bluuebunny/crossref_metadata_2025 huggingface dataset:
Health Promotion: Ten Years On from the Ottawa Charter
Authors: Labonte Ron
Published: August 2009

Good morning all, and a warm hello! It's a treat to be here in Hobart with a roomful of dedicated and compassionate souls, bringing a warmth of collegiality to the chill of an almost Canadian winter. I emphasise the almost. How many of you have every walked a dog in minus 50 degree weather. Weather that's so damn invigorating that if you survive it you immediately shuffle off in gratitude to Ottawa, the nation's capital, and cheerfully spend a week writing the Ottawa Charter for Health Promotion; the small-typed Canadian version of which includes as one of the basic health prerequisites electrical plug-ins for engine blocks to prevent the oil freezing?
Community Health Service Agreements 1992 to 1995: Changes in Practice and Purpose
Authors: Walker Rae , Lewis Beverley , Mitchell Sally
Published: August 2009

In Victoria, community health centres are undergoing major changes. In this paper, a study of service and funding agreements, their changed purposes, and how the practices surrounding them have also changed, is reported. The study provides some insights into the dynamics of the contractual model of health system management. The information was obtained from the service and funding agreements of community health centres, interviews with staff of the Department of Human Services, and interviews with community health centre managers. At the end of 1995, community health centres were still in a transitional phase. They were changing from being locally focused, multi-disciplinary organisations that approached health as a social and technical issue to ones that were centrally focused, still multi-disciplinary but increasingly attending to the technical provision of services. There were, however, many ambiguities in the system that allowed services to resist the changes that were considered least desirable. To a degree they de-coupled internal operations from the external presentation of them.
Child Abuse and Mandatory Reporting
Authors: Holland Grant
Published: August 2009

In Victoria, and to some extent Australia, the last two decades have seen some clarification in the classification of the various forms of child maltreatment and abuse. Currently, the major forms of child abuse are acknowledged as being:In Victoria, and to some extent Australia, the last two decades have seen some clarification in the classification of the various forms of child maltreatment and abuse. Currently, the major forms of child abuse are acknowledged as being physical abuse or non-accidental physical injury; sexual abuse and exploitation; emotional/psychological abuse and neglect. These forms of maltreatment often convey an implied message of non-accidental or committed harm against children. Abuse, however, can often occur by neglect or a failure to protect children, and therefore can be characterised as abuse by ommission. Many practitioners and professionals now use the term 'child abuse and neglect' rather than the single 'child abuse' term.
Immunisation: Why Bother?
Authors: Finlayson Janice
Published: August 2009

As infectious diseases become less prevalent in western countries, the public becomes more complacent, no longer seeing the diseases as a risk. Community attention soon turns to the complications associated with immunisation. Opponents of immunisation are often vocal and appeal to parents' fears of possible long term side effects. At present, very few parents refuse to immunise their children, but with growing media coverage of arguments against traditional immunisation, more parents are voicing reservations. To enable an informed choice to be made, parents need balanced information on the benefits and possible risks, including the implications for their own and other children of refusing immunisation.
Editorial
Authors: Gardner Heather
Published: August 2009

How should we organise community health services? This is the question posed by Swerissen in his paper in the Forum section of this issue. Within the context of reforms to the health system with an increased focus on improving efficiency, he argues that the organisation of community services should be driven by the functional relations between general care, acute care and co-ordinated care. The efficiency of vertical and horizontal integration and the creation of community health networks is considered in relation to a number of issues including distributional equity. He concludes that community health networks offer the most efficient model for the delivery of community based public health and general, acute and coordinated care services. It is hoped that this paper and the arguments presented will give rise to debate within the primary health care sector.
An Evaluation of a Diabetes 'Shared Care' Program in a Rural Division of General Practice
Authors: Pirkis Jane , Segal Leonie , Dunt David , Orr Tracey , Parsons Terree , Mossop Greg
Published: August 2009

This article describes an evaluation of a diabetes 'shared care' program run in a rural Division of General Practice. A summative evaluation examined the extent to which the program had achieved its aim, which was to achieve reduced morbidity, improved health outcomes and better quality of life for participants. This involved examining routinely collected clinical data, interviewing randomly selected patients (n=23) about self-reported health outcomes, and interviewing 20 participating general practitioners (GPs) about their perceptions of the program's impact on their patients. The program appeared to achieve its aim. Clinical data were limited, but indicated that patients' self care had improved, as evidenced by weight loss. Approximately half reported improved blood glucose self monitoring and diet, and 17% reported increasing their exercise. Nine per cent felt more empowered to deal with health professionals. Over half the patients reported that their health status had improved. The majority of GPs were positive about the impact of the program on their patients. A formative evaluation provided information about program design. This information was elicited through patient and GP interviews. In terms of program design, respondents were positive, but indicated that certain issues required resolution: communication, role delineation and co-operation between the GPs and the diabetes educators. This evaluation provides some clear lessons for future Divisional projects. Such projects can produce health gains, but can be enhanced through a variety of measures ? for example, the use of protocols and guidelines concerning written and verbal communication.
Widening The Net: New Directions For Community Health
Authors: Mann Leona
Published: August 2009

The Central Wellington Health Service, in Central Gippsland, Victoria, has been likened to an 'Area Health Board' or a 'Multi-Purpose Centre', because it has been structured into one organisation with an integrated range of services from acute to community.
A Community Health Information Model: The Basis of a Partnership in Information System Development
Authors: Bargenquast Julie
Published: August 2009

The Community Health Information Development (CHID) Project, a project for NSW Health, was initiated in August 1994. The goal of CHID was to assess the feasibility of an information system for this sector of the NSW health system which could answer questions on the business functions, performance measurement, service planning and service quality of community health. An organisational structure and process were developed by October 1994. That organisational structure and process were utilised for the assessment of the community health environment to determine the feasibility of, and requirements for, a community health information system. A brief overview of the four interrelated Working Parties' findings: Service Domains; Common Data Set; Information Management; and, Information Technology is provided. The key concepts in the Community Health Information Model (CHIM), a deliverable of the Information Management Strategy, is then outlined. This model, built through extensive consultation with community health workers, is accompanied by a dictionary which outlines each community health entity and attribute. The Community Health Information Model has 230 entities, approximately 485 attributes and 357 relationships between those entities and attributes and provides a common language for communication within community health. An overview of the Community Health Function Model, a companion model for the CHIM, is then provided. A Function Model describes the processes which generate the entities and attributes in an Information Model. The Function Model is also used to inform the scope of information system development, the next phase of this project. Following completion of the assessment phase in November 1994, a Business Case for the development of an information system for community health was accepted by the executive of NSW Health (the NSW health department). The paper outlines briefly, progress on the development of the information system and the proposed timeline for implementation.
Community Nursing in a Climate of Economic Rationalism: The Need to Value an Ethic of Care
Authors: Smith Janine
Published: August 2009

For almost 25 years generalist community nurses have provided professional services and developed many innovative programs in response to the needs of Victorian communities. They have established a Primary Health Care role in the co-ordination and management of preventative and therapeutic programs, as well as undertaking their more traditional duties of support and nursing care. At the present time there is unprecedented change occurring in both the structure and practice of community nursing, due, in large part, to measures aimed at achieving economic goals and reducing the high cost of illness care. These changes are creating ethical dilemmas for generalist community nurses who believe that the social costs of economic management might, in the long term, outweigh the gains. At a time of growing socio-dislocation when the community is exhibiting symptoms of alienation, experienced generalist community nurses are needed more than ever to provide a voice for those whose needs are not being met. The dilemma for nurses is how to provide the services that the community needs, cope with increasing and more complex caseloads, meet the demands of the bureaucracy, and become involved in the politics of decision making to influence health policy. The ethical stance of generalist community nurses and the rational stance of politico-economic decision makers are explored, and it is suggested that it is vital for nurses to value their professional ethics and to reaffirm their role if they are to survive the next 25 years.
1997 Awards for Innovation and Excellence in Primary Health Care - Community Support
Authors: Moorhead Steve
Published: August 2009

Brief Description of the Program: The program is a Family Violence Program at the Melton Community Health Centre (MCHC) in a western suburb of Melbourne.
1997 Awards for Innovation and Excellence in Primary Health Care Awards - Community Support: Who's Different? Whose Difference? Assertive Outreach and the Process of Making Parenting Support and Education Accessible to Vulnerable Families
Authors: d Jo Howar , Chaplin Robbi
Published: August 2009

Brief Bescription of the Program: This paper has a dual focus: to consider the language we use in describing the families with whom we work and the influence that language has on the models of service we develop; and to describe our experience with a particular parenting program. This paper is about praxis.
1997 Awards for Innovation and Excellence in Primary Health Care Awards - Alliances and Collaboration: Refugee Health Program
Authors: Mitchell Jenny
Published: August 2009

Brief Description of the Program: This article describes the ways in which three agencies in the Western Region of Melbourne have joined forces to deliver a co-ordinated health service to newly arrived refugees. The three agencies are: ? the Victorian Foundation for Survivors of Torture ? the Western Region Health Centre ? the Western Melbourne Division of General Practice.
1997 Awards for Innovation and Excellence in Primary Health Care - Health Promotion: An Innovative Drug Education Strategy for Young People and Parents of Diverse Cultural Backgrounds
Authors: Mudaly Bala
Published: August 2009

Brief Description of the Program: Increased drug use among young people is of major concern the world over. It is seen as one of many so-called 'at risk' behaviours characteristic of young people. Drug taking can have grave health consequences for some young people, especially for those who are experiencing a level of mental disturbance, such as depression. Young people coming from disadvantaged and marginalised circumstances are also more likely to be vulnerable, and can become easy victims of drug trafficking. In this respect, young people in Australia of Asian backgrounds appear to be one among many groups being drawn into the drug culture. The families in these communities appear generally reticent and fearful of drug issues, almost to the point of denying that a problem exists. Some young people taking to drugs are known to be disowned by their parents. At the same time there is very little in languages other than English or culturally appropriate information on drugs. Such information, if available, can be used in sensitive and strategic ways to raise the awareness of families of Asian backgrounds on drugs and young people, in the context of intergenerational tensions in parenting.
1997 Awards for Innovation and Excellence in Primary Health Care - Health Promotion: Syringe Disposal Hotline
Authors: Palmer Tony
Published: August 2009

Brief Description of the Program: Although needle and syringe exchange programs (NSEP) remain integral to Australia's internationally recognised response to the pandemic, the public have very real concerns about the health risks posed by syringes that are improperly disposed. The Syringe Disposal Hotline provides a seven days per week advice, referral, collection and disposal service for local residents concerned about inappropriately discarded sharps.
1997 Awards for Innovation and Excellence in Primary Health Care - Management Initiatives: Organisational Change and Organisation Design
Authors: Slater Cherie
Published: August 2009

Brief Description of the Initiative: The Inner South Community Health Service was created in 1993 as a result of the voluntary amalgamation of three successful community health centres - Prahran, South-Port and St Kilda. The amalgamation process was used as an opportunity to develop a large multi-site service responsive to each of its local communities and well positioned to meet effectively the challenges of rapidly changing political and health sector environments. The organisation design and change process was developed and implemented using a collaborative approach that was self-directed and self-managed; changes were both radical and developmental. Throughout the process client services were maintained and opportunities for including new programs were pursued. The organisation design was underpinned by two key principles - client focus and integration.
GPs and Practice-Based Health Promotion: An Analysis of Projects Conducted by Divisions of General Practice
Authors: Pirkis Jane , Dunt David , Ruth Denise , Jordan Helen
Published: August 2009

All practice-based health promotion projects conducted by Divisions of General Practice, funded in 1993 and 1994, are examined in this paper. The aims of the study are to describe their characteristics and evaluation; consider their effectiveness and appropriateness; and compare them with a sample funded in 1995 and 1996. Relevant information was analysed from project evaluation reports and summaries. Five immunisation, nine screening and 13 lifestyle counselling projects were funded in 1993-1994. The evaluation activities in these projects were variable, but the projects appeared to have desirable impacts. Evaluation findings indicate they have had high GP and consumer participation rates; lead to changes in GP knowledge and behaviour (for example, increased use of lifestyle counselling resources); and had positive impacts for consumers (for example, increases in immunisation and screening rates). Two immunisation, four screening and eight lifestyle counselling projects were funded in the second funding round in 1995 and the first in 1996. Although similar to the earlier projects, these projects often had a more systemic focus and made use of previously-developed knowledge and resources. Evaluation findings indicate that Divisional projects have increased GPs' capacity to engage in practice-based health promotion activities, and contributed to the achievement of the aims of the General Practice Strategy. Projects have improved the sophistication of their conceptualisation and design over time. Lessons from these projects point to particular policy implications for future funding arrangements, and these are discussed.
Seeking Treatment After Onset of Myocardial Infarction Symptoms: Why do Patients Delay?
Authors: Gassner Lee-Anne
Published: August 2009

Prompt medical attention has the potential to reduce mortality and morbidity related to myocardial infarction. However, many patients do not receive maximum benefit because of a delay in reaching hospital Emergency Departments and definitive treatment. This study uses quantitative and qualitative methods to interview and survey patients (N=50) about their prehospital experiences following the onset of acute symptoms. Results of this study show that a median decision time of 1.5 hours accounted for the largest component of delay time. The findings of this study indicate that patient delay is the result of the interaction of a variety of factors: lengthy evaluation of symptoms by the patient and lay others, extensive self-treatment, and engagement in non-therapeutic activities. The study concludes that community health strategies should aim to reduce patient decision time. Although the usual pathway to hospital care is via the patient's general practitioner, this resulted in an extended response time. Education programs should recommend a more direct pathway to medical assistance. As most patients were at home and had a family member present at the onset of symptoms, recommendations made to reduce patient delay should also target family members.
How Much Care and How Much Control? Looking Critically at Case Management
Authors: Furlong Mark
Published: August 2009

With an emphasis on the Australian context, the paper sets out to critically examine case management (CM). Initially, a brief history of case management is outlined prior to a detailed summary of matters relating to definition. The contention is then developed that the many variations of CM can be evaluated as tending towards either the 'agency-centred' or the 'client-centred'. On a second level of analysis, the historical factors which have driven the development of CM are introduced. These factors include the priority now given to community-based care, 'supply-side economics', the dissatisfaction of human service managers with the performance and loyalty of their professionals, and the priority increasingly being given to risk minimisation and the containment of dangerousness. Despite the stated claim that CM is primarily concerned with promoting the interests of service users, it is argued that CM can be associated with the coercive regulation of clients and practitioners, with the promotion of simplistic and unhelpful images of practice and with the disguising of structural problems. It therefore follows that if CM is not necessarily benevolent it is important to evaluate its actual operations within specific sites in order to consider to what degree instrumental and agency-centred, rather than progressive and client-centred, priorities are being performed.
The Sydney 'PLAY IT SAFE' Program: An Evaluation of an HIV/AIDS Awareness Raising Program for Men from Non-English Speaking Backgrounds
Authors: Rissel Chris , Elias-Schneider Ann-Marie , Marthenas Julia
Published: August 2009

The relatively low rates of HIV/AIDS in Australia can be attributed to extensive and well publicised prevention programs. However, it is not known if there are differential risks of HIV/AIDS for people from non-English speaking backgrounds, particularly given the reluctance in some migrant communities to discuss HIV/AIDS issues. An innovative program was implemented with soccer clubs in Sydney, which have a very high proportion of followers from non-English speaking backgrounds. Educational materials were distributed to male spectators at games, a high profile sticker and poster campaign was implemented and clubs supported the project in a number of ways after extensive liaison. Two hundred and one male spectators aged 18 to 50 years, and generally from non-English speaking backgrounds, were selected randomly (44% response rate) at three games and asked a series of questions about recall of project messages and HIV/AIDS risk behaviour. Recall of the project slogan 'PLAY IT SAFE' was high (66%) and significantly higher among frequent game attenders. Twenty per cent of respondents were considered at potentially elevated risk of HIV/AIDS, with older men and smokers significantly more likely to be at potentially elevated risk. Ethnicity was not associated with greater risk.
Raising Awareness of Postnatal Depression
Authors: Puts Kerrie
Published: August 2009

Berwickwide Community Health Service (BCHS) conducted a project during National Mothering Week that set out to raise community awareness of Postnatal Depression (PND) and to assess the need for establishing a PND support group in Northern Casey, Victoria. Target groups included mothers of young children, general practitioners (CPs) and the general community. A reference group consisting of professional and community representatives was involved in the planning, implementation and evaluation of all strategies. Approaches used included health education, professional development, information development, creating supportive environments, supporting community action, intersectoral collaboration and policy development. The project highlighted the need for a PND support group in Northern Casey and was successful in terms of raising awareness of PND, information development and dissemination, and needs assessment of mothers in Northern Casey. Mothering Week provided an ideal opportunity to give a relatively small project a larger, more attractive profile and provided an ideal vehicle to introduce the 'heavy' issue of PND in a forum that celebrated and raised the status of motherhood. Although as health promotion practitioners we are not encouraged to run ad hoc events and to strive instead for sustainable outcomes, this project showed that applying health promotion principles to one-off events such as Mothering Week can be very useful in needs assessment and in determining characteristics particular to the target group. The increase in knowledge and skills and the sense of ownership that participants can experience through participation in such a project can also foster a sense of community spirit that lays the groundwork for more sustainable, future projects.
1997 Awards for Innovation and Excellence in Primary Health Care - Direct Care: Intensive Adult Psychiatric Rehabilitation Program of the Central Highlands (APROTCH)
Authors: Beasley April
Published: August 2009

The Intensive Adult Psychiatric Rehabilitation Program of the Central Highlands (APROTCH) is a psycho-social rehabilitation program which aims to address the needs of young adults who have recently experienced the onset of serious mental illness. The program was developed in 1996 in consultation with the Early Psychosis Prevention and Intervention Centre (EPPIC) Victorian statewide services, in response to a significant change in the characteristics of referrals received.
Guest Editorial: Global Warming and Population Health
Authors: Tong Shilu
Published: August 2009

Since the industrial revolution, the contribution of anthropogenic sources of greenhouse gases to the global environment has significantly increased. Greenhouse gases, including carbon dioxide (CO2), methane (CH4), and nitrous oxide (N2O), are accumulating in the atmosphere. These trends are largely attributed to human activities, primarily fossil-fuel combustion, some industrial processes, for example cement production and mining, changes in land use, and agricultural practices. The International Panel on Climate Change (IPCC), made up of more than 2,500 of the world's leading scientists, has recently concluded that human activity might have already begun to change the global climate, and in the absence of efforts to reduce greenhouse gases, the concentrations of these gases are expected to increase significantly throughout the next century (IPCC, 1996).
Community-based Health Promotion: An Analysis of Projects Conducted by Divisions of General Practice
Authors: Naccarella Lucio
Published: August 2009

A descriptive analysis of community-based health promotion projects conducted by Divisions of General Practice between 1993 and 1994 and in 1996 is provided, and their design, evaluation, impact and appropriateness are considered. A total of 55 community-based health promotion projects were funded between 1993 and 1994. Analysis of the 1993 and 1994 projects revealed that: most project goals and objectives lacked clarity and measurability; almost all projects undertook some form of needs assessment; projects tended not to be targeted; participation rates and reporting varied greatly; and project evaluations were designed to measure process and impact at the individual level, rather than on a system wide level. Fifty comparable community-based health promotion projects were funded in 1996.An analysis of project proposals revealed that they were designed on the whole to be more targeted, intersectoral, collaborative and to use multiple settings and strategies than their 1993 and 1994 counterparts. Projects have increased the visibility and capacity of general practitioners (GPs) to engage in community-based health promotion, and provide evidence that they can do more than individual service provision activities, such as community-based health promotion in a diverse range of settings, and with a broad range of population groups.
It's not as Easy as just Walking in the Door': Interpretations of Indigenous People's Access to Health Care
Authors: Paul David
Published: August 2009

Discussion about the on-going poor health status of Aboriginal and Torres Strait Island peoples in Australia needs to be better informed about both history, and the nature of health determining factors. Access is only one of many factors of importance in health seeking behaviour. This paper explores how the cultural appropriateness of health care services is a determinant of whether they are accessed or not. Contemporary attitudes, and their historical roots, are key issues which need to be addressed by health care providers and services. The onus is on health care providers to be informed and to act appropriately in all their interactions with health care consumers. The Royal Commission into Aboriginal Deaths in Custody provides some useful suggestions for improving the quality of health care services for Indigenous Australians.
Strategic Planning in Perinatal Mental Health
Authors: Barclay Lesley , Barclay Kate
Published: August 2009

This article presents the story of the beginning of a movement to improve the perinatal mental health of families in the South Eastern Sydney Area Health Service. The movement is made up of practitioners and consumers who want to improve services. An early initiative was to provide information on appropriate referral procedures for postnatal depression, for General Practitioners (GPs), early childhood nurses and others who may be asked for help by women. A second project was a submission for inpatient accommodation for women with acute psychoses or depression and their infants. The key theme that has emerged is that perinatal mental health is an issue with many disparate causes and effects, some of which health systems can address. The promotion and maintenance of perinatal mental health requires a great deal of collaboration between health professionals from various disciplines. Existing levels of collaboration between services are insufficient and approaches to perinatal mental health should be re-oriented in order to facilitate a move from fragmented care to continuity of care. Primary care is the most appropriate starting point for co-ordinating collaborative efforts. Currently, the focus is completing a Perinatal Mental Health Strategic Plan to be considered in planning mental health services for the South Eastern Sydney Area Health Service.
Equity Issues in Dental Health Care Services in Thailand
Authors: Vichathai Charay , Barraclough Simon
Published: August 2009

Thailand's dental health care system and provisions for public services are described. The Thai Ministry of Public Health has sought to pursue the goal of oral health for all by creating greater equity in opportunities for dental care. Severely disadvantaged Thais are able to seek free treatment, and a subsidized health card system offers medical and dental care to those able to purchase it. Despite these efforts, inequities related to socio-economic status and geography remain. The growth of the private sector has contributed to inequities by drawing dentists away from the public sector. Most dentists wish to work in the more lucrative private sector and to offer curative treatment. The organisational structure of the dental health system in Thailand and certain attitudes of the dental profession have also worked against equity, despite statements of support for equity in the country's Constitution and on the part of policy makers. More research is needed on equity in dental care in Thailand, and ways to reduce shortages of dentists in the public sector and in rural areas need to be explored. The most effective way of promoting equity in dental health care in Thailand is through reinforcing primary dental care with its emphasis upon education and prevention.
Writing for Publication
Authors: Pirkis Jane , Gardner Heather
Published: August 2009

Most people working in primary health would recognise the value of sharing their knowledge through publishing their research or reporting on successful intervention strategies, but many view writing as a daunting task. One of the most effective means of passing on information is through articles published in peer reviewed journals.
Indirect Services Funded by the National Women's Health Program in Victoria
Authors: Wilson Gai , Butler Paul , Szirom Tricia , Cameron Jenny
Published: August 2009

Victoria's Women's Health Services and Centres Against Sexual Assault have implemented a range of indirect activities utilising various strategies and methods with a particular focus on information and resource provision, education and training, community development and promotional activity. They have increased women's access to existing services by working to make those services more appropriate and relevant. To achieve this they have involved women in the community in program management, design and implementation. Collaboration with other agencies in health and related services has also been a key strategy in achieving changes to mainstream services and fulfilling the aims of the dual strategy.
Women's Health in a Changing Society: Changing Women's Health
Authors: R. Grant Karen
Published: August 2009

Women's health and health care for women have been undergoing significant changes in Canada in recent years. In part, change has occurred as a result of health care restructuring (or health reform), brought on by reduced funding by the federal government. Whereas in 1971 (when Canadian Medicare was established), the federal government contributed 50% of the costs of all insured services, today its contribution is a mere 15% and declining. Demands for greater economic efficiencies in the health sector, coupled with concerns about the ageing of the population have also led many provincial governments to restructure health services. There has been a growing shift toward community-based health care, as well as changes to how health care in institutions is delivered. In all of this restructuring, relatively little attention has been focused on the impact of these changes on women.
The Women's Health Australia Project and Policy Development
Authors: Bryson Lois
Published: August 2009

The Women's Health Australia (WHA) project plans to follow the health of a national sample of around 42,000 women who, in 1996, were in the age cohorts 18-22, 45-49 and 70-74. The multi-disciplinary research team adopts a social approach to health, focuses on biological, psychological, social and lifestyle factors and their relationship to physical health and emotional wellbeing, and is examining the use of, and satisfaction with, health care services. Base-line survey data highlight diversity and the need for health policy to tailor communications to the different age groups. In terms of general wellbeing and service appropriateness, the young are the most problematic, the mid cohort next, while older women indicate fewest problems. Young women experience the highest levels of stress, often suffer from tiredness and are over-concerned with their weight and shape. They are also most dissatisfied with GP services. Issues of employment and health are also central. In general employment is associated with good health, but strains are evident when there are family commitments. As employment becomes increasingly normalised for women, health policy must be mindful of these effects and the significant difficulties faced by a small group of women whose health precludes employment.
Rural Women's Health
Authors: Jo Wainer
Published: August 2009

Rural women in Australia have reduced access to health and illness-management services, live in more hazardous environments, and yet describe themselves as healthier than urban women. These contradictions illustrate some of the consequences of different ways of measuring health. Data based on presentations to hospital for episodes of illness management, within a conceptual framework of biomedicine which has been developed with little input from women, presents one picture of the health of a community. Data based on asking women what is going on provides another picture. These different pictures highlight the distinction between health and illness management. This article introduces the reader to rural culture, considers some of the epidemiological evidence about the presentation of illness and mortality for rural women, summarises the outcomes of research and consultations with women, and concludes by making recommendations about effective ways to enhance rural women's health through service delivery.
Best Practice in Women's Health: Outcomes, Processes and Pre-conditions
Authors: Wilson Gai , Legge David , Butler Paul , Wright Maria
Published: August 2009

The pre-conditions, processes, and outcomes associated with best practice in women's health at the primary health care level are discussed. The paper draws on a study which identified projects that exemplified best practice in relation to: collaboration with consumers and communities; the adoption of a social model of health; the collaboration between providers at different levels of the health system and government; and addressing immediate health needs in a way which recognises the underlying conditions which cause ill health. The methodology involved identifying 187 recently published and documented episodes of primary health care practice. Using ratings and reports from 90 experienced referees from around Australia, the 187 case studies were reduced to 25 which the referees agreed represented 'best practice'. A more detailed investigation of these 25 studies was undertaken to determine what structures contributed to the good processes and outcomes. Of these, eight were women's health projects, with six undertaken by women's health services in Victoria. The paper outlines the kinds of outcomes, processes and pre-conditions which are associated with best practice as illustrated by one of the Victorian women's health projects. The findings from this research project provided practical, informative and useful models of best practice which can be of assistance to women, health workers, policy makers and government.
Towards Healthy Ageing of Women with Long Term Disabilities
Authors: Cooper Margaret , Temby Dianne
Published: August 2009

Women with longterm or lifelong disabilities are invisible in Australian statistics on disabilities or ageing. Current literature indicates unrecognised and untreated secondary conditions may lead to increased disability. Definitions of disability are explored for their relevance to the experience of women with disabilities and for health promotion within this group. A Victorian study included anecdotal accounts by some women with disabilities which identified both a knowledge of the wider meaning of health, and specific social issues which prevented their achievement of maximum wellbeing. Strategies are suggested for enabling women with disabilities to age more healthily.
Improving Women's Health Care: The Experiences of Women Patients and General Practitioners in the Western Region of Melbourne
Authors: Gridley Heather , Moore Susan , Higgins Jill , Johnson Kelley
Published: August 2009

This paper documents two studies conducted in the western metropolitan region of Melbourne, which developed from concerns expressed by some women about sexually intrusive medical practices. They aimed to explore women's experiences, as well as general practitioners' views of their practices with women. Following a survey of 472 women, 13 semi-structured interviews were held with respondents who had reported negative experiences with medical examinations. All had experienced something about which they felt uncomfortable, but few had felt able to take action at the time or afterwards. Long-term consequences included impairment of subsequent relationships with health professionals, with implications for the women's ongoing health maintenance, and in some cases, severe emotional disablement. Concurrently, twelve interviews were conducted with general practitioners to explore issues of concern to them in working with women patients on sensitive issues. These interviews indicated that general practitioners were concerned about issues they perceived to be on the boundary of medical practice, including emotional and psychological issues for women, sexuality and sexual relationships. The study found differences between men and women general practitioners in their responses to women's health issues. The interviews also suggested that the structures of medical practices posed barriers for doctors in developing good practice models.
Rural Women's Health Education: A Model of Best Practice
Authors: Farrell Elizabeth , Knight Sara
Published: August 2009

The Jean Hailes Foundation has a distinct approach to the health care of women. The integration of a team of clinicians, educators and researchers enables the Foundation to give women access to relevant, timely and clear information about their health and health care issues to assist them in making informed health choices. The Rural Women's Education Program has been developed to meet the increasing demand for more information by rural Australians. The isolation of rural women, their difficulties in service access and transport availability are some of the problems addressed in the planning process for each respective area. To date each program has consisted of large public seminars, interactive information sessions and professional training. The response to each program has been overwhelming. Local ownership of the event has been part of its success. The 'Regional Women's Health Plan, 1998 - 2000' for the Barwon-South Western Region outlined certain health needs in the area. The Foundation responded to this need and, in collaboration with local network leaders, devised a program to meet the specific needs of that community. The planning process, delivery and evaluation of this successful program are discussed.
Smoking and Quitting Smoking: Crucial Issues for Women
Authors: Stillman Suzanne
Published: August 2009

It is undeniable that tobacco use by women and girls continues to limit the real improvements in quality of life and longevity that we might expect, as it does for men and boys. Smoking is the main cause of preventable death and disease in our country. Women's smoking is not an emerging health issue; it is a health concern that has been with us for decades. Smoking rates for women were at their highest in the 1970s and we are now reaping the results of this in the peaking of disease rates that have taken twenty years to emerge. It is hoped we will not see a repeat of this pattern, but we cannot afford to be complacent. The challenge now is to bring the smoking rates for women down even further, as quickly as possible.
Issues of Women Carers in Australian-Greek Families
Authors: A. Morse Carol , Messimeri-Kianidis Voula
Published: August 2009

Several myths prevail regarding family-based caregiving in migrant groups from non-English-speaking backgrounds (NESB): i) a low need for formal services because of extensive family networks (i.e. informal assistance); ii) NESB groups prefer to 'look after their own' to a greater extent than do Anglo-Australian communities; and iii) caregiving is a 'natural' role for women in migrant families. In 1995 a survey was undertaken of 150 care-giving families in the Australian Greek community in Melbourne, identified from the register of the Australian Greek Welfare Society (AGWS), matched by age and gender with 150 Australian Greeks with no caregiving roles. Health status and social experiences were examined of providing family-based caregiving for a co-resident member with developmental delay, physical and/or mental disorder or frail age.
Women as Carers of Alcoholic and Drug Addicted Men
Authors: Zajdow Grazyna
Published: August 2009

This article looks at some of the experiences of women who care for alcoholic and drug addicted men. Through biographical interviews it describes how this group of women has dealt with the problems which women have to confront in the face of difficulties with the health and welfare systems, as well as their own expectations of what it means to be good wives and partners in very stressful situations. The article argues that the normative expectations of women as wives and mothers is to care for families, and while there is now an extensive literature on women's caring, the group of women described in these pages is generally ignored by this same literature.
Prenatal Screening Strategies for Down Syndrome: Many Options but Few Answers
Authors: M. Wallace Euan
Published: August 2009

Down syndrome is the single most common cause of severe mental handicap in Australia. Prenatal screening for Down syndrome is therefore an important component of modern antenatal care. However, while effective second trimester serum screening for Down syndrome has been available in Australia for almost a decade it appears that the majority of Australian women, particularly those outside South Australia and New South Wales, are still not offered it. Newer methods of screening have been recently described and are already being offered in routine clinical practice. These methods, including nuchal translucency, will afford results earlier in pregnancy than second trimester serum screening and so are attractive to women. However, available evidence suggests that nuchal translucency may not perform as well as second trimester serum screening and further evaluation of the newer screening strategies in an Australian population is urgently required. Alteration of practice prior to such an evaluation is simply not warranted at this time.
Mental Health and a Mature Society: Who Cares?
Authors: Hall David , Tomlinson John
Published: August 2009

Community responsibility for mental health remains ambiguous. Despite welcome reform of State and Territory 'mental health systems', the majority of Australia's effort - in dollar and personnel terms - is directed to 'serious mental illness' and chronic psychiatric disability. Positive mental health, in the sense of the capacity to lead satisfyingly balanced, productive and resilient lives, is poorly studied and attracts little policy comment. This paper addresses some of the fundamental characteristics of a mature, caring society. These are contrasted with examples of current policies that perpetuate tendencies to 'blame the victim'. For as long as mental health is merely a construct of the health (read 'ilth') system, with funding skewed towards clinical crisis intervention, progress will be measured only in terms of the control or management of mental illness. What is proposed is reorientation of our ways of thinking about 'mental health' policies and service systems. Australians deserve a collaborative, coherent, comprehensive and caring mental health system. Such a system is described, through positive examples of models being adopted in some Aboriginal communities. Recommendations are made for practical initiatives at the local community level.
Issues in the Development and Implementation of HIV/AIDS Policy in Thailand's Prisons
Authors: Suriyawong Atchara , Barraclough Simon
Published: August 2009

Thailand's prisons are overcrowded, house many prisoners at high risk of HIV infection, and have a high turn-over of prisoners. Prevention and management of HIV is therefore important both for prisoners and staff and for the wider population. It is argued that although HIV/AIDS policy in Thailand's correctional institutions has often lagged behind policy developments in the wider Thai society it has nevertheless become more liberalised. Segregation and testing have been abandoned in favour of education and universal preventative precautions. Problems with financial and human resources continue to hamper the effective implementation of policy. There is also a greater need for co-operation between correctional services and non-government organisations to support HIV-positive prisoners upon their release.
Exercise Participation Motives of Pregnant Women
Authors: S. Kolt Gregory , L. Nicoll Belinda
Published: August 2009

The aims of this study were to investigate the participation motives of pregnant women involved in exercise classes and to examine the differences in reasons for participation based on age, stage of pregnancy, and prior exercise levels. To assess the exercise motives of pregnant women, the Participation Motivation Questionnaire for Exercise in Pregnancy (PMQEP) was administered to 131 women (mean age, 32.2 years) participating in exercise classes designed specifically for pregnant women. Findings indicated that the most important exercise motive was 'to keep healthy for the baby', followed by 'to cope better with the physical changes of pregnancy', 'I want to be physically fit', ?I want to stay in shape', and 'to cope better with labour'. Principal components analysis of the PMQEP established five factors: 'Social', 'Physical Fitness', 'Coping with Pregnancy', 'Achievement/Energy Release', and 'Preparation for Labour/Challenge'. Further, discriminant function analysis revealed differences in motives based on age and prior exercise levels. These findings have important implications for designing and implementing exercise classes for pregnant women, and should be considered when encouraging pregnant women to exercise throughout pregnancy.