The meaning of cancer for Australian Aboriginal women : changing the focus of cancer nursing

Aim: The purpose of the study was to explore why Aboriginal women participate in cancer screening programs but appear reluctant to following-up results, or accept medical advice about treatment. Methods: Interpretive ethnography, a qualitative methodology, was used to explore Aboriginal women’s perception of cancer, and the cultural context in which meaning was constructed and influenced treatment decision. Data collection, which occurred over two years, involved fieldwork, participant-observation, face-to-face interviews and focus groups, in two rural Aboriginal communities. Forty eight interviews were recorded from a cross section of the communities, including cancer survivors and patients, family members, health care providers and other women from the community. Results: Key findings were that Aboriginal women’s had a fearful and fatalistic attitude toward cancer, doubted the efficacy of treatment and carried an enduring ambivalence toward the authority of whiteman’s medicine. The women faced a dilemma of wanting access to cancer treatment options but feared entering hospital or clinics not attuned to their cultural needs. Conclusion: The findings highlight the need for a culture-centred approach that decentres the authority of conventional services and instead gives prominence to Aboriginal cultural values as a focal point in cancer control. It should be the responsibility of cancer nurses and others to engage with their local Aboriginal communities to build relationships that foster an exchange of learning about cultural differences that make a difference to how cancer control is practiced.

Does research into sensitive areas do harm? Experiences of research participation after a child’s diagnosis with Ewing’s Sarcoma

Objective: To investigate family members’ experiences of involvement in a previous study (conducted August 1995 to June 1997) following their child’s diagnosis with Ewing’s sarcoma. Design: Retrospective survey, conducted between 1 November and 30 November 1997, using a postal questionnaire. Participants: Eighty-one of 97 families who had previously completed an in-depth interview as part of a national case–control study of Ewing’s sarcoma. Main outcome measures: Participants’ views on how participation in the previous study had affected them and what motivated them to participate. Results: Most study participants indicated that taking part in the previous study had been a positive experience. Most (n = 79 [97.5%]) believed their involvement would benefit others and were glad to have participated, despite expecting and finding some parts of the interview to be painful. Parents whose child was still alive at the time of the interview recalled participation as more painful than those whose child had died before the interview. Parents who had completed the interview less than a year before our study recalled it as being more painful than those who had completed it more than a year before. Conclusions: That people suffering bereavement are generally eager to participate in research and may indeed find it a positive experience is useful information for members of ethics review boards and other “gatekeepers”, who frequently need to determine whether studies into sensitive areas should be approved. Such information may also help members of the community to make an informed decision regarding participation in such research.

Social Participation of Community Dwelling Stroke Survivors [Published Abstract: From the Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke Conference 2009]

Disability following a stroke can impose various restrictions on patients’ attempts at participating in life roles. The measurement of social participation, for instance, is important in estimating recovery and assessing quality of care at the community level. Thus, the identification of factors influencing social participation is essential in developing effective measures for promoting the reintegration of stroke survivors into the community. Data were collected from 188 stroke survivors (mean age 71.7 years) 12 months after discharge from a stroke rehabilitation hospital. Of these survivors, 128 (61 %) had suffered a first ever stroke, and 81 (43 %) had a right hemisphere lesion. Most (n = 156, 83 %) were living in their own home, though 32 (17 %) were living in residential care facilities. Path analysis was used to test a hypothesized model of participation restriction which included the direct and indirect effects between social, psychological and physical outcomes and demographic variables. Participation restriction was the dependent variable. Exogenous independent variables were age, functional ability, living arrangement and gender. Endogenous independent variables were depressive symptoms, state self-esteem and social support satisfaction. The path coefficients showed functional ability having the largest direct effect on participation restriction. The results also showed that more depressive symptoms, low state self-esteem, female gender, older age and living in a residential care facility had a direct effect on participation restriction. The explanatory variables accounted for 71% of the variance in explaining participation restriction. Prediction models have empirical and practical applications such as suggesting important factors to be considered in promoting stroke recovery. The findings suggest that interventions offered over the course of rehabilitation should be aimed at improving functional ability and promoting psychological aspects of recovery. These are likely to enhance stroke survivors resume or maximize their social participation so that they may fulfill productive and positive life roles.

Disease prevention and control

Globally, the main contributors to morbidity and mortality are chronic diseases, including cardiovascular disease and diabetes. Chronic diseases are costly and partially avoidable, with around sixty percent of deaths and nearly fifty percent of the global disease burden attributable to these conditions. By 2020, chronic illnesses will likely be the leading cause of disability worldwide. Existing health care systems, both national and international, that focus on acute episodic health conditions, cannot address the worldwide transition to chronic illness; nor are they appropriate for the ongoing care and management of those already afflicted with chronic diseases. International and Australian strategic planning documents articulate similar elements to manage chronic disease; including the need for aligning sectoral policies for health, forming partnerships and engaging communities in decision-making. The Australian National Chronic Disease Strategy focuses on four core areas for managing chronic disease; prevention across the continuum, early detection and treatment, integrated and coordinated care, and self-management. Such a comprehensive approach incorporates the entire population continuum, from the ‘healthy’, to those with risk factors, through to people suffering from chronic conditions and their sequelae. This chapter examines comprehensive approach to the prevention, management and care of the population with non-communicable, chronic diseases and communicable diseases. It analyses models of care in the context of need, service delivery options and the potential to prevent or manage early intervention for chronic and communicable diseases. Approaches to chronic diseases require integrated approaches that incorporate interventions targeted at both individuals and populations, and emphasise the shared risk factors of different conditions. Communicable diseases are a common and significant contributor to ill health throughout the world. In many countries, this impact has been minimised by the combined efforts of preventative health measures and improved treatment of infectious diseases. However in underdeveloped nations, communicable diseases continue to contribute significantly to the burden of disease. The aim of this chapter is to outline the impact that chronic and communicable diseases have on the health of the community, the public health strategies that are used to reduce the burden of those diseases and the old and emerging risks to public health from infectious diseases.

Building climate change resilience and adaptive capacity in Australia’s community sector using social media and technology innovation

Public and private sector organisations worldwide are putting strategies in place to manage the commercial and operational risks of climate change. However, community organisations are lagging behind in their understanding and preparedness, despite them being among the most exposed to the effects of climate change impacts and regulation. This poster presents a proposal for a multidisciplinary study that addresses this issue by developing, testing and applying a novel climate risk assessment methodology that is tailored to the needs of Australia’s community sector and its clients. Strategies to mitigate risks and build resilience and adaptive capacity will be identified including new opportunities afforded by urban informatics, social media, and technologies of scale making.

Rethinking health planning : a framework for organising information to underpin collaborative health planning

The field of collaborative health planning faces significant challenges created by the narrow focus of the available information, the absence of a framework to organise that information and the lack of systems to make information accessible and guide decision-making. These challenges have been magnified by the rise of the ‘healthy communities movement’, as a result of which, there have been more frequent calls for localised, collaborative and evidence-driven health related decision-making. This paper discusses the role of decision support systems as a mechanism to facilitate collaborative health decision-making. The paper presents a potential information management framework to underpin a health decision support system and describes the participatory process that is currently being used to create an online tool for health planners using geographic information systems. The need for a comprehensive information management framework to guide the process of planning for healthy communities has been emphasised. The paper also underlines the critical importance of the proposed framework not only in forcing planners to engage with the entire range of health determinants, but also in providing sufficient flexibility to allow exploration of the local setting-based determinants of health.

Case study 3. A subtropical urban community. Medium to high density residential typologies

Subtropical Urban Communities Project Urban design and residential buildings The Centre for Subtropical Design has researched design concepts for livable subtropical neighbourhoods characterised by higher-density, mixed-use, family oriented housing by conducting a design charrette and analysing the proposed designs to evaluate how well these typologies might support economic, environmental and social sustainability. http://www.subtropicaldesign.org.au/index.php?option=com_content&task=view&id=125&Itemid=163 The QUT Team produced designs (Case Study 3) within the research framework of the design charrette.

Is there a need for routine follow-up after primary total hip arthroplasty?

Background: The objective of routine outpatient assessment of well functioning patients after primary total hip arthroplasty (THA) is to detect asymptomatic failure of prostheses to guide recommendations for early intervention. We have observed that the revision of THAs in asymptomatic patients is highly uncommon. We therefore question the need for routine follow-up of patients after THA. Methods: A prospective analysis of an orthopaedic database identified 158 patients who received 177 revision THAs over a 4 year period. A retrospective chart review was conducted. Patient demographics, primary and revision surgery parameters and follow-up information was recorded and cross referenced with AOA NJRR data. Results: 110 THAs in 104 patients (average age 70.4 (SD 9.8 years). There were 70 (63.6%) total, 13 (11.8%) femoral and 27 (24.5%) acetabular revisions. The indications for revision were aseptic loosening (70%), dislocation (8.2%), peri-prosthetic fracture (7.3%), osteolysis (6.4%) and infection (4.5%). Only 4 (3.6%) were asymptomatic revisions. A mean of 5.3 (SD 5.2 and 1.9 (SD 5.3 follow-up appointments were required before revision in patients with and without symptoms, respectively. The average time from the primary to revision surgery was 11.8 (SD 7.23) years. Conclusions: We conclude that patients with prostheses with excellent long term clinical results as validated by Joint Registries, routine follow-up of asymptomatic THA should be questioned and requires further investigation. Based on the work of this study, the current practice of routine follow-up of asymptomatic THA may be excessively costly and unnecessary and a less resource-intensive review method may be more appropriate.

Community knowledge and beliefs about ADHD

Accurate knowledge and positive attitudes within the community are important for the effective diagnosis, treatment and support of people with ADHD. Most previous research about knowledge and attitudes has focused only on professional groups and parents of children with ADHD. The aim of this study was to explore knowledge about ADHD characteristics and causes, and attitudes towards issues such as medication in the general population. Six hundred and forty-five members of the Australian community, all of whom were parents, completed a questionnaire. The findings showed that the core features of ADHD were well-known, but there were misconceptions and considerable uncertainty about many aspects. Most respondents failed to recognise the genetic basis of the disorder and its potentially lifelong nature. Fathers were less knowledgeable than mothers. Although most participants believed that ADHD is a genuine disorder and recognised the benefits of medication, the majority believed that it is diagnosed too frequently and that medication is prescribed too readily. The study concluded that, in many respects, the public is not well-informed about ADHD and suggested that the media may have an important role in enhancing community awareness of the disorder through responsible, sensitive and accurate reporting.

Green energy : sustainable energy sources and alternative technologies

Despite the general evolution and broadening of the scope of the concept of infrastructure in many other sectors, the energy sector has maintained the same narrow boundaries for over 80 years. Energy infrastructure is still generally restricted in meaning to the transmission and distribution networks of electricity and, to some extent, gas. This is especially true in the urban development context. This early 20th century system is struggling to meet community expectations that the industry itself created and fostered for many decades. The relentless growth in demand and changing political, economic and environmental challenges require a shift from the traditional ‘predict and provide’ approach to infrastructure which is no longer economically or environmentally viable. Market deregulation and a raft of demand and supply side management strategies have failed to curb society’s addiction to the commodity of electricity. None of these responses has addressed the fundamental problem. This chapter presents an argument for the need for a new paradigm. Going beyond peripheral energy efficiency measures and the substitution of fossil fuels with renewables, it outlines a new approach to the provision of energy services in the context of 21st century urban environments.

Community voices, votes and action

The diversity of community voices in the SEQ ‘bellwether region’ has grown from a muted murmur in the mid twentieth century supporting provision of urban services, rural conservation and green belts, to the current clamour against over-development, and in favour of protecting local and regional open space, wetlands and natural habitats. This in turn has often resulted in vigorous campaigns against unpopular roads, dams, dumps and tall buildings. In the last twenty years community issues have played a major part in local government elections throughout the region and have even helped unseat (in 1995-1996) a state government which discounted their authenticity and community resolve.

Knowledge-based approach for planning healthy cities : the case of Logan-Beaudesert, Australia

Introduction - The planning for healthy cities faces significant challenges due to lack of effective information, systems and a framework to organise that information. Such a framework is critical in order to make accessible and informed decisions for planning healthy cities. The challenges for planning healthy cities have been magnified by the rise of the healthy cities movement, as a result of which, there have been more frequent calls for localised, collaborative and knowledge-based decisions. Some studies have suggested that the use of a ‘knowledge-based’ approach to planning will enhance the accuracy and quality decision-making by improving the availability of data and information for health service planners and may also lead to increased collaboration between stakeholders and the community. A knowledge-based or evidence-based approach to decision-making can provide an ‘out-of-the-box’ thinking through the use of technology during decision-making processes. Minimal research has been conducted in this area to date, especially in terms of evaluating the impact of adopting knowledge-based approach on stakeholders, policy-makers and decision-makers within health planning initiatives. Purpose – The purpose of the paper is to present an integrated method that has been developed to facilitate a knowledge-based decision-making process to assist health planning Methodology – Specifically, the paper describes the participatory process that has been adopted to develop an online Geographic Information System (GIS)-based Decision Support System (DSS) for health planners. Value – Conceptually, it is an application of Healthy Cities and Knowledge Cities approaches which are linked together. Specifically, it is a unique settings-based initiative designed to plan for and improve the health capacity of Logan-Beaudesert area, Australia. This setting-based initiative is named as the Logan-Beaudesert Health Coalition (LBHC). Practical implications - The paper outlines the application of a knowledge-based approach to the development of a healthy city. Also, it focuses on the need for widespread use of this approach as a tool for enhancing community-based health coalition decision making processes.

Pre-service teacher education and the development of middle school teacher identity : an exploratory study

This research study investigated the factors that influenced the development of teacher identity in a small cohort of mature-aged graduate pre-service teachers over the course of a one-year Graduate Diploma program (Middle Years). It sought to illuminate the social and relational dynamics of these pre-service teachers’ experiences as they began new ways of being and learning during a newly introduced one-year Graduate Diploma program. A relational-ontological perspective underpinned the relational-cultural framework that was applied in a workshop program as an integral part of this research. A relational-ontological perspective suggests that the development of teacher identity is to be construed more as an ontological process than an epistemological one. Its focus is more on questions surrounding the person and their ‘becoming’ a teacher than about the knowledge they have or will come to have. Hence, drawing on work by researchers such as Alsup (2006), Gilligan, (1982), Isaacs, (2007), Miller (1976), Noddings, (2005), Stout (2001), and Taylor, (1989), teacher identity was defined as an individual pre-service teacher’s unique sense of self as a teacher that included his or her beliefs about teaching and learning (Alsup, 2006; Stout, 2001; Walkington, 2005). Case-study was the preferred methodology within which this research project was framed, and narrative research was used as a method to document the way teacher identity was shaped and negotiated in discursive environments such as teacher education programs, prior experiences, classroom settings and the practicum. The data that was collected included student narratives, student email written reflections, and focus group dialogue. The narrative approach applied in this research context provided the depth of data needed to understand the nature of the mature-aged pre-service teachers’ emerging teacher identities and experiences in the graduate diploma program. Findings indicated that most of the mature-aged graduate pre-service teachers came in to the one-year graduate diploma program with a strong sense of personal and professional selves and well-established reasons why they had chosen to teach Middle Years. Their choice of program involved an expectation of support and welcome to a middle-school community and culture. Two critical issues that emerged from the pre-service teachers’ narratives were the importance they placed on the human support including the affirmation of themselves and their emerging teacher identities. Evidence from this study suggests that the lack of recognition of preservice teachers’ personal and professional selves during the graduate diploma program inhibited the development of a positive middle-school teacher identity. However, a workshop program developed for the participants in this research and addressing a range of practical concerns to beginning teachers offered them a space where they felt both a sense of belonging to a community and where their thoughts and beliefs were recognized and valued. Thus, the workshops provided participants with the positive social and relational dynamics necessary to support them in their developing teacher identities. The overall findings of this research study strongly indicate a need for a relational support structure based on a relational-ontological perspective to be built into the overall course structure of Graduate Pre-service Diplomas in Education to support the development of teacher identity. Such a support structure acknowledges that the pre-service teacher’s learning and formation is socially embedded, relational, and a continual, lifelong process.

Managing illegal street racing and associated risky driving behaviour : An Australian perspective

Illegal street racing has received increased attention in recent years from the media, governments and road safety professionals. At the same time, there has been a shift from treating illegal street racing as a public nuisance issue to a road safety problem in Australia, as this behaviour now attracts a penalty of increased periods of vehicle impoundment leading to permanent vehicle forfeiture for repeat offences. This severe vehicle sanction is typically applied to repeat drink driving offenders and drivers who breach suspensions and disqualifications in North American jurisdictions, but was first introduced in Australia to deal with illegal street racing and associated risky driving behaviours, grouped together under the label of ‘hooning’ in Australian jurisdictions. This paper describes how Australian jurisdictions are dealing with this issue. The research described in this paper drew on multiple data sources to explore illegal street racing and the management of this issue in Australia. First, the paper reviews the relevant legislation in each Australian state to describe the cross-jurisdictional similarities and differences in approaches. It also describes some results from focus group discussions and a quantitative online survey with drivers who self-report engaging in illegal street racing and associated behaviours in Queensland, Australia. It was found that approaches to dealing with illegal street racing and associated risky driving behaviours in each Australian state are similar, with increasing periods of vehicle impoundment (leading to vehicle forfeiture) applied to repeat hooning offences within prescribed periods. Participants in the focus groups and respondents to the questionnaire generally felt these penalty periods were severe, with perceptions of severity increasing with the length of the penalty period. It was concluded that there is a need for each jurisdiction to objectively evaluate the effectiveness of their vehicle impoundment and forfeiture programs for hooning. These evaluations should compare the relative costs of these programs (e.g., enforcement, unrecovered towing and storage fees, and court costs) to the observed benefits (e.g., reduction in target behaviours, reduction in community complaints, and reduction in the number and severity of associated crashes).