Medicine & Health

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  • (2007) Chan, Bibiana Chi Wing
    Under-utilisation of mental health services is widespread globally and within Australia, especially among culturally and linguistically diverse (CALD) communities. Improving service access is a priority, as is the need to deliver culturally competent services to the CALD communities. Having migrated to Australia in waves for approximately 150 years from China and South East Asia for various social, political and economic reasons, the Chinese population in Sydney is now the fastest growing non-English speaking ethnic group. There is a need to better understand the impact of culture on the emotional experiences of these Chinese in Australia. How do Chinese make sense of their depressive episodes? To address this question, this study explored the ways participants reach out for medical and/or non-medical help. Lay concepts of illness underpin these decisions and were thus unveiled. Mixed-method research design provided the opportunity to bring together multiple vantage points of investigation: population mental health, transcultural psychiatry and medical anthropology. A study combining quantitative survey and qualitative focus groups was undertaken in metropolitan Sydney. Narratives on symptoms, explanatory models and help-seeking strategies were articulated by focus group informants. Surveys covered demographics, symptom-recognition, previous depressive experiences and professional help sought. Depression measurement tools were cross-culturally validated. Self-ratings of ethnic identities and the Suinn-Lew Self-Identity Acculturation Scale were used to quantify Chinese participants’ acculturation level. This allowed comparisons between ‘low-acculturated’ Chinese’, ‘highly-acculturated’ Chinese and Australians. Survey results showed comparable levels of symptom-recognition in all subgroups. Focus group discussions provided rich data on informants’ help-seeking strategies. Highly acculturated Chinese closely resembled the Australians in many study variables, yet qualitative data suggested cultural gaps beyond language barriers in influencing service use. Participants believed that trustful relationships could work as the bridge to link services with those in need. The implications for Australia’s mental health policy include recognising the importance of rapport-building and the existence of cultural gaps. The study indicated professionals can benefit from acquiring information about the mental health beliefs both of individual clients and the wider ethnic communities in which they belong, and respecting the cultural differences between helper and helped as the first step towards cultural competency.

  • (2008) Chan, Bibiana Chi Wing
    心理衛生服務不被廣泛採用﹐不單是澳洲也是全球性的現象﹐尤其是那些多元文化和語言背景 (Cultural and Linguistically Diverse)的社區。改善接觸服務的各種 門徑自然是當前急務﹐還需要考慮到服務範疇對多元文化的社區是否適切。華裔人士早於一百五十年前從中國及東南亞地區移民到澳洲﹐他們包括來自不同社會﹑政治﹑經濟背景的人士。悉尼的華人人口是澳洲近年增長最迅速的少了民族! 有見及此, 我們需要了解一下文化對情緒表現的影響. 華裔人士怎樣解釋他們的 抑鬱經歷呢? 要回答以上的問題﹐這個研究主要探討參加者怎樣尋求醫療和非醫療的服務。一般華人做這些決定時所持的病理概念就得以揭示出來! 混合式的研究設計 正好提供一個 機會去從一個垮躍多個學術領域 (公共衛生﹑ 跨文化心理學和 醫護人類學)的角度 來進行研究。這個在悉尼市區進行的研究,融合了‘數量’的問卷調查和‘質量’的社區座談會。取得的資料包括 病癥﹑病人的詮釋方法﹐求助途徑等. 問卷搜集到背 景資料, 病癥識辨﹐以往的抑鬱經歷和 曾向那些專業服務求助, 抑鬱症的量表和其 他跨文化的工具都經過嚴格測試覆核﹐其中用來量度華裔參加者的文化適應能力的量表 Suinn-Lew Self-Identity Acculturation Scale, 把參加者客觀地分成較傳統 和較澳洲化兩個組別﹑ 和澳洲人的一組作比較。 問卷調查顯示兩組華人和一組澳洲人對抑鬱症的病癥識辨能力相約﹔社區座談會的討論則引出了有關求助途徑的豐富資料。較澳洲化的華人跟澳洲人組別在很多個研究指標 (或稱變數﹐variables) 上都很接近。不過座談會資料卻指出文化上的差異對選 擇甚麼樣的服務有一定影響,很明顯這是超越語言上的障礙!參加者認為對專業人士或服務機構的信任是連接服務與病者的重要一環。研究結果呼籲澳洲心理衛生的策劃者必須正視‘建立良好關係的重要’。專業人士必需增強了解個別病者和少數民族對精神或心理病的詮釋。尊重求助者和施予援助者之間的文化差異’是踏出推動多元民化心理衛生服務的第一步.

  • (2007) Amoroso, Cheryl; Proudfoot, Judy; Bubner, Tanya; Swan, Edward; Espinel, Paola; Barton, Christopher; Beilby, Justin; Harris, Mark
    Journal Article
    BACKGROUND: Clinical audit is recognised worldwide as a useful tool for quality improvement. METHODS: A feedback report profiling capacity for chronic disease care was sent to 97 general practices. These practices were invited to complete a clinical audit activity based on that feedback. Data were analysed quantitatively and case studies were developed based on the free text responses. RESULTS: Eighty-two (33%) of 247 general practitioners participated in the clinical audit process, representing 57 (59%) of 97 general practices. From the data in their feedback report, 37 (65%) of the 57 practices recognised the area most in need of improvement. This was most likely where the need related to clinical practice or teamwork, and least likely where the need related to linkages with other services, and business and finance. Only 25 practices (46%) developed an action plan related to their recognised area for improvement, and 22 (39%) practices implemented their chosen activity. Participating GPs judged that change activity focused on teamwork was most successful. DISCUSSION: The clinical audit process offered participating GPs and practices an opportunity to reflect on their performance across a number of key areas and to implement change to enhance the practice’s capacity for quality chronic disease care. The relationship between need and action was weak, suggesting a need for greater support to overcome barriers.

  • (2012) Richmond, Robyn; Butler, Tony; Wodak, Alex; Wilhelm, Kay; Indig, Devon
    The UNSW Prison Research Team conducted a randomised controlled trial to evaluate the effectiveness of a behavioural intervention for smoking cessation among prisoners. Male inmates who were current smokers were randomly assigned to placebo or active nortriptyline. All inmates received brief cognitive behavioural therapy, active patch, a prison specific stress package and referral to the Quitline. Assessments were at baseline, and at 3, 6 and 12 months following treatment.

  • (2012) Poulos, Roslyn; Hatfield, Julie; Rissel, Chris; Grzebieta, Raphael; McIntosh, Andrew S
    Journal Article
    Introduction: There are clear personal, social and environmental benefits of cycling. However, safety concerns are among the frequently cited barriers to cycling. In Australia, there are no exposure-based measures of the rates of crash or ‘near miss’ experienced by cyclists. Design and setting: A prospective cohort study over 12 months, with all data collected via web-based online data entry. Participants: Two thousand adults aged 18 years and older, living in New South Wales (Australia), who usually bicycle at least once a month, will be recruited from March to November 2011. Methods: In the 12 months following enrolment, cyclists will be surveyed on 6 occasions (weeks 8, 16, 24, 32, 40, and 48 from the week of the enrolment survey). In these survey weeks, cyclists will be asked to provide daily reports of distance travelled; time, location and duration of trips; infrastructure used; crashes, near misses and crash-related injuries. Information on crashes and injuries will also be sought for the intervening period between the last and current survey. A subsample of participants will receive bicycle trip computers to provide objective measurement of distance travelled. Discussion: This study protocol describes the prospective cohort study developed to assess near misses, crashes and injuries among cyclists by time and distance travelled and by type of infrastructure used, with recruited participants entering data remotely using the internet. We expect to be able to calculate event rate according to exposure overall and for different infrastructure types and to report in-depth information about event causation.

  • (2012) Poulos, Roslyn; Donaldson, Alex
    Journal Article
    Aim To investigate the level of translation of the Australian Rugby Union “Mayday” safety procedure into practice among community rugby union coaches in New South Wales (Australia). Methods All registered coaches of senior community rugby union teams in five zones/associations in the north eastern region of the state were invited to complete a short online questionnaire at the end of the 2010 rugby season. The questionnaire was designed around the five RE-AIM dimensions and assessed: Reach, perceived Effectiveness, Adoption, Implementation, and Maintenance of the Mayday procedure. Results Seventy (39%) coaches participated. There was a high level of awareness of the Mayday procedure, and most coaches believed it was effective in preventing injuries. The majority reported training their players in the procedure, although training was generally infrequent. Coaches were confident that their own players could implement the procedure appropriately if required to do so, but less confident that other teams or referees could do so. Barriers to providing training included: not enough players at training; players not taking training seriously; and technical difficulties (e.g. verbalisation of instructions for physical tasks). Conclusion The findings suggest that the translation of the Mayday ‘policy’ could be improved by building individual coach, and club or zone organisational capacity by: ensuring coaches have the resources and skills in ‘how’ to train their players to complement their existing knowledge on ‘what’ to train them; setting expectations that encourage coaches to provide regular training for players; and regular monitoring of player competency to perform the procedure appropriately.

  • (2012) Bunde-Birouste, Anne; Nathan, Sally; McCarroll, Brad; Kemp, Lynn; Shwe, Tun; Gran Ortega, Marcia
    Australia accepts more than 13,000 refugee and humanitarian immigrants annually and young people account for a large overall percentage of the refugee population in New South Wales (NSW). There is evidence that refugee families are highly vulnerable to social isolation in their countries of resettlement. The difficulties of refugee settlement are well documented, including the need to learn new languages, negotiate differing cultural and societal values and address past emotional trauma. Development through sport refers to the use of sporting activities to provide opportunities for personal and community development with effects that go well beyond the sphere of physical activity and [elite] player and game development. In recent years there has been an increase in programs that use sport to foster social development and engagement, however little robust research has been performed to evaluate these efforts. Football United ® was developed from a vision that people’s love for Football (soccer) can be used to build opportunities for belonging, racial harmony and community cohesion. Football United ®’s six years of operations confirms the Crawford report findings, and highlights other effects of inequity in participation: • Gaps in equity of participation in both community and public education sector sport which can contribute to general disaffection within society, including leaving school, aggressive behaviour and unemployment as examples. • Lack of opportunity to interact across cultural groups which can translate to racism and the ensuing problems it provokes. Football United ® addresses these issues basing its foundations on the premise that structural variables and social processes act at multiple levels to impact on health and social behaviour. Results of the study underline Football United ®’s positive impact on participating young people’s sense of self, and appreciation for and engagement with peers from diverse backgrounds. Learning from interviews found unanticipated connections between participating in Football United ® and learning English, positive engagement with school, and building self confidence.

  • (2004) Baker, Amanda; Kay-Lambkin, Frances; Bucci, Sandra; Haile, Melanie; Richmond, Robyn; Carr, Vaughan
    The prevalence of smoking among people with a psychiatric illness, especially schizophrenia, is much higher than in the general population (Goff et al., 1992). Smoking is associated with adverse mental and physical consequences among people with psychotic disorders. In terms of adverse physical consequences, smoking related diseases are the greatest contributor to early mortality among people with a psychotic illness (Lawrence, Holma & Jablensky, 2001). Despite the high prevalence of smoking, smoking cessation programs have not typically been part of treatment regimens available to people with psychiatric illness. This manual describes an intervention delivered over six weekly sessions, followed by two fortnightly booster sessions, and conducted on an individual basis. It includes some of the theoretical and contextual background information relevant to the treatment program, and its evaluation in the randomised controlled trial conducted over 2000-2003. Outcomes for the randomised controlled trial are briefly summarised. Each subsequent section contains a detailed session-by-session guide to the content of the tobacco reduction intervention evaluated in the randomised controlled trial. Many handouts, homework activities and therapist and client resources are additionally provided.

  • (2011) MacIntyre, Raina; Torzillo, Paul; McIntyre, Peter; Richmond, Peter; Andrews, Ross; Goldblatt, David; Grabenstein, John; Ridda, Iman; Menzies, Robert; Macartney, Kristine
    Conference Paper
    Researchers, policy makers, healthcare professionals, advisory groups and industry representatives reviewed the latest research and discussed future directions at a forum on adult vaccination against pneumococcal disease on 29-30th August, 2011 at UNSW in Sydney, Australia. The Forum was organized and chaired by Professor Raina MacIntyre with sponsorship from CSL Biotherapies. Hosted by the School of Public Health and Community of Medicine at UNSW, the forum featured national and international speakers including Professor David Goldblatt, Professor Peter McIntyre, Professor Peter Richmond and Dr John Grabenstein. This report describes some of the key messages and issues discussed at the forum.

  • (2013) Liu, Bette; Roberts, Christine; Clarke, Marilyn; Jorm, Louisa; Hunt, Jenny; Ward, James
    Journal Article
    Objectives: To examine the association between prior chlamydia and gonorrhoea infections and adverse obstetric outcomes. Methods: Records of women resident in New South Wales, Australia with a singleton first birth during 1999-2008 were linked to chlamydia and gonorrhoea notifications using probabilistic linkage. Obstetric outcomes and potential confounders were ascertained from the birth record. Logistic regression, adjusted for potential confounders was used to estimate the association between a disease notification prior to the birth and adverse birth outcomes: spontaneous preterm birth (SPTB), small for gestational age (SGA) and stillbirth. Results: Among 354217 women, 1.0% (n=3658) had a prior chlamydia notification; 0.06% (n=196) had a prior gonorrhoea notification. The majority of notifications (>80%) occurred before the estimated conception date. 4.1% of women had a SPTB, 12.1% had a SGA baby and 0.6% of women had a stillbirth. Among women with a prior chlamydia notification, the risk of SPTB and stillbirth was increased, aOR 1.17 (95%CI 1.01,1.37) and aOR 1.42 (95%CI 1.02,1.99) respectively but there was no association with SGA, aOR 0.99 (95%CI 0.89,1.09). For women with gonorrhoea the risks for SPTB, stillbirth and SGA were respectively aOR 2.50 (95%CI 1.39-4.50), 2.26 (95%CI 0.55-9.26) and 0.98 (95%CI 0.57-1.67). Among women with a prior chlamydia diagnosis, the risk of SPTB did not differ between women diagnosed >1 year prior to conception, within the year prior to conception or during the pregnancy, (p=0.9). Conclusions: Sexually transmissible infections in pregnancy and the pre-conception period may be important in predicting pregnancy outcomes.