The rehabilitation of indigenous prisoners : an Australian perspective

The massive problems experienced by Indigenous Australians in their encounters with the criminal justice system have been well documented and widely discussed. This paper applies the Risk, Needs and Responsivity Model of rehabilitation to Indigenous offenders. While much of the review is devoted to a discussion of Australian Indigenous offenders, the issues raised are likely to be relevant to Indigenous groups from other countries and, possibly, ethnic minority offenders more generally. We concluded that whilst the model clearly has value, rehabilitation programs would benefit from a careful consideration of issues relating specifically to the Risk, Needs and Responsivity of Indigenous offenders.

Assessing treatment readiness in violent offenders

Although violent offenders are widely considered to be difficult to engage in therapeutic change, few methods of assessing treatment readiness currently exist. In this article the validation of a brief self-report measure designed to assess treatment readiness in offenders who have been referred to violent offender treatment programs is described. The measure, which is an adaptation of a general measure of treatment readiness developed in a previous work, displayed acceptable levels of convergent and discriminant validity and was able to successfully predict treatment engagement in violent offender treatment. These results suggest that the measure has utility in the assessment of treatment readiness in violent offenders.

Alcohol use and negative affect in the offence cycle

Introduction : It is commonly acknowledged that, for many offenders, alcohol use is strongly associated with criminal behaviour. The belief held by many professionals that the two phenomena are associated, probably in a causal way, has led to the inclusion of alcohol use as a ‘criminogenic need’ in many settings where rehabilitation programmes are used to reduce recidivism. However, the mechanisms and pathways involved in the alcohol–crime link remain poorly understood.

Argument and conclusion : This paper reviews the literature relating to alcohol–offending links and draws some inferences about the role of alcohol use as a criminogenic need in offender rehabilitation. It is proposed that the bi-directional relationship between alcohol use and negative affective states is important in understanding the offence cycle, and that deficits in self-regulation not only characterize both alcohol misuse and negative affect but are also implicated in the offending behaviour itself.

Knowledge-in-practice in the caring professions : multidisciplinary perspectives

Contents:  Ideas of knowledge in practice / Struan Jacobs -- Information, knowledge, and wisdom in medical practice / P. B. Greenberg -- The practice of the psychiatrist / Alex Holmes -- Social work knowledge-in-practice / Heather D'Cruz -- Disability : a personal approach / Lisa Chaffey -- Knowledge in the making : an analytical psychology perspective / Joy Norton -- Knowledge to action in the practice of nursing / Alison Hutchinson, Tracey Bucknall -- The risky business of birth / Frances Sheean and Jennifer M. Cameron -- Skills for person-centred care : health professionals supporting chronic condition prevention and self-management / Sharon Lawn and Malcolm Battersby -- Knowledge and reasoning in practice : an example from physiotherapy and occupational therapy / Megan Smith ... [et al.] -- Using knowledge in the practice of dealing with addiction : an ideal worth aiming for / Peter Miller.

Supporting self-management of chronic health conditions : Common approaches

Objective : The aims of this paper are to provide a description of the principles of chronic condition self-management, common approaches to support currently used in Australian health services, and benefits and challenges associated with using these approaches.
Methods : We examined literature in this field in Australia and drew also from our own practice experience of implementing these approaches and providing education and training to primary health care professionals and organizations in the field.
Results : Using common examples of programs, advantages and disadvantages of peer-led groups (Stanford Courses), care planning (The Flinders Program), a brief primary care approach (the 5As), motivational interviewing and health coaching are explored.
Conclusions : There are a number of common approaches used to enhance self-management. No one approach is superior to other approaches; in fact, they are often complimentary.
Practice implications : The nature and context for patients’ contact with services, and patients’ specific needs and preferences are what must be considered when deciding on the most appropriate support mode to effectively engage patients and promote self-management. Choice of approach will also be determined by organizational factors and service structures. Whatever self-management support approaches used, of importance is how health services work together to provide support.

The role of focus groups in a randomised controlled trial : the ADEPT study

In a recent study we developed a decision aid for prenatal testing of fetal abnormalities. The effectiveness of the decision aid compared with a pamphlet in increasing women's informed choice and decreasing conflict was evaluated using a cluster randomised controlled trial, A DEcision aid for Prenatal Testing for fetal abnormalities (ADEPT) [ISRCTN22532458]. Challenged with the need to ensure that the decision aid best suited the needs of women and health professionals involved General Practitioners (GPs), we explored the potential of both quantitative and qualitative methodologies to inform the development phase. In this article we discuss our rationale for, and provide some insights regarding our experience of, using qualitative methods during the development phase of the decision aid.

Evaluation of a decision aid for prenatal testing of fetal abnormalities : a cluster randomised trial [ISRCTN22532458]

Background: By providing information on the relative merits and potential harms of the options available and a framework to clarify preferences, decision aids can improve knowledge and realistic expectations and decrease decisional conflict in individuals facing decisions between alternative forms of action. Decision-making about prenatal testing for fetal abnormalities is often confusing and difficult for women and the effectiveness of decision aids in this field has not been established. This study aims to test whether a decision aid for prenatal testing of fetal abnormalities, when compared to a pamphlet, improves women's informed decision-making and decreases decisional conflict.

Methods/design: A cluster designed randomised controlled trial is being conducted in Victoria, Australia. Fifty General Practitioners (GPs) have been randomised to one of two arms: providing women with either a decision aid or a pamphlet. The two primary outcomes will be measured by comparing the difference in percentages of women identified as making an informed choice and the difference in mean decisional conflict scores between the two groups. Data will be collected from women using questionnaires at 14 weeks and 24 weeks gestation.

The sample size of 159 women in both arms of the trial has been calculated to detect a difference of 18% (50 to 68%) in informed choice between the two groups. The required numbers have been adjusted to accommodate the cluster design, miscarriage and participant lost – to – follow up.

Baseline characteristics of women will be summarised for both arms of the trial. Similarly, characteristics of GPs will be compared between arms.

Differences in the primary outcomes will be analysed using 'intention-to-treat' principles. Appropriate regression techniques will adjust for the effects of clustering and include covariates to adjust for the stratifying variable and major potential confounding factors.

Discussion: The findings from this trial will make a significant contribution to improving women's experience of prenatal testing and will have application to a variety of maternity care settings. The evaluation of a tailored decision aid will also have implications for pregnancy care providers by identifying whether or not such a resource will support their role in providing prenatal testing information.

Correlates of screening mammography for Italian and Anglo-Australian women

The first aim of the research was to determine the applicability of certain variables from the Health Belief Model (HBM), the Theory of Reasoned Action (TRA), the risk dimensions from the Psychometric Paradigm, the Common-Sense Model of Illness Representations and the Locus of Control to Italian women’s beliefs and behaviours in relation to screening mammography. These models have predominantly been derived and evaluated with English-speaking persons. The study used quantitative and qualitative methods to enable explanation of research-driven and participant-driven issues. The second aim was to include Italian women in health behaviour research and to contrast the Italian sample with the Anglo-Australian sample to determine if differences exist in relation to their beliefs. In Australia many studies in health behaviour research do not include women whose first language is not English. The third aim was to evaluate the Anti-Cancer Council of Victoria’s (ACCV) Community Language Program (CLP) by: (a) identifying the strengths and weaknesses of the program as seen by the participants; and (b) assessing the impact of the program on women’s knowledge and beliefs about breast cancer, early detection of breast cancer, self-reported and intended breast screening behaviours. The CLP is an information service that uses women’s first language to convey information to women whose first language is not English. The CLP was designed to increase knowledge about breast and cervical cancer. The research used a pre-test-intervention-post-test design with 174 Italian-born and 138 Anglo-Australian women aged 40 years and over. Interviews for the Italian sample were conducted in Italian. The intervention was an information session that related to breast health and screening mammography. Demographic variables were collected in the Pre-Test only. Qualitative open-ended questions that related specifically to the information session were collected in the Post-Test phase of the study. Direct logistic regression was used with the participants’ beliefs and behaviours to identify the relevant variables for language (Italian speaking and English-speaking), attendance to an information session, mammography screening and breast self-examination (BSE) behaviour. Pre- and Post-Test comparisons were conducted using chi-square tests for the non-parametric data and paired sample t-tests for the parametric data. Differences were found between the Italian and Anglo-Australian women in relation to their beliefs about breast cancer screening. The Italian women were: (1) more likely to state that medical experts understood the causes of breast cancer; (2) more likely to feel that they had less control over their personal risk of getting breast cancer; (3) more likely to be upset and frightened by thinking about breast cancer; (4) less likely to perceive breast cancer as serious; (4) more likely to only do what their doctor told them to do; and (5) less likely to agree that there were times when a person has cancer and they don’t know it. A pattern emerged for the Italian and Anglo-Australian women from the logistic regression analyses. The Italian women were much more likely to comply with medical authority and advice. The Anglo-Australian women were more likely to feel that they had some control over their health. Specifically, the risk variable ‘dread’ was more applicable to the Italian women’s behaviour and internal locus of control variable was more relevant to the Anglo-Australian women. The qualitative responses also differed for the two samples. The Italian women’s comments were more general, less specific, and more limited than that of the Anglo-Australian women. The Italian women talked about learning how to do BSE whereas the Anglo-Australian women said that attending the session had reminded them to do BSE more regularly. The key findings and contributions of the present research were numerous. The focus on one cultural group ensured comprehensive analyses, as did the inclusion of an adequate sample size to enable the use of multivariate statistics. Separating the Italian and Anglo-Australian samples in the analyses provided theoretical implications that would have been overlooked if the two groups were combined. The use of both qualitative and quantitative data capitalised on the strengths of both techniques. The inclusion of an Anglo-Australian group highlighted key theoretical findings, differences between the two groups and unique contributions made by both samples during the collection of the qualitative data. The use of a pre-test-intervention-post-test design emphasised the reticence of the Italian sample to participate and talk about breast cancer and confirmed and validated the consistency of the responses across the two interviews for both samples. The inclusion of non-cued responses allowed the researcher to identify the key salient issues relevant to the two groups. The limitations of the present research were the lack of many women who were not screening and reliance on self-report responses, although few differences were observed between the Pre- and Post-Test comparisons. The theoretical contribution of the HBM and the TRA variables was minimal in relation to screening mammography or attendance at the CLP. The applicability of these health behaviour theories may be less relevant for women today as they clearly knew the benefits of and the seriousness of breast cancer screening. The present research identified the applicability of the risk variables to the Italian women and the relevance of the locus of control variables to the Anglo-Australian women. Thus, clear cultural differences occurred between the two groups. The inclusion of the illness representations was advantageous as the responses highlighted ideas and personal theories salient to the women not identified by the HBM. The use of the illness representations and the qualitative responses further confirmed the relevance of the risk variables to the Italian women and the locus of control variables to the Anglo-Australian women. Attendance at the CLP did not influence the women to attend for mammography screening. Behavioural changes did not occur between the Pre- and Post-Test interviews. Small incremental changes as defined by the TTM and the stages of change may have occurred. Key practical implications for the CLP were identified. Improving the recruitment methods to gain a higher proportion of women who do not screen is imperative for the CLP promoters. The majority of the Italian and Anglo-Australian women who attended the information sessions were women who screen. The fact that Italian women do not like talking or thinking about cancer presents a challenge to promoters of the CLP. The key theoretical finding that Italian women dread breast cancer but comply with their doctor provides clear strategies to improve attendance at mammography screening. In addition, the inclusion of lay health advisors may be one way of increasing attendance to the CLP by including Italian women already attending screening and likely to have attended a CLP session. The present research identified the key finding that improving Anglo-Australian attendance at an information session is related to debunking the myth surrounding familial risk of breast cancer and encouraging the Anglo-Australian women to take more control of their health. Improving attendance for Italian women is related to reducing the fear and dread of breast cancer and building on the compliance pattern with medical authority. Therefore, providing an information session in the target language is insufficient to attract non-screeners to the session and then to screen for breast cancer. Suggestions for future research in relation to screening mammography were to include variables from more than one theory or model, namely the risk, locus of control and illness representations. The inclusion of non-cued responses to identify salient beliefs is advantageous. In addition, it is imperative to describe the profile of the cultural sample in detail, include detailed descriptions of the translation process and be aware of the tendency of Italian women to acquiesce with medical authority.

Cholesterol is necessary both for the toxic effect of Abeta peptides on vascular smooth muscle cells and for Abeta binding to vascular smooth muscle cell membranes

Accumulation of beta amyloid (Aβ) in the brain is central to the pathogenesis of Alzheimer's disease. Aβ can bind to membrane lipids and this binding may have detrimental effects on cell function. In this study, surface plasmon resonance technology was used to study Aβ binding to membranes. Aβ peptides bound to synthetic lipid mixtures and to an intact plasma membrane preparation isolated from vascular smooth muscle cells. Aβ peptides were also toxic to vascular smooth muscle cells. There was a good correlation between the toxic effect of Aβ peptides and their membrane binding. 'Ageing' the Aβ peptides by incubation for 5 days increased the proportion of oligomeric species, and also increased toxicity and the amount of binding to lipids. The toxicities of various Aβ analogs correlated with their lipid binding. Significantly, binding was influenced by the concentration of cholesterol in the lipid mixture. Reduction of cholesterol in vascular smooth muscle cells not only reduced the binding of Aβ to purified plasma membrane preparations but also reduced Aβ toxicity. The results support the view that Aβ toxicity is a direct consequence of binding to lipids in the membrane. Reduction of membrane cholesterol using cholesterol-lowering drugs may be of therapeutic benefit because it reduces Aβ-membrane binding.

Population monitoring of language and cognitive development in Australia : the Australian early development index

The Australian Early Development Index (AEDI) is a population measure of child development. The AEDI measures Language and Cognitive Development, Social Competence, Emotional Maturity, Physical Health and Wellbeing, and Communication Skills and General Knowledge. In Australia these data are collected by teachers for children in their first full time year of schooling. The aim of this paper is to aid people's understanding and interpretation of population measures such as the AEDI. With a greater awareness of the merits and complexities of population data clinicians and allied health professionals can play a vital role in aiding communities and policy makers to interpret and act upon the data in an intelligent way. This paper is primarily descriptive providing background information on the development and use of the instrument utilizing one of the 5 developmental domains (Language and Cognitive Development) as an example. The results show a complex relationship between children residing in differing socio-economic regions, children with English as their primary or secondary language and children who are able or not able to effectively communicate in English.

Grafts in myringoplasty : utilizing a silk fibroin scaffold as a novel device

Chronic perforations of the eardrum or tympanic membrane represent a significant source of morbidity worldwide. Myringoplasty is the operative repair of a perforated tympanic membrane and is a procedure commonly performed by otolaryngologists. Its purpose is to close the tympanic membrane, improve hearing and limit patient susceptibility to middle ear infections. The success rates of the different surgical techniques used to perform a myringoplasty, and the optimal graft materials to achieve complete closure and restore hearing, vary significantly in the literature. A number of autologous tissues, homografts and synthetic materials are described as graft options. With the advent and development of tissue engineering in the last decade, a number of biomaterials have been studied and attempts have been made to mimic biological functions with these materials. Fibroin, a core structural protein in silk from silkworms, has been widely studied with biomedical applications in mind. Several cell types, including keratinocytes, have grown on silk biomaterials, and scaffolds manufactured from silk have successfully been used in wound healing and for tissue engineering purposes. This review focuses on the current available grafts for myringoplasty and their limitations, and examines the biomechanical properties of silk, assessing the potential benefits of a silk fibroin scaffold as a novel device for use as a graft in myringoplasty surgery.