Characteristics of culturally and linguistically diverse mental health clients

The present study examined Queensland Transcultural Mental Health Centre (QTMHC) client characteristics in order to provide a better understanding for development of future health service delivery models. Archived data that was collected for 1499 clients over two years period (2007-2009) was analysed using descriptive statistics and Chi squares. The results indicated that clients were referred from a range of sources and were generally adults. There were more women than men, who sought services. At least half of the clients had language barriers and relied on bilingual workers. Most frequently expressed mental health issues were mood disorder symptoms, followed by symptoms of schizophrenia and psychosis and anxiety. Acculturation strains and stressors were described as the most common psychosocial issues. Mental health and psychosocial issues differed for age, gender and world regions from which the CALD clients originated. The findings provided an understanding of clients who seek services at QTMHC. Various ways in which transcultural services and data bases can be further improved are discussed.

Sustainable, safe, smart—three key elements of Singapore’s evolving transport policies

Sustainability, safety and smartness are three key elements of a modern transportation system. This study illustrates various policy directions and initiatives of Singapore to address how its transportation system is progressing in light of these three components. Sustainability targets economical efficiency, environmental justice and social equity by including policies for integrating land use and transport planning, ensuring adequate transport supply measures, managing travel demand efficiently, and incorporating environment-friendly strategies. Safety initiatives of its transportation system aim to minimize injuries and incidents of all users including motorists, public transport commuters, pedestrians, and bicyclists. Smartness incorporates qualities like real time sensing, fast processing and decision making, and automated action-taking into its control, monitoring, information management and revenue collection systems. Various policy implications and technology applications along these three directions reveal that smart technologies facilitate implementation of policies promoting sustainability and safety. The Singapore experience could serve as a good reference for other cities in promoting a transportation system that is sustainable, safe and smart.

Thai family support (TFS) : working with families of young substance users in primary health care

Living with substance users negatively impacts upon family members in many ways, and distress is common. Despite these deep and wide-ranging impacts, supportive interventions for family members in their own right are rarely available. Thailand has substantial and growing problems with substance use, and there is very little support or family members of drug users, especially in community setting. The Thai Family Support (TFS) program was designed for implementation in primary health care units (PCUs) in Thailand. TFS was based on two approaches with existing empirical support in Western contexts—the 5-step method and CRAFT—with adaptations to a Thai setting that included integration with Buddhist practices. Its aims were to increase well-being of family members, reduce mental distress, improve family relationships between family members, and engage substance users in behaviour change. A small-scale randomised controlled trial on TFS with a Delayed Treatment control was conducted, with assessments at 8 weeks (Post 1) and 20-24 weeks (Post 2). Structured interviews with participants and PCU staff and an examination of five case studies augmented the quantitative results. Mixed Model Analyses were applied to quantitative outcomes, and thematic analysis was used for qualitative data. Thirty-six participants (18 in each of Immediate and Delayed Conditions) were recruited. A significant difference at Baseline between the two conditions was observed on the Thai GHQ-28 and Gender, but it was not possible to statistically control for these effects. There was a significant Time by Condition interaction on the Thai GHQ-28, WHOQOL-BREF-THAI and FAS, reflecting greater improvements in the Immediate condition by Post 1, but with the Delayed condition meeting or exceeding that effect by Post 2. On FES Cohesion and Conflict, there were falls across conditions at Post 2, but only Cohesion also showed a Time by Condition interaction, and that effect was consistent with a delayed impact of treatment. Overall, TFS by PCU staff in the Delayed Condition gave similar results to TFS conducted by the researcher, supporting the viability of its dissemination to standard health services. Qualitative data also confirmed the quantitative results. Most participants reported physiological and psychological improvements even though their substance-using relative did not change their drug use behaviour. After completing TFS, participants reported increased knowledge, group support and sharing feeling, having positive patient-professional relationship, having greater knowledge of substance abuse and social support. In particular, they changed their behaviour towards the substance user, resulting in improvements to family relationships. PCU staff gave similar responses on the efficacy of TFS, and saw it as feasible for routine use, although some implementation challenges were identified. The cultural adaptation and in particular the religious activities, were recognised by participants and PCU staff as an important component of TFS to support psychological health and well-being. Findings from this study showed the impact of substance use on family members and difficulties that they experienced when living with the substance users, resulting distresses and burden that may develop severe mental health disease. Drug use policies should be modified to support family members and response to their needs effectively for early prevention. This study also gave preliminary support for application of the TFS program in rural primary care settings and identified some policies that will be required for it to be disseminated more broadly.

Private health insurance status and utilisation of dental services in Australia

This article focuses on the relationship between private insurance status and dental service utilisation in Australia using data between 1995 and 2001. This article employs joint maximum likelihood to estimate models of time since last dental visit treating private ancillary health insurance (PAHI) as endogenous. The sensitivity of results to the choice between two different but related types of instrumental variables is examined. We find robust evidence in both 1995 and 2001 that individuals with a PAHI policy make significantly more frequent dental consultations relative to those without such coverage. A comparison of the 1995 and 2001 results, however, suggests that there has been an increasing role of PAHI in terms of the frequency of dental consultations over time. This seems intuitive given the trends in the price of unsubsidised private dental consultations. In terms of policy, our results suggest that while government measures to increase private health insurance coverage in Australia has been successful to a significant degree, it may have come at some cost in terms of socio-economic inequality as the privately insured are provided much better access to care and financial protection.

The effectiveness of energy feedback for conservation and peak demand : a literature review

This paper reviews electricity consumption feedback literature to explore the potential of electricity feedback to affect residential consumers’ electricity usage patterns. The review highlights a substantial amount of literature covering the debate over the effectiveness of different feedback criteria to residential customer acceptance and overall conservation and peak demand reduction. Researchers studying the effects of feedback on everyday energy use have observed substantial variation in effect size, both within and between studies. Although researchers still continue to question the types of feedback that are most effective in encouraging conservation and peak load reduction, some trends have emerged. These include that feedback be received as quickly as possible to the time of consumption; be related to a standard; be clear and meaningful and where possible both direct and indirect feedback be customised to the customer. In general, the literature finds that feedback can reduce electricity consumption in homes by 5 to 20 per cent, but that significant gaps remain in our knowledge of the effectiveness and cost benefit of feedback.

A basis for inquiry into policy considerations for increasing the application of biophilic urbanism

Urban design that harnesses natural features (such as green roofs and green walls) to improve design outcomes is gaining significant interest, particularly as there is growing evidence of links between human health and wellbeing, and contact with nature. The use of such natural features can provide many significant benefits, such as reduced urban heat island effects, reduced peak energy demand for building cooling, enhanced stormwater attenuation and management, and reduced air pollution and greenhouse gas emissions. The principle of harnessing natural features as functional design elements, particularly in buildings, is becoming known as ‘biophilic urbanism’. Given the potential for global application and benefits for cities from biophilic urbanism, and the growing number of successful examples of this, it is timely to develop enabling policies that help overcome current barriers to implementation. This paper describes a basis for inquiry into policy considerations related to increasing the application of biophilic urbanism. The paper draws on research undertaken as part of the Sustainable Built Environment National Research Centre (SBEnrc) In Australia in partnership with the Western Australian Department of Finance, Parsons Brinckerhoff, Green Roofs Australasia, and Townsville City Council (CitySolar Program). The paper discusses the emergence of a qualitative, mixed-method approach that combines an extensive literature review, stakeholder workshops and interviews, and a detailed study of leading case studies. It highlights the importance of experiential and contextual learnings to inform biophilic urbanism and provides a structure to distil such learnings to benefit other applications.

Performance characterization of VGCF/epoxy nanocomposite sensors under static load cycles and in static structural health monitoring

Compared to conventional metal-foil strain gauges, nanocomposite piezoresistive strain sensors have demonstrated high strain sensitivity and have been attracting increasing attention in recent years. To fulfil their ultimate success, the performance of vapor growth carbon fiber (VGCF)/epoxy nanocomposite strain sensors subjected to static cyclic loads was evaluated in this work. A strain-equivalent quantity (resistance change ratio) in cantilever beams with intentionally induced notches in bending was evaluated using the conventional metal-foil strain gauges and the VGCF/epoxy nanocomposite sensors. Compared to the metal-foil strain gauges, the nanocomposite sensors are much more sensitive to even slight structural damage. Therefore, it was confirmed that the signal stability, reproducibility, and durability of these nanocomposite sensors are very promising, leading to the present endeavor to apply them for static structural health monitoring.

The Cuban Revolution and Internationalism: Structuring Education and Health

The Capacity to Share is the first book to document how Cubans share their highly developed educational services with other low-income states, especially those in Africa, Latin America, and the Caribbean. A variety of international and Cuban authors break new ground in presenting this research. They investigate the experiences of people who have studied in Cuba on scholarships from the Cuban government, the implications for their home countries, and the work of Cuban teachers and administrators to support education in other countries. The authors discuss how the Cuban "solidarity" approach prioritizes global educational cooperation for mutual support, rather than imposing conditional aid. The book offers original and unusual insights into issues of culture, education, aid, development, and change as they relate to low-income states.

Designing an information accountability framework for eHealth

Information privacy is a crucial aspect of eHealth. Appropriate privacy management measures are therefore essential for its success. However, traditional measures for privacy preservation such as rigid access controls (i.e., preventive measures) are not suitable to eHealth because of the specialised and information - intensive nature of healthcare itself, and the nature of the information. Healthcare professionals (HCP) require easy, unrestricted access to as much information as possible towards making well - informed decisions. On the other end of the scale however, consumers (i.e., patients) demand control over their health information and raise concerns for privacy arising from internal activities (i.e., information use by HCPs). A proper balance of these competing concerns is vital for the implementation of successful eHealth systems. Towards reaching this balance, we propose an information accountability framework (IAF) for eHealth systems.

Tackling the health burden from household air pollution (HAP) : development and implementation of new WHO Guidelines

Household air pollution (HAP), arising mainly from the combustion of solid and other polluting fuels, is responsible for a very substantial public health burden, most recently estimated as causing 3.5 million premature deaths in 2010. These patterns of household fuel use have also important negative impacts on safety, prospects for poverty reduction and the environment, including climate change. Building on previous air quality guidelines, the WHO is developing new guidelines focused on household fuel combustion, covering cooking, heating and lighting, and although global, the key focus is low and middle income countries reflecting the distribution of disease burden. As discussed in this paper, currently in development, the guidelines will include reviews of a wide range of evidence including fuel use in homes, emissions from stoves and lighting, household air pollution and exposure levels experienced by populations, health risks, impacts of interventions on HAP and exposure, and also key factors influencing sustainable and equitable adoption of improved stoves and cleaner fuels. GRADE, the standard method used for guidelines evidence review may not be well suited to the variety and nature of evidence required for this project, and a modified approach is being developed and tested. Work on the guidelines is being carried out in close collaboration with the UN Foundation Global Alliance on Clean cookstoves, allowing alignment with specific tools including recently developed international voluntary standards for stoves, and the development of country action plans. Following publication, WHO plans to work closely with a number of countries to learn from implementation efforts, in order to further strengthen support and guidance. A case study on the situation and policy actions to date in Bhutan provide an illustration of the challenges and opportunities involved, and the timely importance of the new guidelines and associated research, evaluation and policy development agendas.

Physical characteristics of the indoor environment that affect health and wellbeing in healthcare facilities : a review

Understanding the physical characteristics of the indoor environment that affect human health and wellbeing is the key requirement underpinning the beneficial design of a healthcare facility (HCF). We reviewed and summarised physical factors of the indoor environment reported to affect human health and wellbeing in HCFs. Research materials included articles identified in a Pubmed search, guidelines, books, reports and monographs, as well as the bibliographies of review articles in the area studied. Of these, 209 publications were selected for this review. According to the literature, there is evidence that the following physical factors of the indoor environment affect the health and wellbeing of human beings in an HCF: safety, ventilation and HVAC systems, thermal environment, acoustic environment, interior layout and room type, windows (including daylight and views), nature and gardens, lighting, colour, floor covering, furniture and its placement, ergonomics, wayfinding, artworks and music. Some of these, in themselves, directly promote or hinder health and wellbeing, but the physical factors may also have numerous indirect impacts by influencing the behaviour, actions, and interactions of patients, their families and the staff members. The findings of this research enable a good understanding of the different physical factors of the indoor environment on health and wellbeing and provide a practical resource for those responsible for the design and operate the facilities as well as researchers investigating these factors. However, more studies are needed in order to inform the design of optimally beneficial indoor environments in HCFs for all user groups.