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.
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.
25074678
Towards evidence-based general practice in rural and remote Australia: an overview of key issues and a model for practice.
There is an extensive global move towards evidence-based practice intended to increase the quality and effectiveness of health care. However there are barriers and issues when rural general practitioners attempt to incorporate evidence-based medicine in their practice. Key issues affecting the uptake of evidence-based medicine by rural general practitioners include the gaps in the scientific evidence relevant to general practice, time limitations, and the cost of Internet access, geographical isolation from centres of evidence-based practice and limited training opportunities. General practitioner consultations may involve multiple, ill-defined problems and the patients' views about their treatment may conflict with an evidence-based treatment approach. Rural general practitioners may require additional supports to access information from research through Internet-based resources, accessible summaries of evidence or clinical practice guidelines. In addition a model to assist rural general practitioners use evidence-based medicine is suggested. This model may enable the clinical decision-making process to integrate clinical experience, patient preferences and an understanding of the rural context of practice with the best available evidence, to in turn produce best practice.
4935452
A summary of the theory of velocity selective neural recording
This paper describes improvements to the technique of velocity selective recording (VSR) in which multiple neural signals are matched and summed to identify excited axon populations in terms of velocity. This form of recording has been termed intrinsic velocity selective recording (IVSR). The signals are acquired using a multi-electrode cuff (MEC) which is now available as a component for use in implantable neuroprostheses. The improvements outlined in the paper involve the use of bandpass filters at the output of the system which allows a higher level of selectivity to be obtained than is possible using IVSR.
205326823
Practitioner assessments of 'good enough' parenting: factorial survey.
AIM
The aim of this study was to measure health visitors' professional judgements on 'good enough' parenting and identify what factors and combinations of these are important when making such judgements.


BACKGROUND
The relationship between parenting and child health is unclear. Whilst agreement exists that 'good enough' parenting requires boundary setting, consistency and putting the child's needs first, attempting to define 'good enough' parenting in precise terms is complex. When faced with a complex situation, practitioners rely on relatively few factors to form judgements.


DESIGN
Factorial survey methods were employed using vignette techniques.


METHODS
Vignettes were constructed using previous research on those variables, which may influence nurses' judgements, for example, accommodation and child dentition. The level of factors was randomly varied. Two thousand vignettes were administered to a sample of 200 health visitors in two Health Boards who then made a judgement about this scenario.


ANALYSIS
Data were analysed through multiple regression with dummy variables and one-way analysis of variance. Regression equations for both good enough mothering and good enough parenting are reported.


RESULTS
The models used are significant predictors of parenting and mothering. Significant predictors on health visitor judgements' were boundary setting in sleep behaviours, type of housing inhabited and health behaviours. Although parenting and mothering are often conflated, health visitors appear to separate these aspects when making judgements based on type of housing.


CONCLUSIONS
Most professionals can articulate what makes a 'good' parent, equally they may have strong views regarding what constitutes 'poor' parenting. The difficulty is in determining when parenting is 'good enough' to provide a child with a nurturing environment.


RELEVANCE TO CLINICAL PRACTICE
This study suggests that practitioners move their thresholds of what is 'good enough' depending on a narrow range of factors. Awareness of the factors, which influence individuals' judgements is important in safeguarding children.
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.
13468480
ESPERR: learning strong and weak signals in genomic sequence alignments to identify functional elements.
Genomic sequence signals - such as base composition, presence of particular motifs, or evolutionary constraint - have been used effectively to identify functional elements. However, approaches based only on specific signals known to correlate with function can be quite limiting. When training data are available, application of computational learning algorithms to multispecies alignments has the potential to capture broader and more informative sequence and evolutionary patterns that better characterize a class of elements. However, effective exploitation of patterns in multispecies alignments is impeded by the vast number of possible alignment columns and by a limited understanding of which particular strings of columns may characterize a given class. We have developed a computational method, called ESPERR (evolutionary and sequence pattern extraction through reduced representations), which uses training examples to learn encodings of multispecies alignments into reduced forms tailored for the prediction of chosen classes of functional elements. ESPERR produces a greatly improved Regulatory Potential score, which can discriminate regulatory regions from neutral sites with excellent accuracy ( approximately 94%). This score captures strong signals (GC content and conservation), as well as subtler signals (with small contributions from many different alignment patterns) that characterize the regulatory elements in our training set. ESPERR is also effective for predicting other classes of functional elements, as we show for DNaseI hypersensitive sites and highly conserved regions with developmental enhancer activity. Our software, training data, and genome-wide predictions are available from our Web site (http://www.bx.psu.edu/projects/esperr).
33756647
Individual differences in electrodermal responsivity to predictable aversive stimuli and substance dependence.
To determine if the inability to take advantage of the predictability of an aversive stimulus to diminish its psychological impact reflects a deficit in inhibitory control related to the development of substance dependence, we recorded skin conductance responses (SCRs), heart rate (HR), and anticipatory electrodermal nonspecific fluctuations (NSFs) from 175 16-18-year-old boys when a white noise blast was either unpredictable or temporally predictable. Compared with boys who had moderately reduced or augmented SCRs to predictable blasts (moderate and poor modulators, respectively), boys whose SCRs were greatly reduced (good modulators) had fewer symptoms of alcohol and nicotine dependence and more anticipatory NSFs. HR appeared to index an active coping response for good and moderate modulators. The autonomic response pattern evident for good modulators may index an inhibitory control mechanism protecting them from developing substance dependence.