decision support process to compare Riparian revegetation options in Scheu Creek catchment in North Queensland

While riparian vegetation can play a major role in protecting land, water and natural habitat in catchments, there are high costs associated with tree planting and establishment and in diverting land from cropping. The distribution of costs and benefits of riparian revegetation creates conflicts in the objectives of various stakeholder groups. Multicriteria analysis provides an appropriate tool to evaluate alternative riparian revegetation options, and to accommodate the conflicting views of various stakeholder groups. This paper discusses an application of multicriteria analysis in an evaluation of riparian revegetation policy options for Scheu Creek, a small sub-catchment in the Johnstone River catchment in north Queensland, Australia. Clear differences are found in the rankings of revegetation options for different stakeholder groups with respect to environmental, social and economic impacts. Implementation of a revegetation option will involve considerable cost for landholders for the benefits of society. Queensland legislation does not provide a means to require farmers to implement riparian revegetation, hence the need for subsidies, tau incentives and moral suasion. (C) 2001 Academic Press.

Estimating economic relationships subject to firm- and time-varying equality and inequality constraints

Applied econometricians often fail to impose economic regularity constraints in the exact form economic theory prescribes. We show how the Singular Value Decomposition (SVD) Theorem and Markov Chain Monte Carlo (MCMC) methods can be used to rigorously impose time- and firm-varying equality and inequality constraints. To illustrate the technique we estimate a system of translog input demand functions subject to all the constraints implied by economic theory, including observation-varying symmetry and concavity constraints. Results are presented in the form of characteristics of the estimated posterior distributions of functions of the parameters. Copyright (C) 2001 John Wiley Sons, Ltd.

Commercial-in-confidence: An obituary to transparency?

This article addresses the issue of accountability and transparency in relation to the use of commercial-in-confidence clauses to withhold information. The issue is contentious. On the one hand some like the Senate Finance and Public Administration Reference Committee (SFPARC) argue that: 'Put simply there can be no accountability if there is no information' (SFPARC 2000). On the other hand, an alternative view is: 'I think that the sanctity of contract... [is] a fundamental pillar of our legal system, and if private businesses enter into contracts with governments that specify confidentiality, then that ought to be respected' (Paterson 1999). This paper is an abridged version of a keynote address to CPA Australia (Queensland Division) Audit Intensive Day 2000, Brisbane Hilton, 10 November 2000.

Loss as a universal concept: Review of the literature to identify common aspects of loss in diverse situations

It has long been recognized that loss and its associated grief are important elements of many adverse life events that affect the entire global population: death, disability, traumatic events, abuse., terminal and chronic illness, aging, addiction, unemployment, relationship breakdown, war, migration, and educational failure. While there is significant empirical evidence of the potential deleterious effects of specific situations of loss across the global community, systematic discussion concerning the common elements of loss that are associated with adverse life situations in general has been limited. This review of the theoretical and empirical literature concerning various losses and the recommendations for care of those affected by such losses identifies common aspects of situations of loss and common recommendations in the care of those confronted by such losses. These common themes of loss are described by simple summary statements that can be communicated to a broad audience, hence enhancing community education and, potentially, community-wide mental health promotion.