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1.
Aust J Rural Health ; 32(3): 554-559, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38511486

RESUMO

OBJECTIVE: The relationship between chronic pain and complementary and alternative medicine (CAM) use is poorly understood, and the situation in rural Australia is particularly unclear. The objective here was to determine the socio-demographic factors associated with the use of CAM for the treatment of chronic pain in a region of rural Australia. METHODS: This secondary analysis used data from a population health survey, Crossroads-II, to assess the relationships of various socio-demographic factors with the use of CAM by those suffering from chronic pain. DESIGN: Face-to-face surveys at households randomly selected from residential address lists. SETTING: A large regional centre and three nearby rural towns in northern Victoria, Australia. PARTICIPANTS: Sixteen years of age and older. MAIN OUTCOME MEASURES: Use of a CAM service to treat chronic pain. RESULTS: Being female (2.40 [1.47, 3.93], p < 0.001) and having a bachelor's degree (OR 2.24 [1.20, 4.20], p < 0.001) had a significant positive relationship with the use of CAM overall to redress chronic pain and those 50 years and older had greater odds of using manipulation therapies relative to those below 50 years (50-64: OR 0.52 [0.32, 0.86], p = 0.010; 65+: 0.37 [0.18, 0.75], p = 0.005). CONCLUSION: In the studied region, females and those with university education have the greatest odds of using CAM to treat chronic pain. This study needs to be complemented with more mechanistic investigations into the reasons people make the decisions they make about using CAM for the management of chronic pain.


Assuntos
Dor Crônica , Terapias Complementares , População Rural , Humanos , Vitória , Feminino , Terapias Complementares/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Dor Crônica/terapia , Adulto , População Rural/estatística & dados numéricos , Idoso , Adolescente , Adulto Jovem
2.
Aust J Rural Health ; 30(5): 601-607, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35816572

RESUMO

OBJECTIVE: To assess awareness and risk of Q fever among agricultural show attendees. SETTING: University of New England's Farm of the Future Pavilion, 2019, Sydney Royal Agricultural Show. PARTICIPANTS: Participants were ≥18 years, fluent in English, Australian residents, and gave their informed consent. MAIN OUTCOME MEASURES: Participants reported whether they had ever heard of Q fever and then completed the 'Q Tool' (www.qfevertool.com), which was used to assess participants' demographics and risk profiles. Cross-tabulations and logistic regression analyses were used to examine the relationship between these factors. RESULTS: A total of 344 participants were recruited who, in general, lived in major NSW cities and were aged 40-59 years. 62% were aware of Q fever. Living in regional/remote areas and regular contact with livestock, farms, abattoirs and/or feedlots increased the likelihood of Q fever awareness. Direct or indirect contact with feral animals was not associated with Q fever awareness after controlling for the latter risk factors. 40% of participants had a high, 21% a medium, and 30% a low risk of exposure. Slightly less than 10% reported a likely existing immunity or vaccination against Q fever. Among those who were not immune, living in a regional or remote area and Q fever awareness were independently associated with increased likelihood of exposure. CONCLUSIONS: Awareness of Q fever was relatively high. Although 61% of participants had a moderate to high risk of exposure to Q fever, they had not been vaccinated. This highlights the need to explore barriers to vaccination including accessibility of providers and associated cost.


Assuntos
Coxiella burnetii , Febre Q , Animais , Austrália , Febre Q/epidemiologia , Febre Q/prevenção & controle , Fatores de Risco , Vacinação , Zoonoses
3.
Australas Psychiatry ; 27(4): 362-365, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31165642

RESUMO

OBJECTIVE: This study determined the cultural appropriateness of the Structured Clinical Interview for the DSM-IV Axis I Disorders (SCID-I) as an acceptable tool for diagnosing mental illness among Indigenous people. METHODS: De-identified qualitative feedback from participants and psychologists regarding the cultural appropriateness of the SCID-I for Indigenous people using open-ended anonymous questionnaires was gathered. Aboriginal Medial Service staff and Indigenous Support Workers participated in a focus group. RESULTS: A total of 95.6% of participants felt comfortable during the 498 questionnaires completed. Psychologists also provided qualitative feedback for 502 (92.3%) interviews, of whom 40.4% established a good rapport with participants. Of the participants, 77.7% understood the SCID-I questions well, while 72.5% did not require any cultural allowances to reach a clinical diagnosis. CONCLUSION: When administered by a culturally safe trained psychologist, SCID-I is well tolerated in this group.


Assuntos
Competência Cultural , Entrevista Psicológica/métodos , Entrevista Psicológica/normas , Transtornos Mentais/diagnóstico , Havaiano Nativo ou Outro Ilhéu do Pacífico/estatística & dados numéricos , Austrália/etnologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Retroalimentação , Serviços de Saúde do Indígena/organização & administração , Humanos , Transtornos Mentais/etnologia , Reprodutibilidade dos Testes , Inquéritos e Questionários
4.
BMC Psychiatry ; 17(1): 219, 2017 06 13.
Artigo em Inglês | MEDLINE | ID: mdl-28610603

RESUMO

BACKGROUND: Little is known of the appropriateness of existing gatekeeper suicide prevention programs for Indigenous communities. Despite the high rates of Indigenous suicide in Australia, especially among Indigenous youth, it is unclear how effective existing suicide prevention programs are in providing appropriate management of Indigenous people at risk of suicide. METHODS: In-depth, semi-structured interviews and focus groups were conducted with Indigenous communities in rural and regional areas of Southern Queensland. Thematic analysis was performed on the gathered information. RESULTS: Existing programs were time-intensive and included content irrelevant to Indigenous people. There was inconsistency in the content and delivery of gatekeeper training. Programs were also not sustainable for rural and regional Indigenous communities. CONCLUSIONS: Appropriate programs should be practical, relevant, and sustainable across all Indigenous communities, with a focus on the social, emotional, cultural and spiritual underpinnings of community wellbeing. Programs need to be developed in thorough consultation with Indigenous communities. Indigenous-led suicide intervention training programs are needed to mitigate the increasing rates of suicide experienced by Indigenous peoples living in rural and remote locations.


Assuntos
Serviços Comunitários de Saúde Mental , Encaminhamento e Consulta , Prevenção do Suicídio , Grupos Focais , Humanos , Entrevistas como Assunto , Havaiano Nativo ou Outro Ilhéu do Pacífico , Avaliação de Programas e Projetos de Saúde , Queensland , Suicídio/etnologia
6.
BMC Psychiatry ; 16(1): 357, 2016 10 21.
Artigo em Inglês | MEDLINE | ID: mdl-27769204

RESUMO

BACKGROUND: Suicide is a leading cause of death among Indigenous youth worldwide. The aim of this literature review was to determine the cultural appropriateness and identify evidence for the effectiveness of current gatekeeper suicide prevention training programs within the international Indigenous community. METHOD: Using a systematic strategy, relevant databases and targeted resources were searched using the following terms: 'suicide', 'gatekeeper', 'training', 'suicide prevention training', 'suicide intervention training' and 'Indigenous'. Other internationally relevant descriptors for the keyword "Indigenous" (e.g. "Maori", "First Nations", "Native American", "Inuit", "Metis" and "Aboriginal") were also used. RESULTS: Six articles, comprising five studies, met criteria for inclusion; two Australian, two from USA and one Canadian. While pre and post follow up studies reported positive outcomes, this was not confirmed in the single randomised controlled trial identified. However, the randomised controlled trial may have been underpowered and contained participants who were at higher risk of suicide pre-training. CONCLUSION: Uncontrolled evidence suggests that gatekeeper training may be a promising suicide intervention in Indigenous communities but needs to be culturally tailored to the target population. Further RCT evidence is required.


Assuntos
Indígena Americano ou Nativo do Alasca/psicologia , Competência Cultural/educação , Assistência à Saúde Culturalmente Competente/métodos , Havaiano Nativo ou Outro Ilhéu do Pacífico/psicologia , Prevenção do Suicídio , Adolescente , Austrália , Canadá , Feminino , Humanos
7.
Fam Pract ; 33(1): 75-81, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26502809

RESUMO

BACKGROUND: Australia is one of the highest users of antibiotics in the developed world. OBJECTIVE: This study aimed to identify consumer antibiotic information needs to improve targeting of medicines information. METHODS: We conducted a retrospective, mixed-method study of consumers' antibiotic-related calls to Australia's National Prescribing Service (NPS) Medicines Line from September 2002 to June 2010. Demographic and question data were analysed, and the most common enquiry type in each age group was explored for key narrative themes. Relative antibiotic call frequencies were determined by comparing number of calls to antibiotic utilization in Australian Statistics on Medicines (ASM) data. RESULTS: Between 2002 and 2010, consumers made 8696 antibiotic calls to Medicines Line. The most common reason was questions about the role of their medicine (22.4%). Patient age groups differed in enquiry pattern, with more questions about lactation in the 0- to 4-year age group (33.6%), administration (5-14 years: 32.4%), interactions (15-24 years: 33.4% and 25-54 years: 23.3%) and role of the medicine (55 years and over: 26.6%). Key themes were identified for each age group. Relative to use in the community, antibiotics most likely to attract consumer calls were ciprofloxacin (18.0 calls/100,000 ASM prescriptions) and metronidazole (12.9 calls/100,000 ASM prescriptions), with higher call rates than the most commonly prescribed antibiotic amoxicillin (3.9 calls/100,000 ASM prescriptions). CONCLUSIONS: Consumers' knowledge gaps and concerns about antibiotics vary with age, and certain antibiotics generate greater concern relative to their usage. Clinicians should target medicines information to proactively address consumer concerns.


Assuntos
Antibacterianos , Informação de Saúde ao Consumidor , Comportamento de Busca de Ajuda , Comportamento de Busca de Informação , Adolescente , Adulto , Idoso , Amoxicilina , Austrália , Criança , Pré-Escolar , Ciprofloxacina , Bases de Dados Factuais , Esquema de Medicação , Interações Medicamentosas , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Feminino , Humanos , Lactente , Recém-Nascido , Lactação , Masculino , Metronidazol , Pessoa de Meia-Idade , Motivação , Estudos Retrospectivos , Adulto Jovem
8.
Med Educ ; 50(2): 225-35, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26813001

RESUMO

OBJECTIVES: To determine the impact of the presence of a medical student on the satisfaction and process of the general practice consultation from the perspective of the general practitioner (GP), patient and student. METHODS: An observational study was conducted in regional general practices accepting third-year medical students. General practitioners, patients and medical students were asked to complete a questionnaire after each consultation. The main outcome measures were: patient satisfaction; GPs' perceived ability to deliver care; medical students' satisfaction with their learning experience; length of consultation; and patient waiting times. RESULTS: Of the 26 GP practices approached, 11 participated in the study (42.3%). Patients returned 477 questionnaires: 252 consultations with and 225 without a student present. Thirteen GPs completed 473 questionnaires: 248 consultations with and 225 without a student. Twelve students attended 255 consultations. Most patients (83.5%) were comfortable with the presence of a student. There were no significant differences between consultations with and without a student regarding the time the patients spent in the waiting room (p = 0.6), the patients' perspectives of how the GPs dealt with their presenting problems (100% versus 99.2%; p = 0.6) and overall satisfaction with the consultation (99.2% versus 99.1%; p = 0.5). Despite these reassuring findings, a significantly higher proportion of patients in consultations without students raised sensitive or personal issues (26.3% versus 12.6%; p < 0.001). There were no statistically significant differences in the lengths of consultations with and without students (81% versus 77% for 6-20 minutes consultation; p = 0.1) or in the GPs' perceptions of how they effectively managed the presenting problem (95.1% versus 96.0%; p = 0.4). Students found that the majority (83.9%) of the 255 consultations were satisfactory for learning. CONCLUSIONS: The presence of a medical student during the GP consultation was satisfactory for all participant groups. These findings support the ongoing and increased placement of medical students in regional general practice. Medical educators and GPs must recognise that patients may not raise personal issues with a student present.


Assuntos
Atitude do Pessoal de Saúde , Medicina Geral/organização & administração , Clínicos Gerais/psicologia , Satisfação do Paciente , Estudantes de Medicina/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Relações Médico-Paciente , Aprendizagem Baseada em Problemas , Fatores de Tempo , Listas de Espera , Adulto Jovem
9.
Med J Aust ; 202(1): 41-5, 2015 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-25588445

RESUMO

OBJECTIVE: To determine the role of rural background and years of rural clinical school training on subsequent rural clinical practice. DESIGN, SETTING AND PARTICIPANTS: Retrospective cohort study of University of Queensland (UQ) medical graduates who graduated during the period 2002-2011 (contacted via internet, telephone and mail, using information obtained from UQ, the Australian Health Practitioner Regulation Agency, and telephone directory and internet searches) who completed an online or hard copy questionnaire during the period December 2012 to October 2013. MAIN OUTCOME MEASURE: Current clinical practice in a rural location. RESULTS: Of 1572 graduates to whom the questionnaire was sent, 754 (48.0%) completed the questionnaire. Of the respondents, 236 (31.3%) had a rural background and 276 (36.6%) had attended the University of Queensland Rural Clinical School (UQRCS). Clinical practice location was rural for 18.8% (90/478) of UQ metropolitan clinical school attendees and 41.7% (115/276) of UQRCS attendees (P < 0.001). In the multivariate model with main effects, independent predictors of rural practice were (OR [95% CI]): UQRCS attendance for 1 year (1.84 [1.21-2.82]) or 2 years (2.71 [1.65-4.45]), rural background (2.30 [1.57-3.36]), partner with rural background (3.08 [1.96-4.84]), being single (1.98 [1.28-3.06]) and having a bonded scholarship (2.34 [1.37-3.98]). In the model with interaction between UQRCS attendance and rural background, independent predictors of rural practice were rural background and UQRCS attendance for 1 year (4.44 [2.38-8.29]) or 2 years (7.09 [3.57-14.10]), partner with rural background (3.14 [1.99-4.96]), being single (2.02 [1.30-3.12]) and bonded scholarship (2.27 [1.32-3.90]). The effects of rural background and UQRCS attendance were duration dependent. CONCLUSIONS: This study strengthens evidence that, after adjusting for multiple confounders, a number of exposures are independent predictors of rural medical practice. The strong positive interaction between rural background and rural clinical school exposure, and the duration-dependent relationships, could help inform policy changes aimed at enhancing the efficacy of Australia's rural clinical school program.


Assuntos
Serviços de Saúde Rural , Estudos de Coortes , Educação Pré-Médica , Previsões , Modelos Estatísticos , Queensland , Estudos Retrospectivos , Inquéritos e Questionários
10.
Aust N Z J Psychiatry ; 49(5): 412-29, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25690747

RESUMO

OBJECTIVE: This review aimed to draw on published literature to identify the prevalence rates of psychiatric disorders in Australia's Indigenous populations, Aboriginal and Torres Strait Islander peoples. METHOD: A systematic review following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) model was conducted using the following electronic databases: PubMed, Scopus, Web of Science, MEDLINE, PsycINFO, PsycARTICLES, and Informit Indigenous and Health Collections. Studies were included for analysis if they were empirical quantitative studies reporting prevalence rates for any psychiatric disorder in Indigenous people. RESULTS: Of the 1584 papers extracted by the search strategy, 17 articles met the eligibility criteria and were reviewed in detail. Methodology, sampling strategy and study design varied greatly across these 17 studies. Prevalence rates varied by disorder and are as follows: major depressive disorder (4.3-51%); mood disorders (7.7-43.1%); post-traumatic stress disorder (14.2-55.2%); anxiety disorders (17.2-58.6%); substance dependence (5.9%-66.2%); alcohol dependence (21.4-55.4%); and psychotic disorders (1.68-25%). While the number of studies on community-based Indigenous populations was limited, available evidence suggested that prevalence rates are higher in prison populations compared with community-based studies. CONCLUSIONS: It was identified that there is limited evidence on the occurrence of psychiatric disorders for Indigenous people in the general community. More research in this area is essential to provide accurate and reliable estimates and to provide a baseline for evaluating the effectiveness of programs aimed at reducing the high mental health burden experienced by Indigenous Australians. Future research needs to ensure that standardised and validated methods are used to accurately estimate the prevalence of psychiatric disorders among Indigenous Australians.


Assuntos
Transtornos Mentais/classificação , Transtornos Mentais/epidemiologia , Havaiano Nativo ou Outro Ilhéu do Pacífico/psicologia , Austrália , Humanos
11.
Aust N Z J Public Health ; 47(6): 100099, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38016201

RESUMO

OBJECTIVE: To investigate the level of Q fever awareness in Australia. METHODS: A scoping review was conducted by searching the electronic databases Medline, PubMed and Web of Science using keywords for Q fever, awareness, knowledge, and Australian locations. The search was initially limited to articles published in the 10 years prior to June 2022 and then extended up to and including August 2023; yielding 387 records. RESULTS: Fifteen articles were assessed as being eligible. These articles reported on surveys and interviews conducted with farmers, veterinary practitioners and nurses, medical practitioners, policy makers, researchers, industry representatives, animal science students, cat breeders, wildlife rehabilitators, and agriculture show attendees. Farmers were the largest group represented. Level of Q fever awareness amongst these communities, including those at high-risk, was generally low. The need for increased awareness was recognised. General practitioner awareness levels were low and recognised to be so by high-risk groups. Awareness of preventive measures including vaccination was greater among those with greater awareness and risk. CONCLUSION: With the availability of a highly effective vaccine in Australia, there is a need to increase Q fever knowledge and awareness among high-risk groups and primary health care practitioners. IMPLICATIONS FOR PUBLIC HEALTH: Strategies to increase awareness and knowledge of Q fever risks and prevention strategies may assist with reducing Q fever burden in Australia.


Assuntos
Febre Q , Animais , Humanos , Febre Q/epidemiologia , Febre Q/prevenção & controle , Austrália/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos e Questionários , Vacinação
12.
Aust Health Rev ; 46(3): 383-384, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35613711

RESUMO

What is known about the topic? Avoidable adverse events are often being attributed to health workforce shortages associated with the coronavirus disease 2019 (COVID-19) pandemic and government funding cuts. What does this paper add? Health workforce shortages were predicted well before the COVID-19 pandemic. What are the implications for practitioners? Senior executives and leaders should unitedly take action to influence change in funding and models of care.


Assuntos
COVID-19 , Pandemias , Mão de Obra em Saúde , Humanos , Pandemias/prevenção & controle , SARS-CoV-2
14.
BMC Health Serv Res ; 11: 273, 2011 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-21999305

RESUMO

BACKGROUND: Communities of Practice (CoPs) are promoted in the healthcare sector as a means of generating and sharing knowledge and improving organisational performance. However CoPs vary considerably in the way they are structured and operate in the sector. If CoPs are to be cultivated to benefit healthcare organisations, there is a need to examine and understand their application to date. To this end, a systematic review of the literature on CoPs was conducted, to examine how and why CoPs have been established and whether they have been shown to improve healthcare practice. METHODS: Peer-reviewed empirical research papers on CoPs in the healthcare sector were identified by searching electronic health-databases. Information on the purpose of establishing CoPs, their composition, methods by which members communicate and share information or knowledge, and research methods used to examine effectiveness was extracted and reviewed. Also examined was evidence of whether or not CoPs led to a change in healthcare practice. RESULTS: Thirty-one primary research papers and two systematic reviews were identified and reviewed in detail. There was a trend from descriptive to evaluative research. The focus of CoPs in earlier publications was on learning and exchanging information and knowledge, whereas in more recently published research, CoPs were used more as a tool to improve clinical practice and to facilitate the implementation of evidence-based practice. Means by which members communicated with each other varied, but in none of the primary research studies was the method of communication examined in terms of the CoP achieving its objectives. Researchers are increasing their efforts to assess the effectiveness of CoPs in healthcare, however the interventions have been complex and multifaceted, making it difficult to directly attribute the change to the CoP. CONCLUSIONS: In keeping with Wenger and colleagues' description, CoPs in the healthcare sector vary in form and purpose. While researchers are increasing their efforts to examine the impact of CoPs in healthcare, cultivating CoPs to improve healthcare performance requires a greater understanding of how to establish and support CoPs to maximise their potential to improve healthcare.


Assuntos
Setor de Assistência à Saúde/organização & administração , Relações Interprofissionais , Eficiência Organizacional , Humanos , Disseminação de Informação , Conhecimento , Qualidade da Assistência à Saúde
15.
JMIR Cancer ; 7(4): e26425, 2021 Oct 13.
Artigo em Inglês | MEDLINE | ID: mdl-34643534

RESUMO

BACKGROUND: Cancer is one of the predominant causes of morbidity and mortality in older adult populations worldwide. Among a range of barriers, comorbidity particularly poses a clinical challenge in cancer diagnosis, prognosis, and treatment owing to its heterogeneous nature. While accurate comorbidity assessments and appropriate treatment administration can result in better patient outcomes, evidence related to older adult cancer populations is limited as these individuals are often excluded from regular clinical trials due to age and comorbid conditions. OBJECTIVE: To determine the prevalence of physical comorbidity and the impact of physical comorbidities and rurality on treatment and its outcomes in older adult cancer populations. METHODS: Scientific databases Embase and PubMed were searched for published scientific literature on physical comorbidity and older adult cancer patients. Google Scholar was searched for scholarly literature published in nonindexed journals. Snowballing was utilized to identify research papers missed in the above searches. Included studies : (1) reported on original research involving cancer patients; (2) included patients aged 65 years or older; (3) had patients receiving cancer-related treatment and (4) cancer survivors; (5) reported on physical comorbidity as a variable; (6) were published in English; and (7) conducted from any geographical location. RESULTS: In total, 29 studies were selected for data extraction, evidence synthesis, and quality assessment. In these, comorbidities ranged from 37.9%-74.3% in colorectal cancer, 74%-81% in head and neck cancer, and 12.6%-49% in breast cancer. Moderate comorbidities ranged from 13%-72.9%, and severe comorbidities from 2.5%-68.2%. Comorbidity increased with age, with comorbidity affecting both treatment choice and process. Physical comorbidities significantly affected treatment initiation, causing delay, toxicity, and discontinuation. Older adult cancer patients were given less vigorous and nonstandard treatments and were also less likely to be offered treatment. Where patients are given more vigorous treatment, several studies showed better survival outcomes. Appropriate treatment in older adult cancer patients increased both overall and disease-related survival rates. None of the studies noted rurality as a distinct variable. CONCLUSIONS: This systematic review concludes that there is evidence to substantiate the adverse effect of comorbidity on treatment and survival outcomes. However, the mechanism by which comorbidity impedes or impacts treatment is unknown in many cases. Some low-quality evidence is available for considering the functional status and biological age in treatment decisions. Future studies that substantiate the value of comprehensive older adult assessments before treatment initiation in cancer patients, including assessing the nature and severity of comorbidities, and additional consideration of rurality as a factor, could lessen the effect of comorbidities on the treatment process.

16.
Soc Sci Med ; 258: 113015, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32559573

RESUMO

RATIONALE: Suicide prevention training in Aboriginal and Torres Strait Islander communities is a national health priority in Australia. OBJECTIVE: This paper describes a qualitative study to increase understanding of how a mobile application (app) could be used to support suicide prevention gatekeepers in Indigenous communities. We respectfully use the term Indigenous to refer to Australian peoples of Aboriginal and/or Torres Strait Islander descent. METHOD: Two participatory design workshops were held with 12 participants who were either Indigenous health workers or community members. The workshops first explored what knowledge, skills, and support suicide prevention gatekeepers in Indigenous communities may require, as well as how technology, specifically mobile apps, could be used to support these needs. RESULTS: Qualitative analysis identified four themes related to perceptions of who gatekeepers are, their role requirements, technology and supporting resources, as well as broader community issues. Participants thought training programs should target key, accessible, and respected people from diverse, designated, and emergent groups in Indigenous communities to act as gatekeepers, but requested an alternative, more culturally appropriate term to 'gatekeeper' (e.g., responder). Training should prepare gatekeepers for multifaceted suicide prevention roles, including the identification and management of at-risk Indigenous persons, the provision of psychoeducation and ongoing support, as well as facilitate integrated care in collaboration with community services. A combination of multiple support resources was recommended, including multi-platform options in the technology (e.g., mobile applications, social media) and physical domains (e.g., wallet cards, regular meetings). Recommended app features included culturally appropriate refresher content on suicide intervention, training recall, integrated care, how to access gatekeeper peer support, and debriefing. Broader community concerns on gatekeeper support needs were also considered.


Assuntos
Serviços de Saúde do Indígena , Aplicativos Móveis , Prevenção do Suicídio , Austrália , Humanos , Havaiano Nativo ou Outro Ilhéu do Pacífico , Pesquisa Qualitativa
17.
BMC Health Serv Res ; 9: 162, 2009 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-19754942

RESUMO

BACKGROUND: Communities of practice and social-professional networks are generally considered to enhance workplace experience and enable organizational success. However, despite the remarkable growth in interest in the role of collaborating structures in a range of industries, there is a paucity of empirical research to support this view. Nor is there a convincing model for their systematic evaluation, despite the significant potential benefits in answering the core question: how well do groups of professionals work together and how could they be organised to work together more effectively? This research project will produce a rigorous evaluation methodology and deliver supporting tools for the benefit of researchers, policymakers, practitioners and consumers within the health system and other sectors. Given the prevalence and importance of communities of practice and social networks, and the extent of investments in them, this project represents a scientific innovation of national and international significance. METHODS AND DESIGN: Working in four conceptual phases the project will employ a combination of qualitative and quantitative methods to develop, design, field-test, refine and finalise an evaluation framework. Once available the framework will be used to evaluate simulated, and then later existing, health care communities of practice and social-professional networks to assess their effectiveness in achieving desired outcomes. Peak stakeholder groups have agreed to involve a wide range of members and participant organisations, and will facilitate access to various policy, managerial and clinical networks. DISCUSSION: Given its scope and size, the project represents a valuable opportunity to achieve breakthroughs at two levels; firstly, by introducing novel and innovative aims and methods into the social research process and, secondly, through the resulting evaluation framework and tools. We anticipate valuable outcomes in the improved understanding of organisational performance and delivery of care. The project's wider appeal lies in transferring this understanding to other health jurisdictions and to other industries and sectors, both nationally and internationally. This means not merely publishing the results, but contextually interpreting them, and translating them to advance the knowledge base and enable widespread institutional and organisational application.


Assuntos
Comportamento Cooperativo , Pessoal de Saúde/organização & administração , Relações Interprofissionais , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Austrália , Humanos , Inquéritos e Questionários
18.
Aust Fam Physician ; 38(8): 618-20, 2009 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-19893784

RESUMO

BACKGROUND: Well coordinated and integrated home based care is an efficient and cost effective model for providing long term care. There is, however, emerging evidence to suggest that family members pay a price for taking on long term care responsibilities at home. OBJECTIVE: This article draws on published literature to provide an overview of the health, economic, and social issues faced by informal carers. The objective is to contribute to the knowledge base of clinicians about the impact of chronic disease and disability on families taking on the care responsibility in a home environment, thereby informing the delivery of best practice. DISCUSSION: In 2006, there were approximately 632,694 primary carers aged 15 years or more in Australia. These carers collectively have the lowest level of wellbeing scored by any group, and compared to the general population have a significantly higher level of depression, were more likely to experience physical pain, and more likely to experience financial stress. Failure by clinicians to recognise the burden on informal carers may result in long term adverse outcomes for this group that may outweigh the benefits of managing people with disability and chronic illness in the community.


Assuntos
Cuidadores/psicologia , Efeitos Psicossociais da Doença , Serviços de Assistência Domiciliar , Adolescente , Adulto , Idoso , Austrália , Cuidadores/estatística & dados numéricos , Doença Crônica , Humanos , Pessoa de Meia-Idade , Satisfação Pessoal , Isolamento Social , Adulto Jovem
19.
BMJ Open ; 9(5): e024231, 2019 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-31061019

RESUMO

Networks are everywhere. Health systems and public health settings are experimenting with multifarious forms. Governments and providers are heavily investing in networks with an expectation that they will facilitate the delivery of better services and improve health outcomes. Yet, we lack a suitable conceptual framework to evaluate the effectiveness and sustainability of clinical and health networks. This paper aims to present such a framework to assist with rigorous research and policy analysis. The framework was designed as part of a project to evaluate the effectiveness and sustainability of health networks. We drew on systematic reviews of the literature on networks and communities of practice in health care, and on theoretical and evidence-based studies of the evaluation of health and non-health networks. Using brainstorming and mind-mapping techniques in expert advisory group sessions, we assessed existing network evaluation frameworks and considered their application to extant health networks. Feedback from stakeholders in network studies that we conducted was incorporated. The framework encompasses network goals, characteristics and relationships at member, network and community levels, and then looks at network outcomes, taking into account intervening variables. Finally, the short-term, medium-term and long-term effectiveness of the network needs to be assessed. The framework provides an overarching contribution to network evaluation. It is sufficiently comprehensive to account for many theoretical and evidence-based contributions to the literature on how networks operate and is sufficiently flexible to assess different kinds of health networks across their life-cycle at community, network and member levels. We outline the merits and limitations of the framework and discuss how it might be further tested.


Assuntos
Redes Comunitárias , Redes Comunitárias/organização & administração , Atenção à Saúde/organização & administração , Humanos , Avaliação de Programas e Projetos de Saúde
20.
Aust N Z J Public Health ; 32(6): 565-8, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19076750

RESUMO

OBJECTIVE: To estimate the fraction of remaining life lived with and without dementia among Australian males and females at later life. METHOD: Analysis was performed by applying the life table technique that integrates mortality and morbidity statistics to derive a single population health indicator. Observed prevalence rates were used to calculate life expectancy with dementia. RESULTS: At the age of 65 years, males are expected to live an additional 18 years, of which 6% would be lived with dementia. Females surviving to 65 years, are likely to live a further 22 years, 9% of which is expected to be lived with dementia. At the age of 85 years, males live a further six years; one-sixth of this life spent with dementia. Females surviving to this age would live an additional seven years, with one-fourth of that life with dementia. The portion of life lived with dementia out of total remaining years of life increases with age at the rate of 20 to 30% every five years beyond the age of 65. CONCLUSION. The extension of life expectancy is associated with increased duration of life lived with dementia. As females live longer than males, they experience a greater impact of dementia.


Assuntos
Doença de Alzheimer/mortalidade , Demência Vascular/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/epidemiologia , Austrália , Demência Vascular/epidemiologia , Feminino , Humanos , Expectativa de Vida/tendências , Tábuas de Vida , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Fatores de Tempo
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