Improving the measurement and surveillance of child abuse in Queensland emergency departments

There are no population studies of prevalence or incidence of child maltreatment in Australia. Child protection data gives some understanding but is restricted by system capacity and definitional issues across jurisdictions. Child protection data currently suggests that numbers of reports are increasing yearly, and the child protection system then becomes focussed on investigating all reports and diluting available resources for those children who are most in need of intervention. A public health response across multiple agencies enables responses to child safety across the entire population. All families are targeted at the primary level; examples include ensuring all parents know the dangers of shaking a baby or teaching children to say no if a situation makes them uncomfortable. The secondary level of prevention targets families with a number of risk factors, for example subsidised child care so children aren't left unsupervised after school when both parents have to be at work or home visiting for drug-addicted parents to ensure children are cared for. The tertiary response then becomes the responsibility of the child protection system and is reserved for those children where abuse and neglect are identified. This model requires that child safety is seen in a broader context than just the child protection system, and increasingly health professionals are being identified as an important component in the public health framework. If all injury is viewed as preventable and considered along a continuum of 'accidental' through to 'inflicted', it becomes possible to conceptualise child maltreatment in an injury context. Parental intent may not be to cause harm to the child, but by lack of insight or concern about risk, the potential for injury is high. The mechanisms for unintentional and intentional injury overlap and some suggest that by segregating child abuse (with the possible exception of sexual abuse) from unintentional injury, child abuse is excluded from the broader injury prevention initiative that is gaining momentum in the community. This research uses a public health perspective, specifically that of injury prevention, to consider the problem of child abuse. This study employed a mixed method design that incorporates secondary data analysis, data linkage and structured interviews of different professional groups. Datasets from the Queensland Injury Surveillance Unit (QISU) and The Department of Child Safety (DCS) were evaluated. Coded injury data was grouped according to intent of injury according to those with a code that indicated the ED presentation was due to child abuse, a code indicating that the injury was possibly due to abuse or, in the third group, the intent code indicated that the injury was unintentional and not due to abuse. Primary data collection from ED records was undertaken and information recoded to assess reliability and completeness. Emergency department data (QISU) was linked to Department of Child Safety Data to examine concordance and data quality. Factors influencing the collection and collation of these data were identified through structured interview methodology and analysed using qualitative methods. Secondary analysis of QISU data indicated that codes lacking specific information on the injury event were more likely to also have an intent code indicating abuse than those records where there was specific information on the injury event. Codes for abuse appeared in only 1.2% of the 84,765 records analysed. Unintentional injury was the most commonly coded intent (95.3%). In the group with a definite abuse code assigned at triage, 83% linked to a record with DCS and cases where documentation indicated police involvement were significantly more likely to be associated with a DCS record than those without such documentation. In those coded with an unintentional injury code, 22% linked to a DCS record with cases assigned an urgent triage category more likely to link than those with a triage category for resuscitation and children who presented to regional or remote hospitals more likely to link to a DCS record than those presenting to urban hospitals. Twenty-nine per cent of cases with a code indicating possible abuse linked to a DCS record. In documentation that indicated police involvement in the case, a code for unspecified activity when compared to cases with a code indicating involvement in a sporting activity and children less than 12 months of age compared to those in the 13-17 year old age group were all variables significantly associated with linkage to a DCS record. Only 13% of records contained documentation indicating that child abuse and neglect were considered in the diagnosis of the injury despite almost half of the sample having a code of abuse or possible abuse. Doctors and nurses were confident in their knowledge of the process of reporting child maltreatment but less confident about identifying child abuse and neglect and what should be reported. Many were concerned about implications of reporting, for the child and family and for themselves. A number were concerned about the implications of not reporting, mostly for the wellbeing of the child and a few in terms of their legal obligations as mandatory reporters. The outcomes of this research will help improve the knowledge of barriers to effective surveillance of child abuse in emergency departments. This will, in turn, ensure better identification and reporting practises; more reliable official statistical collections and the potential of flagging high-risk cases to ensure adequate departmental responses have been initiated.

Motivations for eWOM exchanges in an online community : self-development, problem solving support, relaxation

Electronic word-of-mouth (eWOM) has gained significant attention from academics and practitioners since it has become an important source of consumers’ product information, which can influence consumer purchase intentions (Cheung & Lee, 2012). eWOM exchanges exist in two types of online communities: online communities of practice and online communities of interest. A few prior studies in online communities of interest have examined members’ motivations for product knowledge exchange (Hung & Li, 2007; Ma & Agarwal, 2007). However, there is a lack of understanding of member motivations for exchanging social bonds and enjoyment in addition to exchanging knowledge pertaining to products in the community. It is important to have an initial comprehension of motivation as an antecedent of these three eWOM exchanges so as to be able to determine the driving factors that lead members to generate eWOM communication. Thus, the research problem "What are the driving factors for members to exchange eWOM in an online community?" was justified for investigation. The purpose of this study was to examine different member motivations for exchanging three types of eWOM. Resource exchange theory and theory on consumer motivation and behavior were applied to develop a conceptual framework for this study. This study focused on an online beauty community since there is an increasing trend of consumers turning to online beauty resources so as to exchange useful beauty product information (SheSpot, 2011). As this study examined consumer motivation in an online beauty community, a web-based survey was the most effective and efficient way to gain responses from beauty community members and these members were appropriate samples from which to draw a conclusion about the whole population. Multiple regression analysis was used to test the relationships between member motivations and eWOM exchanges. It was found that members have different motivations for exchanging knowledge, social bonds, and enjoyment related to products: self-development, problem solving support, and relaxation, respectively. This study makes three theoretical contributions. First, this study identifies the influence of self-development motivation on knowledge exchange in an online community of interest, just as this motivation has previously been found in online communities of practice. This study highlights that members of the two different types of online communities share similar goals of knowledge exchange, despite the two communities evincing different attributes (e.g., member characteristics and tasks’ objectives). Further, this study will assist researchers to understand other motivations identified by prior research in online communities of practice since such motivations may be applicable to online communities of interest. Second, this study offers a new perspective on member motivation for social bonding. This study indicates that in addition to social support from friends and family, consumers are motivated to build social bonds with members in an online community of interest since they are an important source of problem solving support in regard to products. Finally, this study extends the body of knowledge pertaining to member motivation for enjoyment exchange. This study provides a basis for researchers to understand that members in an online community of interest value experiential aspects of enjoyable consumption activities, and thus based on group norms, members have a mutual desire for relaxation from enjoyment exchange. The major practical contribution is that this study provides an important guideline for marketing managers to develop different marketing strategies based on member motivations for exchanging three types of eWOM in an online community of interest, such as an online beauty community. This will potentially help marketing managers increase online traffic and revenue, and thus bring success to the community. Although, this study contributes to the literature by highlighting three distinctive member motivations for eWOM exchanges in an online community of interest, there are some possible research limitations. First, this study was conducted in an online beauty community in Australia. Hence, further research should replicate this study in other industries and nations so as to give the findings greater generalisability. Next, online beauty community members are female skewed. Thus, future research should examine whether similar patterns of motivations would emerge in other online communities that tend to be populated by males (e.g., communities focused on football). Further, a web-based survey has its limitations in terms of self-selection and self-reporting (Bhatnagar & Ghose, 2004). Therefore, further studies should test the framework by employing different research methods in order to overcome these weaknesses.

Health and community services for trafficked women : an exploratory study of policy and practice

The trafficking of women has attracted considerable international and national policy attention, particularly since the UN Protocol to Prevent, Suppress and Punish Trafficking in Persons, Especially Women and Children (2000), of which the Australian Government has been a signatory since 2005. The provision of health and community services for trafficked women is a central feature of this Protocol, but in Australia service provision is made difficult by how trafficked women are understood and treated in policy and legal terms. This study aimed to explore the provision of health and community services for trafficked women in the Greater Sydney region through a series of interviews with government and non-government organisations. The findings reveal that services have been inaccessible as a result of sparse, uncoordinated, and poorly funded provision. The major obstacle to adequate and appropriate service provision has been a national policy approach focusing on 'border protection' and criminalisation rather than on trafficked women and their human rights. We conclude that further policy development needs to focus on the practical implications of how such rights can be translated into the delivery of health and community services that trafficked women can access and be supported by more effectively.

Community-based control of Aedes aegypti by using Mesocyclops in southern Vietnam

We previously reported a new community-based mosquito control strategy that resulted in elimination of Aedes aegypti (Linn.) in 40 of 46 communes in northern and central Vietnam, and with annual recurrent total costs (direct and indirect) of only $0.28-$0.89 international dollars per person. This control strategy was extended to four provinces in southern Vietnam in Long An and Hau Giang (2004-2007) and to Long An, Ben Tre, and Vinh Long (2005-2010). In a total of 14 communes with 124,743 residents, the mean ± SD of adult female Ae. aegypti was reduced from 0.93 ± 0.62 to 0.06 ± 0.09, and the reduction of immature Ae. aegypti averaged 98.8%. By the final survey, no adults could be collected in 6 of 14 communes, and one commune, Binh Thanh, also had no immature forms. Although the community-based programs also involved community education and clean-up campaigns, the prevalence of Mesocyclops in large water storage containers > 50 liters increased from 12.77 ± 8.39 to 75.69 ± 9.17% over periods of 15-45 months. At the conclusion of the study, no confirmed dengue cases were detected in four of the five communes for which diagnostic serologic analysis was performed. The rate of progress was faster in communes that were added in stages to the program but the reason for this finding was unclear. At the completion of the formal project, sustainability funds were set up to provide each commune with the financial means to ensure that community-based dengue control activities continued.

Aliens, borders and social citizens : Health and community services for trafficked women

Australian policy makers recognise women who are trafficked to Australia (and these are largely for the purposes of sexual exploitation) primarily as victims of crime. The main public mechanism by which the "problem" of trafficked people in Australia is managed is the criminal law. At the same time, however, as a signatory to the UN Protocol on Trafficking and the Declaration of Human Rights, the Australian Government also recognises the rights of women trafficked to Australia to access health and community services in the wake of the health damage and trauma they often incur as a consequence of their experience. Current evidence suggests that trafficked women in Australia face considerable barriers in being able to avail themselves of such a right and of the services that accompany it. This paper explores the tensions posed by Australian policy and service approaches to trafficked women in light of the concept of social citizenship and the ways in which it is mediated in the Australian context by national border protection policy.

When Can Oral Health Education Begin? Relative effectiveness of three oral health education strategies starting pre-partum

Objective: To test the impact of oral health education provided to pregnant mothers on subsequent practices within the infant’s family. Research design: A quasi-experimental intervention trial comparing the effectiveness of ‘usual care’ to one, or both, of two oral health education resources: a ‘sample bag’ of information and oral health care products; and/or a nine-minute “Healthy Teeth for Life” video on postnatal oral health issues. Participants: Women attending the midwife clinic at approximately 30 weeks gestation were recruited (n=611) in a public hospital providing free maternity services. Results and Conclusions: Four months after the birth of their infant, relative to the usual care condition, each of the oral health education interventions had independent or combined positive impacts on mother’s knowledge of oral health practices. However young, single, health care card-holder or unemployed mothers were less likely to apply healthy behaviours or to improve knowledge of healthy choices, as a result of these interventions. The video intervention provided the strongest and most consistent positive impact on mothers’ general and infant oral health knowledge. While mothers indicated that the later stage of pregnancy was a good time to receive oral health education, many suggested that this should also be provided after birth at a time when teeth were a priority issue, such as when “baby teeth” start to erupt.

Decision and reasons for calling an ambulance : patients’ perspective

Background: Demand for pre-hospital emergency care is increasing in Australia as in many other countries. Using posthoc criteria such as triage, diagnosis and admission status, some authors view a considerable number of these as "inappropriate". Yet, calling an ambulance at the time of emergency is rarely studied from the patients’ or their carers’ perspective. This study interviewed patients about the decision, circumstances surrounding and reasons for calling an ambulance in Queensland, Australia. Methods: A cross-sectional survey of patients attending a sample of eight public hospital emergency departments in Queensland was undertaken between March and May 2011. In total, 911 questionnaires were collected (response rate: 67%), of whom 226 (24.8%) had arrived by ambulance. Results: In 35.6% of ambulance arrivals, the decision to request an ambulance was made by the patient; 25% by a doctor; 20% by a family member, friend or carer. Other callers included nurse, people at work or school, and passers-by. Reasons to request an ambulance included urgency (87%) and severity (84%) of the condition. Other reasons included requiring special care (76%), getting higher priority at the emergency department (34%), not having a car (34%), and financial concerns (17%). Decision to request an ambulance varied significantly according to the time of illness onset (e.g. on the day, week before), and location (e.g. home, outside). Conclusion: The decision to call an ambulance is made mostly by non-medical professionals in a perceived emergency situation. They call the ambulance for different reasons but mainly take into account the patient’s welfare and safety. Better understanding of these reasons will affect the direction and effectiveness of demand management strategies.

Social enterprises in rural community development

Social enterprises are hybrid organizational forms that combine characteristics of for-profit businesses and community sector organizations. This article explores how rural communities may use social enterprises to progress local development agendas across both economic and social domains. Drawing on qualitative case studies of three social enterprises in rural North West Tasmania, this article explores the role of social enterprises in local development processes. The case study social enterprises, despite differences in size, structure, mission and age, are strongly embedded in their local places and local communities. As deeply contextualized development actors, these social enterprises mobilize multiple resources and assets to achieve a range of local development outcomes, including but not limited to social capital

Sample size considerations and augmentation of computer experiments

Computer Experiments, consisting of a number of runs of a computer model with different inputs, are now common-place in scientific research. Using a simple fire model for illustration some guidelines are given for the size of a computer experiment. A graph is provided relating the error of prediction to the sample size which should be of use when designing computer experiments. Methods for augmenting computer experiments with extra runs are also described and illustrated. The simplest method involves adding one point at a time choosing that point with the maximum prediction variance. Another method that appears to work well is to choose points from a candidate set with maximum determinant of the variance covariance matrix of predictions.

Living a managed community lifestyle : lessons from Queensland

Purpose - The paper aims to improve consumer awareness of the complexities of community living. It does this by clarifying how living in a managed community is different from a ‘traditional’ neighbourhood; and identifying matters that can become disputes Design/methodology/approach - The paper builds on research by other authors into strata scheme disputes by examining recent Queensland cases. Findings - Many disputes appear to result from a lack of understanding of the complexities of community living. Matters that should be able to be easily resolved are therefore escalated to formal disputes. Research limitations/implications - The paper considers law and cases from Queensland. The types of matters considered, however, are relevant for any managed community and therefore the research is relevant for all jurisdictions. The research will be of particular interest to jurisdictions looking to boost living density by increasing the development of managed communities. Practical implications - The research will assist in consumer transactions by providing guidance as to the matters to be considering prior to moving into a managed community. More informed decision making by prospective residents will lead to a decreased likelihood of disputes arising. Originality/value - The paper is an up-to-date consideration of the issues arising from community living. It highlights the benefits arising from increased consumer awareness of the complexities of community living and the potential for consumer education to reduce the number of disputes.

Grunt language versus accent : the perceived communication barriers between international medical graduates and patients in Central Wheatbelt catchments

Due to the chronic shortages of GPs in Australian rural and remote regions, considerable numbers of international medical graduates (IMG) have been recruited. IMG experience many difficulties when relocating to Australia with one of the most significant being effective GP-patient communication. Given that this is essential for effective consultation it can have a substantial impact on health care. A purposive sample of seven practising GPs (five IMG, two Australian-trained doctors (ATD)) was interviewed using a semistructured face-to-face interviewing technique. GPs from Nigeria, Egypt, United Kingdom, India, Singapore and Australia participated. Interviews were transcribed and then coded. The authors used qualitative thematic analysis of interview transcripts to identify common themes. IMG-patient communication barriers were considered significant in the Wheatbelt region as identified by both IMG and ATD. ATD indicated they were aware of IMG-patient communication issues resulting in subsequent consults with patients to explain results and diagnoses. Significantly, a lack of communication between ATD and IMG also emerged, creating a further barrier to effective communication. Analysis of the data generated several important findings that rural GP networks should consider when integrating new IMG into the community. Addressing the challenges related to cross-cultural differences should be a priority, in order to enable effective communication. More open communication between ATD and IMG about GP-patient communication barriers and education programs around GP-patient communication would help both GP and patient satisfaction.

Changing tastes in food media : a study of recipe sharing traditions in the food blogging community

Food is inherently cultural yet traditionally overlooked in many disciplines as a topic worthy of serious investigation. This thesis investigates how food, as a topic of interest, is thriving in an online environment through recipe sharing on food blogs. It applies an ethnographic approach to online community studies, providing a rich description of the food blogging community. The thesis demonstrates how the food blogging can be seen as a community. Through a case study focusing on a one recipe shared across many blogs, it also examines the community in action. As the community has grown, it has become more complex, structured and diverse. The thesis examines its evolution and the response of food-related media and other industries to food blogging. The nature of the food blogging community reflects the cultural and social nature of food and the ongoing evolution of recipe sharing through food-related media. Food blogs provide an insight into the eating habits of ‘ordinary’ people, in a more broad-based manner than traditional food-related media such as cookbooks. Beyond this, food blogs are part of wider cultural trends towards DIY, and provide a useful example of the ongoing transformation of food-related media, food culture, and indeed, culture more broadly.

Identification of symptom clusters in patients with chronic venous leg ulcers

Context Patients with venous leg ulcers experience multiple symptoms, including pain, depression, and discomfort from lower leg inflammation and wound exudate. Some of these symptoms impair wound healing and decrease quality of life (QOL). The presence of co-occurring symptoms may have a negative effect on these outcomes. The identification of symptom clusters could potentially lead to improvements in symptom management and QOL. Objectives To identify the prevalence and severity of common symptoms and the occurrence of symptom clusters in patients with venous leg ulcers. Methods For this secondary analysis, data on sociodemographic characteristics, medical history, venous history, ulcer and lower limb clinical characteristics, symptoms, treatments, healing, and QOL were analyzed from a sample of 318 patients with venous leg ulcers who were recruited from hospital outpatient and community nursing clinics for leg ulcers. Exploratory factor analysis was used to identify symptom clusters. Results Almost two-thirds (64%) of the patients experienced four or more concurrent symptoms. The most frequent symptoms were sleep disturbance (80%), pain (74%), and lower limb swelling (67%). Sixty percent of patients reported three or more symptoms at a moderate-to-severe level of intensity (e.g., 78% reported disturbed sleep frequently or always; the mean pain severity score was 49 of 100, SD 26.5). Exploratory factor analysis identified two symptom clusters: pain, depression, sleep disturbance, and fatigue; and swelling, inflammation, exudate, and fatigue. Conclusion Two symptom clusters were identified in this sample of patients with venous leg ulcers. Further research is needed to verify these symptom clusters and to evaluate their effect on patient outcomes.

Iris based identity verification robust to sample presentation security attacks

Iris based identity verification is highly reliable but it can also be subject to attacks. Pupil dilation or constriction stimulated by the application of drugs are examples of sample presentation security attacks which can lead to higher false rejection rates. Suspects on a watch list can potentially circumvent the iris based system using such methods. This paper investigates a new approach using multiple parts of the iris (instances) and multiple iris samples in a sequential decision fusion framework that can yield robust performance. Results are presented and compared with the standard full iris based approach for a number of iris degradations. An advantage of the proposed fusion scheme is that the trade-off between detection errors can be controlled by setting parameters such as the number of instances and the number of samples used in the system. The system can then be operated to match security threat levels. It is shown that for optimal values of these parameters, the fused system also has a lower total error rate.

Student's experiences with traditional bullying and cyberbullying : findings from a Romanian sample

The field of cyberbullying is relatively new and there is no universal consensus on its definition, measurement and intervention. Authors agree that bullying has entered into the digital domain and professionals require the skills to help identify and prevent these behaviours. Ninety two students were surveyed to determine their experience with different types of bullying behaviors (face-to-face, cyberbullying or both), as bully, victim or witness. Our objective was to explore the association between those types of bullying and anxiety. The results suggest a significant association between face-to-face bullying and anxiety. Similarly, there was significant association between experiencing both types of bullying and anxiety. Further studies are required with larger and more diverse samples in order to verify current findings and to test for additional associations.