The Legal Needs of People Living with a Sexually Transmissible Infection or Blood-Borne Virus: Perspectives From a Sample of the Australian Sexual Health and Blood Borne Virus Workforce.

Law and the legal environment are important factors in the epidemiology and prevention of sexually transmissible infections (STIs) and blood-borne viruses (BBVs). However, there has been no sustained effort to monitor the legal environment surrounding STIs and BBVs. This article presents the first data on the incidence and impacts of unmet legal needs for those affected by an STI or BBV in Australia using a survey administered to a sample of the Australian sexual health and BBV workforce. Migration, Housing, Money/Debt, Health (including complaints about health services), and Crime (accused/offender) were reported as the five most common legal need areas, with 60% of respondents describing these legal problems as generating a "severe" impact on health. These results indicate that unmet legal needs generate significant negative impacts in terms of individual health, on public health, and the ability to provide sustainable services such as testing and treatment to those facing unmet legal needs.

Regulating Health Care Safety: Enforcement and Responsibility Attribution in Response to Iatrogenic Harm.

The regulation of health care safety is undertaken in the name of the public and is motivated and justified by their protection. This regulatory action generates debate concerning the proper limits of responsibility attribution and enforcement, while the actions and opinion - both imagined and real - of the public loom large in this field. However, there exists limited knowledge of public opinion on key aspects of health care safety enforcement and responsibility attribution following iatrogenic harm. This article reports on the results of a survey-administered experimental study to determine how the Australian general public attributes responsibility, moral censure and enforcement actions in the event of health care safety failures in hospital and outpatient settings. The study provide evidence that the general public are sensitive to corporate and individual sources of error; attribute responsibility in a pluralistic manner; differentiate between recklessness and negligence; and will attempt both formal and social enforcement actions in response to harm.

Primary care experience of older Australians with chronic illness.

This large (>1000) cross-sectional study investigates patient-reported primary care experiences of older people with chronic illness. Previous research has found that approximately half of patients with chronic illness receive optimal chronic illness care and outcomes in Australian general practice. A survey was administered via a double opt-in panel method to people aged ≥55 years who have one or more self-reported major chronic diseases (diabetes and/or chronic heart, kidney, lung, mental health and/or musculoskeletal conditions). Health professionals were found to be important to the majority of Australians surveyed. Well-known chronic illness support resources such as care plans and recalls/reminders were reported to be wanting by up to 50 per cent of respondents. Across all chronic illness groups, <42 per cent of respondents reported the provision of information on community resources and 25 per cent reported not having a sound understanding about their medications. Regular local surveys for older people with chronic illness would allow a timely understanding of primary care experiences, needs and preferences of this group, to support quality improvement and drive enhanced patient outcomes.

Procedural sedation in children with autism spectrum disorders in the emergency department.

BACKGROUND AND OBJECTIVES: Children with autism spectrum disorder (ASD) present more frequently to the emergency department (ED) than children with normal development, and frequently have injuries requiring procedural sedation. Our objective was to describe sedation practice and outcomes in children with ASD in the ED. METHODS: We performed a retrospective chart review of children with ASD who underwent sedation at two tertiary care EDs between January 2009-December 2016. Data were collected on children 1-18 years of age with ASD who were sedated in the ED. RESULTS: There were 6020 ED visits by children with ASD, 126 (2.1%) of whom received sedation. The most frequent indications for sedation were laceration repair (24.6%), incision and drainage (17.5%), diagnostic imaging (14.3%), and physical examination (11.9%). The most common sedatives used were ketamine (50.8%) and midazolam (50.8%). Ketamine was most commonly given intravenously (71.9%), while midazolam was usually given intranasally (71.9%). Procedures could not be completed in 4 (3.2%) patients, and adverse events were noted in 23 (18.3%) patients. Only four (3.2%) patients required supplemental oxygenation, and one received positive pressure ventilation. CONCLUSIONS: Children with autism in the ED commonly received sedation; one in four of which were for non-painful diagnostic procedures or physical examination. Over one-third received sedation via a non-parenteral route for intended minimal sedation. Sedative medication dosing and observed adverse events were similar to those reported previously in children without ASD. Emergency providers must be prepared to meet the unique sedation needs of children with ASD.

Chronic disease management support in Australian workplaces-low base, rising need.

ISSUE ADDRESSED: This study investigates the current nature, levels and perceived need for workplace support among mature age Australian workers with chronic illness. METHODS: A cross-sectional population survey was conducted via a double opt-in panel sample of Australian workers aged 45 years and older with one or more of six major chronic diseases (diabetes and/or chronic heart, kidney, lung, mental health and/or musculoskeletal conditions). RESULTS: Three hundred and fourteen respondents reported being in the workforce and having at least one of the chronic conditions under investigation, of which almost one third reported having more than one of the conditions. The findings reveal a number of considerable gaps in Australian workplace support for employees 45 years and older with chronic illness, including workplace flexibility, supportive policies and co-worker support. CONCLUSIONS: This research adds to a scarce existing literature base on workplace support for workers with chronic illness in Australia. Future research is needed to identify opportunities for effective public policy and implementation of workplace interventions to better support this cohort. SO WHAT?: If timely progress is not made in this area, the projected increase in the aged population and scheduled public policy changes impacting retirement age will multiply potential adverse effects on the health of employees with chronic illness and Australia's labour market productivity.

Strong Short-Range Cooperativity in Hydrogen-Bond Chains.

Chains of hydrogen bonds such as those found in water and proteins are often presumed to be more stable than the sum of the individual H bonds. However, the energetics of cooperativity are complicated by solvent effects and the dynamics of intermolecular interactions, meaning that information on cooperativity typically is derived from theory or indirect structural data. Herein, we present direct measurements of energetic cooperativity in an experimental system in which the geometry and the number of H bonds in a chain were systematically controlled. Strikingly, we found that adding a second H-bond donor to form a chain can almost double the strength of the terminal H bond, while further extensions have little effect. The experimental observations add weight to computations which have suggested that strong, but short-range cooperative effects may occur in H-bond chains.

HIV awareness in China among women of reproductive age (1997-2005): a decomposition analysis.

HIV prevalence in China is less than one per cent, but the absolute number of people living with HIV/AIDS is large and growing. Given the limited scope of any potential cure for HIV, prevention plays a crucial role in controlling the epidemic. This paper examines the evolution of HIV awareness among women in China between 1997 and 2005. A regression decomposition analysis technique was used to disentangle the two main components driving a change in HIV awareness. The results show that HIV awareness has increased over time in China. The gaps between groups are narrowing over time and lower HIV awareness groups are catching up with the higher awareness groups. In 2005 education remained one of the main factors associated with HIV awareness, the other main factors being ethnicity, exposure to TV and newspapers. The increases in HIV awareness observed between 1997 and 2001 are similar between groups of women with different demographic characteristics, whereas between 2003 and 2005 increases are more pronounced among specific groups of women such as women from rural areas, women from Western parts of the country, women who belong to ethnic minorities and those with no education or with only primary education. The results suggest that the main driver of the observed change in HIV awareness over time in China is change in the environment such as in political commitment, interventions and campaigns rather than change in population structure.

Reweighting the general household survey 1979-2007.

We have calculated two new sets of weights applicable to the General Household Survey (GHS) from 1979 to 2007. One of these is for use with any general analysis of GHS topics and the second is designed for analyses of data collected in the Family Information section. The methods used follow closely those employed by ONS from 1996 onwards. The performance of the weights is assessed in estimating the Total Fertility Rate (TFR) from 1971-2007, an aggregate measure of fertility for which reliable figures are available at national level from vital registration statistics. Our weights improve the GHS estimates, reducing bias both in the TFR and in age-specific fertility rates.

A multilevel analysis of the effects of a reproductive health programme that encouraged informed choice of contraceptive method rather than use of officially preferred methods, China 2003-2005.

Historically, the Chinese government's family planning (FP) policy has emphasized post-partum IUD use after first birth and sterilization after subsequent births. Was the influence of this policy-driven programme on women's contraceptive choices weakened by a reproductive health intervention programme based on the idea of enabling and encouraging clients to make an informed choice? Multilevel analyses of cross-sectional data from baseline (2003) and endline (2005) surveys conducted as part of the evaluation of a large-scale UNFPA RH/FP programme show significant reductions in the uptake of methods emphasized by official policy between the two surveys. But county-level effects are highly significant, suggesting the continuation of a strong exogenous influence on women's choices. The results suggest that, while the intervention had the effect of weakening the top-down approach towards promoting methods, family planning workers continued to be influential in promoting sterilization for women at higher parities.

Disentangling the complex association between female genital cutting and HIV among Kenyan women.

Female genital cutting (FGC) is a widespread cultural practice in Africa and the Middle East, with a number of potential adverse health consequences for women. It was hypothesized by Kun (1997) that FGC increases the risk of HIV transmission through a number of different mechanisms. Using the 2003 data from the Kenyan Demographic and Health Survey (KDHS), this study investigates the potential association between FGC and HIV. The 2003 KDHS provides a unique opportunity to link the HIV test results with a large number of demographic, social, economic and behavioural characteristics of women, including women's FGC status. It is hypothesized that FGC increases the risk of HIV infection if HIV/AIDS is present in the community. A multilevel binary logistic regression technique is used to model the HIV status of women, controlling for selected individual characteristics of women and interaction effects. The results demonstrate evidence of a statistically significant association between FGC and HIV, after controlling for the hierarchical structure of the data, potential confounding factors and interaction effects. The results show that women who had had FGC and a younger or the same-age first-union partner have higher odds of being HIV positive than women with a younger or same-age first-union partner but without FGC; whereas women who had had FGC and an older first-union partner have lower odds of being HIV positive than women with an older first-union partner but without FGC. The findings suggest the behavioural pathway of association between FGC and HIV as well as an underlying complex interplay of bio-behavioural and social variables being important in disentangling the association between FGC and HIV.

On the spatial inequalities of institutional versus home births in Ghana: a multilevel analysis.

Spatial inequalities related to the choice of delivery care have not been studied systematically in Sub-Saharan Africa where maternal and perinatal health outcomes continue to worsen despite a range of safe motherhood interventions. Using retrospective data from the 1998 and 2003 Demographic and Health Surveys, this paper investigates the extent of changes in spatial inequalities associated with type of delivery care in Ghana with a focus on rural-urban differentials within and across the three ecological zones (Savannah, Forest and Coastal). More than one-half of births in Ghana continue to occur outside health institutions without any skilled obstetric care. While this is already known, we present evidence from multilevel analyses that there exist considerable and growing inequalities, with regard to birth settings between communities, within rural and urban areas and across the ecological zones. The results show evidence of poor and disproportionate use of institutional care at birth; the inequalities remained high and unchanged in both urban and rural communities within the Savannah zone and widening in urban communities of the Forest and Coastal zones. The key policy challenges in Ghana, therefore, include both increasing the uptake of institutional delivery care and ensuring equity in access to both public and private health institutions.

Delivery settings and caesarean section rates in China.

OBJECTIVE: To quantify the influence of increasing use of health-care services on rising rates of caesarean section in China. METHODS: We used data from a population-based survey conducted by the United Nations Population Fund during September 2003 in 30 selected counties in three regions of China. The study sample (derived from birth history schedule) consisted of 3803 births to mothers aged less than 40 years between 1993 and 2002. Multiple logistic regression models were used to estimate the effect of health-care factors on the odds of a caesarean section, controlling for time and selected variables. FINDINGS: Institutional births increased from 53.5% in 1993-1994 to 82.2% in 2001-2002, while the corresponding increase in births by caesarean section was from 8.9% to 24.8%, respectively. Decomposition analysis showed that 69% of the increase in rates of caesarean section was driven by the increase in births within institutions. The adjusted odds of a caesarean section were 4.6 times (95% confidence interval, CI: 3.4-11.8) higher for recent births. The adjusted odds were also significantly higher for mothers who had at least one antenatal ultrasound test. Rates of caesarean section in secondary-level facilities markedly increased over the last decade to the same levels as in major hospitals (P < 0.001). CONCLUSION: The upsurge in rates of births by caesarean section in this population cannot be fully explained by increases in institutional births alone, but is likely to be driven by medical practice within secondary-level hospitals and women's demand for the procedure.

Dyspareunia, urinary sensory symptoms, and incontinence among young Chinese women.

This study examined the prevalence of dyspareunia, urinary sensory symptoms, and urinary incontinence and explored their associations among sexually active Chinese women aged 15-34 years. Data from 3,150 women were analyzed from a survey undertaken during 2003 in 30 counties in China as part of the United Nations Population Fund Country Program. The overall prevalence of dyspareunia was 4.7%. Urinary pain, burning or frequency was reported by 8.5%, 6.2% reported urinary incontinence, and 2.3% reported both sets of urinary symptoms. The prevalence of urinary incontinence, both alone and in combination with sensory symptoms, increased in a linear manner with age. Dyspareunia was associated with early sexual debut, primary level of education, and membership of minority ethnic communities. Urinary sensory symptoms and incontinence were more common among those reporting early sexual debut, those with less schooling, and women engaged in agricultural and manual unskilled occupations. Urinary incontinence was more common among women who had had a previous vaginal delivery compared to nulliparous women. Dyspareunia was strongly associated with the presence of urinary symptoms, particularly among those with both sensory symptoms and incontinence (26.8%). Nearly a quarter of women who had dyspareunia had sought treatment but fewer had done so for urinary incontinence. Dyspareunia and urinary symptoms show distinct but overlapping patterns of association with demographic variables. The findings indicate unmet need for assessment and advice about these symptoms in women's reproductive health programs.