Beyond the hospital door : a retrospective, cohort study of associations between birthing in the public or private sector and women’s postpartum care

Background In Australia, maternity care is available through universal coverage and a parallel, competitive private health insurance system. Differences between sectors in antenatal and intrapartum care and associated outcomes are well documented but few studies have investigated differences in postpartum care following hospital discharge and their impact on maternal satisfaction and confidence. Methods Women who birthed in Queensland, Australia from February to May 2010 were mailed a self-report survey 4 months postpartum. Regression analysis was used to determine associations between sector of birth and postpartum care, and whether postpartum care experiences explained sector differences in postpartum well-being (satisfaction, parenting confidence and feeling depressed). Results Women who birthed in the public sector had higher odds of health professional contact in the first 10 days post-discharge and satisfaction with the amount of postpartum care. After adjusting for demographic and postpartum contact variables, sector of birth no longer had an impact on satisfaction (AOR 0.95, 99% CI 0.78-1.31), but any form of health professional contact did. Women who had a care provider’s 24 hour contact details had higher odds of being satisfied (AOR 3.64, 95% CI 3.00-4.42) and confident (AOR 1.34, 95% CI 1.08- 1.65). Conclusion Women who birthed in the public sector appeared more satisfied because they had higher odds of receiving contact from a health professional within 10 days post-discharge. All women should have an opportunity to speak to and/or see a doctor, midwife or nurse in the first 10 days at home, and the details of a person they can contact 24 hours a day.

Making the fun stop : youth justice reform in Queensland

In 2013 the newly elected conservative Liberal National Party government instigated amendments to the Youth Justice Act 1992 (Qld). Boot camps replaced court ordered youth justice conferencing. In 2014 there were more drastic changes, including opening the Children’s Court proceedings to the public, permitting publication of identifying information of repeat offenders, removing the principle of ‘detention as a last resort’, facilitating prompt transferral of 17 year olds to adult prisons and instigating new bail offences and mandatory boot camp orders for recidivist motor vehicle offenders in Townsville. This article compares these amendments to the legislative frameworks in other jurisdictions and current social research. It argues that these amendments are out of step with national and international best practice benchmarks for youth justice. Early indications are that Indigenous children are now experiencing increased rates of unsentenced remand. The article argues that the government’s policy initiatives are resulting in negative outcomes and that early and extensive evaluations of these changes are essential.

Leading or managing? Assistant Regional Directors, School Performance, in Queensland

Purpose Education reform aimed at achieving improved student learning is a demanding challenge for leaders and managers at all levels of education across the globe. In 2010, the position of Assistant Regional Directors, School Performance (ARD-SP), was established to positively impact upon student learning across public schools in Queensland, Australia. This study explores the perceptions of the role and leadership understandings of ARDs in Queensland in order to understand more fully the tensions and opportunities they face within this reasonably newly created position. Design/methodology/approach This qualitative study is based on interviews with 18 Assistant Regional Directors and two of their supervisors to gauge a better understanding of the nature of the role as it relates to leadership and management in the Queensland context. Findings Interview data revealed three key themes pertaining to the nature of the role and these were performance, supervision, and professional challenges. A key finding was that the notion of supervision was experienced as problematic for ARDs-SP. Research limitations/implications This study has limitations and these include a sample that focused on Assistant Regional Directors within one State of Australia and one schooling system (i.e. public education); and interviews were the primary data collection source. Originality/value Although there have been studies of supervisors of principals (referred to as superintendents, directors) in other countries and other systems, this study is a first to explore the tensions and opportunities faced by executive leaders in Queensland.

Ultrafine Particles from Traffic Emissions and Children’s Health (UPTECH) in Brisbane, Queensland (Australia): Study design and implementation

Ultrafine particles are particles that are less than 0.1 micrometres (µm) in diameter. Due to their very small size they can penetrate deep into the lungs, and potentially cause more damage than larger particles. The Ultrafine Particles from Traffic Emissions and Children’s Health (UPTECH) study is the first Australian epidemiological study to assess the health effects of ultrafine particles on children’s health in general and peripheral airways in particular. The study is being conducted in Brisbane, Australia. Continuous indoor and outdoor air pollution monitoring was conducted within each of the twenty five participating school campuses to measure particulate matter, including in the ultrafine size range, and gases. Respiratory health effects were evaluated by conducting the following tests on participating children at each school: spirometry, forced oscillation technique (FOT) and multiple breath nitrogen washout test (MBNW) (to assess airway function), fraction of exhaled nitric oxide (FeNO, to assess airway inflammation), blood cotinine levels (to assess exposure to second-hand tobacco smoke), and serum C-reactive protein (CRP) levels (to measure systemic inflammation). A pilot study was conducted prior to commencing the main study to assess the feasibility and reliably of measurement of some of the clinical tests that have been proposed for the main study. Air pollutant exposure measurements were not included in the pilot study.

The private problem with public service: Rural teachers in educational markets

Staffing rural and remote schools is an important policy issue for the public good. This paper examines the private issues it also poses for teachers with families working in these communities, as they seek to reconcile careers with educational choices for children. The paper first considers historical responses to staffing rural and remote schools in Australia, and the emergence of neoliberal policy encouraging marketisation of the education sector. We report on interviews about considerations motivating household mobility with 11 teachers across regional, rural and remote communities in Queensland. Like other middle-class parents, these teachers prioritised their children’s educational opportunities over career opportunities. The analysis demonstrates how teachers in rural and remote communities constitute a special group of educational consumers with insider knowledge and unique dilemmas around school choice. Their heightened anxieties around school choice under neoliberal policy are shown to contribute to the public issue of staffing rural and remote schools.

Art and the anxious city: Public art, public interest and the public good

While public art is often considered a key hallmark of a creative city, artworks in the public realm also have the capacity to act as lightening rods for social anxiety at times of perceived crisis. This paper considers recent debates about government-sponsored public art projects in Queensland in light of three international case studies: Rodin’s Thinker in Paris, Tilted Arc in New York and Vault in Melbourne. It considers whether consensus positions on public art are possible or desirable in light of issues of spatial control, and proposes that well-negotiated anxieties about public art may be an indicator of creative vibrancy and dynamism that will assist in the future understanding of Queensland’s experiment with government-mandated public art.

A call for better care: the impact of postnatal contact services on women’s parenting confidence and experiences of postpartum care in Queensland, Australia

Background Universal postnatal contact services are provided in several Australian states, but their impact on women’s postnatal care experience has not been evaluated. Furthermore, there is lack of evidence or consensus about the optimal type and amount of postpartum care after hospital discharge for maternal outcomes. This study aimed to assess the impact of providing Universal Postnatal Contact Service (UPNCS) funding to public birthing facilities in Queensland, Australia on women’s postnatal care experiences, and associations between amount and type (telephone or home visits) of contact on parenting confidence, and perceived sufficiency and quality of postnatal care. Methods Data collected via retrospective survey of postnatal women (N = 3,724) were used to compare women who birthed in UPNCS-funded and non-UPNCS-funded facilities on parenting confidence, sufficiency of postnatal care, and perceived quality of postnatal care. Associations between receiving telephone and home visits and the same outcomes, regardless of UPNCS funding, were also assessed. Results Women who birthed in an UPNCS-funded facility were more likely to receive postnatal contact, but UPNCS funding was not associated with parenting confidence, or perceived sufficiency or perceived quality of care. Telephone contact was not associated with parenting confidence but had a positive dose–response association with perceived sufficiency and quality. Home visits were negatively associated with parenting confidence when 3 or more were received, had a positive dose–response association with perceived sufficiency and were positively associated with perceived quality when at least 6 were received. Conclusions Funding for UPNCS is unlikely to improve population levels of maternal parenting confidence, perceived sufficiency or quality of postpartum care. Where only minimal contact can be provided, telephone may be more effective than home visits for improving women’s perceived sufficiency and quality of care. Additional service initiatives may be needed to improve women’s parenting confidence.

Links between unlicensed and unregistered driving: Literature review. Report to Queensland Department of Transport and Main Roads

Vehicle registration represents an important component of the management of the road transport system in Queensland, with most vehicles required to be registered before they can be driven or parked on a public road (Department of Transport and Main Roads, 2010b). In addition to the collection of taxes for road construction and maintenance, the current registration system also: • Sets the safety standards required for vehicles to be allowed on public roads; • Allows driver behaviour to be managed by identifying vehicles, and the responsible owners of vehicles, for enforcement purposes; and • Facilitates the collection of insurance premiums for the Queensland Compulsory Third Party (CTP) insurance scheme.

Urban public space and the marginalisation of children and young people

In the 21st century city, public space for a range of users, but especially children and young people, has come under threat. Watson proposed that “public space itself has come under attack from several directions-thematisation, enclosure into malls and other controlled spaces, and privatisation, or from urban planning and design interventions to erase its uniqueness”. Largely as a result of these trends, Scott observed that “young urbanites form a marginalised age class movement is restricted, out of fear and distrust, within aims to protect, monitored by city surveillance methods within the security-obsessed fabric”. The use of public space by children and young people is a contentious issue in a number of countries and a range of measures deployed to control public space curtail the rights of children and young people to claim the space for their use through curfews, oppressive camera surveillance and at times, the unwarranted attentions of police and private security personnel.

Links between unlicensed and unregistered driving (Data analysis). Report to Queensland Department of Transport and Main Roads

There is a current lack of understanding regarding the use of unregistered vehicles on public roads and road-related areas, and the links between the driving of unregistered vehicles and a range of dangerous driving behaviours. This report documents the findings of data analysis conducted to investigate the links between unlicensed driving and the driving of unregistered vehicles, and is an important initial undertaking into understanding these behaviours. This report examines de-identified data from two sources: crash data; and offence data. The data was extracted from the Queensland Department of Transport and Main Roads (TMR) databases and covered the period from 2003 to 2008.

Back to normal: A retrospective, cross-sectional study of the multi-factorial determinants of normal birth in Queensland, Australia

Background Currently, care providers and policy-makers internationally are working to promote normal birth. In Australia, such initiatives are being implemented without any evidence of the prevalence or determinants of normal birth as a multidimensional construct. This study aimed to better understand the determinants of normal birth (defined as without induction of labour, epidural/spinal/general anaesthesia, forceps/vacuum, caesarean birth, or episiotomy) using secondary analyses of data from a population survey of women in Queensland, Australia. Methods Women who birthed in Queensland during a two-week period in 2009 were mailed a survey approximately three months after birth. Women (n=772) provided retrospective data on their pregnancy, labour and birth preferences and experiences, socio-demographic characteristics, and reproductive history. A series of logistic regressions were conducted to determine factors associated with having labour, having a vaginal birth, and having a normal birth. Findings Overall, 81.9% of women had labour, 66.4% had a vaginal birth, and 29.6% had a normal birth. After adjusting for other significant factors, women had significantly higher odds of having labour if they birthed in a public hospital and had a pre-existing preference for a vaginal birth. Of women who had labour, 80.8% had a vaginal birth. Women who had labour had significantly higher odds of having a vaginal birth if they attended antenatal classes, did not have continuous fetal monitoring, felt able to ‘take their time’ in labour, and had a pre-existing preference for a vaginal birth. Of women who had a vaginal birth, 44.7% had a normal birth. Women who had a vaginal birth had significantly higher odds of having a normal birth if they birthed in a public hospital, birthed outside regular business hours, had mobility in labour, did not have continuous fetal monitoring, and were non-supine during birth. Conclusions These findings provide a strong foundation on which to base resources aimed at increasing informed decision-making for maternity care consumers, providers, and policy-makers alike. Research to evaluate the impact of modifying key clinical practices (e.g., supporting women׳s mobility during labour, facilitating non-supine positioning during birth) on the likelihood of a normal birth is an important next step.

Public private partnership infrastructure delivery: Benefits and costs for society

This research provides additional knowledge on the benefits and costs to society, in particular of road transport procured through Public-Private Partnership (PPP) arrangements. Currently, the public sector comparator (PSC) and cost-benefit analysis (CBA) used to evaluate and measure the benefits and costs of PPP are limited in their capacity to predict and forecast long-term events. PPP is attractive to governments due to the non-upfront payment, perceived value for money, and risk allocation and transfer to the private investor. However, public sector remains the guarantor, and under-writer of the private investor's loan from financial institutions and other voluntary risks which are unlimited to future compensatory claims. The new knowledge from this research is the introduction of a framework capable of evaluating, and measuring the associated PPP benefits, as well as the costs, effects, and impacts to society which are protracted and sporadic by nature.

Modified MLVA for genotyping Queensland invasive Streptococcus pneumoniae

Background Globally, over 800 000 children under five die each year from infectious diseases caused by Streptococcus pneumoniae. To understand genetic relatedness between isolates, study transmission routes, assess the impact of human interventions e.g. vaccines, and determine infection sources, genotyping methods are required. The ‘gold standard’ genotyping method, Multi-Locus Sequence Typing (MLST), is useful for long-term and global studies. Another genotyping method, Multi-Locus Variable Number of Tandem Repeat Analysis (MLVA), has emerged as a more discriminatory, inexpensive and faster technique; however there is no universally accepted method and it is currently suitable for short-term and localised epidemiology studies. Currently Australia has no national MLST database, nor has it adopted any MLVA method for short-term or localised studies. This study aims to improve S. pneumoniae genotyping methods by modifying the existing MLVA techniques to be more discriminatory, faster, cheaper and technically less demanding than previously published MLVA methods and MLST. Methods Four different MLVA protocols, including a modified method, were applied to 317 isolates of serotyped invasive S. pneumoniae isolated from sterile body sites of Queensland children under 15 years from 2007–2012. MLST was applied to 202 isolates for comparison. Results The modified MLVA4 is significantly more discriminatory than the ‘gold standard’ MLST method. MLVA4 has similar discrimination compared to other MLVA techniques in this study). The failure to amplify particular loci in previous MLVA methods were minimised in MLVA4. Failure to amplify BOX-13 and Spneu19 were found to be serotype specific. Conclusion We have modified a highly discriminatory MLVA technique for genotyping Queensland invasive S. pneumoniae. MLVA4 has the ability to enhance our understanding of the pneumococcal epidemiology and the changing genetics of the pneumococcus in localised and short-term studies.

Submission for the Queensland Government Parliamentary Inquiry into personal health promotion interventions using telephone and web-based technologies

Telephone and web-based technologies such as SMS, smartphone apps, gamification, online/mobile games, online quizzes and tools can be used in personal health interventions in two ways: health promotion or social marketing. In response to the Queensland government's call for submissions to the parliamentary inquiry, a social marketing and design submission from four of the faculties at Queensland University of Technology was submitted. There appears to be a great deal of confusion in government circles about the terms ‘social marketing’ and ‘health promotion’ and often they are used interchangeably when they are actually significantly different approaches. Social marketing is the science and practice of behaviour change and involves goods and services that offer a value proposition, and which incentivises citizens to change their behaviour voluntarily. However, social marketing is often mistakenly used to describe advertising and communication or social media marketing. This submission contains an overview of how technology interventions need to be implemented to be successful, provides examples of the evidence that telephone and web-based interventions can effectively influence public health outcome. This submission poses seven critical factors.

The Library beyond (just) the book: Collaboration and co-working spaces for new technology and new technological practices

Libraries have often been first adopters of many new technological innovations, such as, punch cards, computers, barcodes, and e-book readers. It is thus not surprising that many libraries have embraced the advent of the internet as an opportunity to move away from just being repositories of books, towards becoming ideas stores and local network hubs for entrepreneurial thinking and new creative practices. This presentation will look at the case of “The Edge” – an initiative of the State Library of Queensland in Brisbane, Australia, to establish a digital culture centre and learning environment deliberately designed for the co-creation and co-construction of knowledge. This initiative illustrates the potential role of libraries as testing grounds for new technologies and technological practices, which is particularly relevant in the context of the NBN rollout across Australia. It also provides an example of new engagement strategies for innovative co-working spaces that are a vital element in a trend that sees professionals, creatives and designers leave their traditional places of work and embrace the city as their office.