Hysterectomy trends in australia between--2000/01 and 2004/05

Background: Hysterectomy is a major and common surgical procedure that has the potential to provide relief from ongoing gynaecological problems, but is often associated with negative impacts on health and wellbeing. Research indicates that hysterectomy rates and trends vary widely between and within countries; yet little is known about patterns in Australia.

Aims: This research aimed to describe hysterectomy rates and trends in Australia between 2000/01 and 2004/05.

Methods: This repeat cross-sectional study used routinely collected data from all hospitals in Australia. Data on all women admitted to hospital for a hysterectomy were obtained from the National Hospital Morbidity Database (2000/01–2004/05). Data were analysed by calculating population rates for each type of hysterectomy. Incidence rate ratios were calculated to assess changes over time.

Results: Hysterectomy rates in Australia declined from 34.8 per 10 000 women in 2000/01 to 31.2 per 10 000 women in 2004/05. A decline in the incidence rate for abdominal hysterectomy (from 18.7 to 15.1 per 10 000 women) and the incidence rate for concurrent oophorectomy (from 12.4 to 11.3 per 10 000 women) were also observed during this time period. At each point in time, the highest incidence rates for hysterectomy were for women aged 45–54 years.

Conclusions: Hysterectomy rates in Australia are declining over time and currently appear to be lower than most other countries. More hysterectomies are performed vaginally than in Canada, the USA, the UK and Finland and the rate of concurrent oophorectomy is less than that reported in the USA and the UK.

The Cool Little Kids randomised controlled trial population-level early prevention for anxiety disorders

Background: The World Health Organization predicts that by 2030 internalising problems (e.g. depression and anxiety) will be second only to HIV/AIDS in international burden of disease. Internalising problems affect 1 in 7 school aged children, impacting on peer relations, school engagement, and later mental health, relationships and employment. The development of early childhood prevention for internalising problems is in its infancy. The current study follows two successful ‘efficacy’ trials of a parenting group intervention to reduce internalising disorders in temperamentally inhibited preschool children. Cool Little Kids is a population-level randomised trial to determine the impacts of systematically screening preschoolers for inhibition then offering a parenting group intervention, on child internalising problems and economic costs at school entry.
Methods/Design: This randomised trial will be conducted within the preschool service system, attended by more than 95% of Australian children in the year before starting school. In early 2011, preschool services in four local government areas in Melbourne, Australia, will distribute the screening tool. The ≈16% (n≈500) with temperamental inhibition will enter the trial. Intervention parents will be offered Cool Little Kids, a 6-session group program in the local community, focusing on ways to develop their child’s bravery skills by reducing overprotective parenting interactions. Outcomes one and two years post-baseline will comprise child internalising diagnoses and symptoms, parenting interactions, and parent wellbeing. An economic evaluation (costconsequences framework) will compare incremental differences in costs of the intervention versus control children to incremental differences in outcomes, from a societal perspective. Analyses will use the intention-to-treat principle, using logistic and linear regression models (binary and continuous outcomes respectively) to compare outcomes between the trial arms.
Discussion: This trial addresses gaps for internalising problems identified in the 2004 World Health Organization Prevention of Mental Disorders report. If effective and cost-effective, the intervention could readily be applied at a population level. Governments consider mental health to be a priority, enhancing the likelihood that an effective early prevention program would be adopted in Australia and internationally.

Developing a scholarly approach to the evaluation of assessment practices

Purpose – The purpose of this paper is to examine and reflect on current assessment practice in a large undergraduate accounting programme delivered both in Australia and offshore, from the perspective of academics in their first semester at a “new-to-them” university.

Design/methodology/approach – The changing higher education environment and the reality of assessment in the current context are considered, as they raise a number of important issues around assessment practice. Some of the often cited literature linking teaching, learning and assessment, including student-centred learning and Confucian heritage culture, is also discussed. A reflective approach is used where Säljö's five categories of student learning are used as the basis for informed reflection of the assessment used in the “new” academics' first semester at the university. The use of empirical evidence to test these reflections would be the next step in this scholarly approach to teaching and learning.

Findings – The reflections reveal a disparity between reality and the ideal in relation to assessment practice. Issues regarding timely feedback to students and timing of assessments can result in summative assessment when it has the potential to be formative. This paper has provided an opportunity for “new” academics to engage with the higher education literature early in their careers.

Originality/value – This paper is a resource for academics beginning to engage with the higher education literature around assessment, teaching and learning and can also be used to inform and improve the teaching and learning practices of many academics in higher education.

Reflections on the mentoring process with academics entering a 'new' educational experience

Purpose – Increasingly, academics new to higher education find themselves in a “publish or perish” environment, with little if any formal or informal support structures. This is a situation that many academics have faced and lamented. The discussion in this paper emanates from the objective of seeking to change this environment. The mentoring provided an opportunity to work collaboratively with accounting academics who are new to the higher education sector, and focuses on developing and/or enhancing a scholarly approach to teaching and learning.

Design/methodology/approach – The reflective practitioner model provides the theoretical framework that underpins this mentoring process. The discussion in this research paper provides an opportunity to explore this mentoring process, primarily aimed at developing and encouraging a scholarly approach to teaching and learning by academics new to the environment. Data on the process were collected using a survey questionnaire and as a result of informal discussions during the mentoring process.

Findings – The findings indicate an overall positive response to the process for both the mentor and the mentee and the achievement of the planned research outcomes.

Originality/value – The discussion in this paper outlines a framework and process that others may follow when mentoring academics entering a “new” educational experience.

Pharmacy access to the emergency contraceptive pill : a national survey of a random sample of Australian women

Background : The emergency contraceptive pill (ECP) has the potential to assist in reducing unintended pregnancy and abortion rates. Since its rescheduling to pharmacy availability without prescription in Australia in January 2004, there is little information about Australian women's knowledge, attitudes and use of the ECP. The aim of this study was to measure the knowledge about the ECP and sociodemographic patterns of and barriers to use of the ECP.

Study Design : A cross-sectional study, using a computer-assisted telephone interview (CATI) survey conducted with a national random sample of 632 Australian women aged 16–35 years.

Results : Most women had heard of the ECP (95%) and 26% had used it. The majority of women agreed with pharmacy availability of the ECP (72%); however, only 48% were aware that it was available from pharmacies without a prescription. About a third (32%) believed the ECP to be an abortion pill. The most common reason for not using the ECP was that women did not think they were at risk of getting pregnant (57%). Logistic regression showed that women aged 20–29 years (OR 2.58; CI: 1.29–5.19) and 30–35 years (OR 3.16; CI: 1.47–6.80) were more likely to have used the ECP than those aged 16–19 years. Women with poor knowledge of the ECP were significantly less likely to have used it than those with very good knowledge (OR 0.28; CI: 0.09–0.77). Those in a de facto relationship (OR 2.21; CI: 1.27–3.85), in a relationship but not living with the partner (OR 2.46; 95% CI 1.31–4.63) or single women (OR 2.40; CI: 1.33–4.34) were more likely to have used the ECP than married women.

Conclusions : Women in Australia have a high level of awareness of the ECP, but more information and education about how to use it and where to obtain it are still needed.

Provision of the emergency contraceptive pill without prescription : attitudes and practices of pharmacists in Australia

Background : As 5 years have elapsed since the emergency contraceptive pill (ECP) was made available without prescription in Australia, information was sought about the current attitudes and practices of pharmacists in relation to their increased role in ECP provision.

Study Design : A mail survey was implemented; questionnaires were distributed to 750 pharmacies across Australia during 2008-2009. Descriptive statistics were calculated and multiple logistic regression was used to examine factors associated with declining to dispense ECP.

Results : Response rate was 29%. Most pharmacists used a protocol to guide ECP dispensing (77.3%) and the majority had declined ECP provision (75.1%) in certain circumstances. Many usually counselled where confidentiality could be assured (62.8%), and agreed that it is a pharmacist's role to counsel on regular contraception (81.9%). Factors significantly associated (p≤.05) with dispensing practices included pharmacists' attitudes towards acceptability of advance prescription, their age, gender and pharmacy accessibility.

Conclusions : New information about Australian pharmacists' current attitudes and practices towards ECP dispensing was identified. Pharmacists had stronger, more conservative attitudes than overseas pharmacists; however, the issues that emerged were similar to those reported overseas. To address these, revised training for local pharmacists is recommended.