32957442
Approach to sustainable primary health care service delivery for rural and remote South Australia.
We describe the operation of four University Teaching Practices established by the South Australian Centre for Rural and Remote Health (SACRRH) and the Adelaide University Department of General Practice. These practices were established in response to the acknowledged difficulty in recruiting and retaining GPs in rural South Australia. The practices are co-located with a hospital or accident and emergency service and community based nurses and allied health professionals. They provide integrated health care and multidisciplinary health care student placements in a learning environment where students experience rural multidisciplinary practice and country life. The study found that although the sites differed in significant ways, they all provided integrated care and effective placements for students. This style of health care delivery is flexible and broadly applicable. Sustainability is achieved through financially viability, attracting and retaining health care professionals and the development of electronic information systems, to support integrated practice.
42040828
The Station Community Mental Health Centre Inc: nurturing and empowering.
INTRODUCTION
Consumer-driven community mental health services play an important role in rehabilitation, recovery, and advocacy in rural and remote Australia. The origins of services often lie in the need to provide options for people with mental illness and their carers when there is a lack of on-the-ground support. This article adds to the information about the strengths and limitations of consumer-driven mental health services by presenting the findings of an evaluation of The Station Inc. in rural South Australia. This consumer-driven mental health service provides a safe and supportive environment, social connections, and activities for its members (those with a lived experience of mental illness). Using a realist evaluation approach, the evaluation identified the contextual factors and the program mechanisms that produce positive outcomes for members.


METHOD
The evaluation was conducted as participatory action research with The Station members, volunteers, management committee members, and staff involved in all phases of the research process. Because of the complexity of The Station's functioning a realist evaluation using qualitative data was conducted to identify how the program worked, for whom, and in what circumstances. Twenty-five in-depth interviews were conducted with participants who were randomly selected from within the groups identified above. Interviews focused on The Station's role in assisting recovery from mental illness, the limitations and strengths of the program, and relationships with the mental health system. The Station's goals, policies and procedures, and the role of stakeholders were analysed in order to identify any links among these contextual factors, program mechanisms, and program outcomes. Qualitative data were entered into descriptive categories in N6 software (QSR; www.qsr.international.com). Data from the stakeholder analysis were entered into Microsoft Excel. Using an iterative approach to include the three data sets, a model was developed that identified important contextual factors that linked with two groups of program mechanisms that produced positive outcomes for members.


RESULTS
Program mechanisms are categorised by descriptive themes referred to as 'nurturing' and 'empowering'. Nurturing' is experienced as feeling of belonging and being accepted 'as one is' and 'empowerment' mechanisms engender a belief in oneself. Respondents identified features of The Station's program, policies, atmosphere, connections and networks, stakeholder relationships, and staff and volunteers that are nurturing and empowering. Five key contextual factors enable the program mechanisms to work. The Station's coordinators ensure that nurturing and empowerment processes are highlighted through careful facilitation. The governance arrangements, policies, and administrative systems at The Station are well developed but flexibly implemented so that they support the nurturing and empowerment processes. Support and legitimacy for the program is obtained from the mental health system at state and local levels. The Station obtains resources and connections to its rural community through key stakeholders and a peak organisation One Voice Network acts as an advocate.


CONCLUSIONS
Information about the benefits and limitations of consumer-driven mental health services in rural and remote Australia is in short supply. Increasing the available information about the contribution these services make may result in services being legitimised, understood, and resourced within mental health systems thus making the services sustainable. The benefits of consumer-driven services are that they provide flexibility and adaptation, an ability to capture the energy and passion of rural communities to improve the wellbeing of community members, and they overcome the power differential that exists between professionals and 'patients' or 'clients'.
11212329
Intergenerational learning about keeping health: a qualitative regional Australian study.
Understanding the conditions under which families try to influence members' health-related practices can provide information to build concepts adding to models of health promotion. This paper reports on an exploratory qualitative study examining the influences of intergenerational relationships in shaping beliefs, knowledge and practices about health and illness in a regional Australian city. We conducted semi-structured interviews with 27 adults with family members of other generations living in the city, all of whom had experience of asthma. We found that overall people's experience of health and illness, particularly in childhood, was taken for granted and not reflected upon. It was in the face of serious illness or death of a family member that objective knowledge about health and illness was sought and integrated within the family leading, in most cases, to significant lifestyle changes or 'doing things differently'. We drew on Bourdieu's concept of the three forms of theoretical knowledge in analysing our findings. We found the concept of knowledge as 'primary taken-for-granted experience', and the concept of praxeological knowledge as the knowledge created by the dialectical relationships between an individual subject and objectives structures were helpful. To influence individual health practices, we need to acknowledge how the family context confirms the taken-for-granted health practices of an individual and the family circumstances that might lead families to seek objective knowledge and make lifestyle changes to promote health.
31260021
Improving transfer of mental health care for rural and remote consumers in South Australia.
In Australia, it is commonplace for tertiary mental health care to be provided in large regional centres or metropolitan cities. Rural and remote consumers must be transferred long distances, and this inevitably results in difficulties with the integration of their care between primary and tertiary settings. Because of the need to address these issues, and improve the transfer process, a research project was commissioned by a national government department to be conducted in South Australia. The aim of the project was to document the experiences of mental health consumers travelling from the country to the city for acute care and to make policy recommendations to improve transitions of care. Six purposively sampled case studies were conducted collecting data through semistructured interviews with consumers, country professional and occupational groups and tertiary providers. Data were analysed to produce themes for consumers, and country and tertiary mental healthcare providers. The study found that consumers saw transfer to the city for mental health care as beneficial in spite of the challenges of being transferred over long distances, while being very unwell, and of being separated from family and friends. Country care providers noted that the disjointed nature of the mental health system caused problems with key aspects of transfer of care including transport and information flow, and achieving integration between the primary and tertiary settings. Improving transfer of care involves overcoming the systemic barriers to integration and moving to a primary care-led model of care. The distance consultation and liaison model provided by the Rural and Remote Mental Health Services, the major tertiary provider of services for country consumers, uses a primary care-led approach and was highly regarded by research participants. Extending the use of this model to other primary mental healthcare providers and tertiary facilities will improve transfer of care.
32831734
A Role for Communities in Primary Prevention of Chronic Illness? Case Studies in Regional Australia
In regional Australia “communities of place,” defined as bounded geographic locations with a local society, undertake community-wide primary prevention programs. In helping to prevent chronic illness, communities provide valuable resources to the health system. To understand the role of community–health sector partnerships for primary prevention and the community contextual factors that affect them, we studied eight partnerships. We used an embedded multiple case study design and collected data through interviews, nonparticipant observation, and document analysis. These data were analyzed using a typology of community–health sector partnerships and community interaction theory to frame the key community contextual factors that affected partnerships. The dominant factor affecting all partnerships was the presence of a collective commitment that communities brought to making the community a better place through developing health. We call this a communitarian approach. Additional research to investigate factors influencing a communitarian approach and the role it plays in partnerships is required.
20101328
Community participation in organising rural general practice: is it sustainable?
OBJECTIVE
We analysed community participation in organising rural general medical practice in order to suggest ways to extend and sustain it.


DESIGN
A multisite, embedded case-study design collecting data through semistructured interviews, non-participation observation and a document analysis.


SETTING
One remote and two rural communities in Australia.


PARTICIPANTS
Community members, GPs, health professionals, government officers and rural medical workforce consultants.


RESULTS
High levels of community participation in recruiting and retaining GPs, organising the business model, and contributing to practice infrastructure were evident. Community participation in designing health care was uncommon. Participation was primarily to ensure viable general practice services necessary to strengthen the social and economic fabric of the community. There were factors about the decision-making and partnership processes in each of the communities that threatened the viability of community participation.


CONCLUSIONS
We recommend that a concept of community development and explicit facilitation of the processes involved is necessary to strengthen participation, create effective partnerships and ensure inclusive decision-making.
31432346
Hepatitis delta virus: Cis and Trans functions required for replication
8695495
The Florida State Twin Registry: research aims and design.
Relatively little is known about the relationship of most personality disorders to executive cognitive functioning despite their associations with frontal cortex activity. Research on genetic influence is lacking for most personality disorders, and research on genetic influences associated with executive cognitive functioning is sparse and mixed. The Florida State Twin Registry was created to conduct a pilot twin study aimed at examining genetic influence on personality disorders and executive cognitive functioning. Measures included structured clinical interviews for symptoms and diagnoses of personality disorders (borderline, histrionic, narcissistic, antisocial, obsessive-compulsive, avoidant, and dependent), depression, substance abuse/dependence, anxiety disorders, and eating disorders. The Wisconsin Card Sorting Test and the Stroop Color-Word Test were administered to assess executive cognitive functioning. Self-report questionnaires were included to assess maladaptive personality traits. Data sharing and future directions for growing the Florida State Twin Registry are discussed.
46164621
The rhetoric vs. the reality in child care and protection: ideology and practice in working with fathers.
Within child care and protection, practitioners can be paralysed by a fundamental gap between the rhetoric and the reality in engaging fathers in their children's care. In an earlier paper we argued that there is a lack of an effective framework to guide practice with fathers in child care and protection work. We examined how health visitors and social workers could begin to assess how fathers could be categorized as either (or both) a risk or an asset to the child. Based on a review of the literature we now explore the limitations of current models of practice and trace the theoretical strands that influence them, drawing from the legal framework, attachment theory and models for anti-oppressive practice. We then highlight messages for practice with fathers for health care professionals involved in child protection. The working context for this paper is Scotland, although we believe that the ideas may be extrapolated to other geographical areas.
44845847
Human hepatitis delta virus: an agent with similarities to certain satellite RNAs of plants.
One of the most intriguing aspects of hepatitis delta virus (HDV) is that, even though it is a naturally occurring infectious agent of human beings, it nevertheless shows a number of remarkable similarities to viroids, the subviral agents of plants that are considered elsewhere in this volume. The recognition and exploitation of this analogy has been a major contributor to studies of HDV genome replication. This review will concentrate on the structure of the HDV genome and the mechanism by which the genome is replicated, with special emphasis on similarities to the viroids. The review will not consider in any depth other important aspects of HDV, such as the assembly of genomes into virus particles, experimental transmission, host responses, or epidemiology. For such information the reader is directed to other more extensive reviews (Lai 1995; Purcell and Gerin 1996; Hadziyannis 1997; Margolis et al. 1997). However, to put this review in perspective, we will present a limited amount of background material.
22359555
Dental hygiene student experiences in external placements in Australia.
While placements in external locations are being increasingly used in dental education globally, few studies have explored the student learning experience at such placements. The purpose of this study was to investigate student experiences while on external placement in a baccalaureate dental hygiene program. A self-reporting questionnaire was distributed to final-year dental hygiene students (n=77) at the University of Newcastle, Australia, in 2010. The questionnaire included questions regarding the type of placement, experiences offered, supervision, resources available, and lasting impressions. Responding students were generally positive about their external placement experience and indicated that the majority of facilities provided them with the opportunity to provide direct patient care and perform clinical tasks typical of a practicing hygienist. However, there was a statistically significant difference in their opinions about discipline-focused and community placements. Students indicated that their external placement experience provided opportunities to learn more about time and patient management, including hands-on experience with specific clinical tasks. Ongoing evaluations are necessary to ensure that external placements meet both student needs and intended learning outcomes within dental hygiene programs.