RESUMO
BACKGROUND: Pregnancy can be a time of joy and a time of significant stress. For many Aboriginal and Torres Strait Islander (hereafter, respectfully, Indigenous) women, cigarette smoking, even during pregnancy, is a socially sanctioned behavioural response to stress. Indigenous women smoke during pregnancy at higher rates than their non-Indigenous counterparts. METHODS: A mixed methods, exploratory study, undertaken in an urban, Indigenous primary health care service, tested the impact and acceptability of a smoking cessation intervention for women pregnant with an Indigenous baby, their significant other (SO), and their primary health care service. The intervention included case management, incentivised smoking cessation support and culturally-based art activities. RESULTS: Thirty-one pregnant women and 16 SOs participated. Nearly half attempted to quit at least once during the study, 36% (4/11) of pregnant women had quit at the 3 month assessment and two remained smoke free 1 month postpartum. Most participants self-reported a reduction in tobacco smoking. Exhaled CO confirmed this for SOs (mean reduction - 2.2 ppm/assessment wave, 95% CI: -4.0, - 0.4 ppm/assessment wave, p = 0.015) but not for pregnant women. Many participants experienced social and economic vulnerabilities, including housing and financial insecurity and physical safety concerns. CONCLUSIONS: Tobacco smoking is normalised and socially sanctioned in Indigenous communities and smoking is frequently a response to the multitude of stressors and challenges that Indigenous people experience on a daily basis. Smoking cessation interventions for pregnant Indigenous women must be cognisant of the realities of their private lives where the smoking occurs, in addition to the impact of the broader societal context. Narrow definitions of success focussing only on smoking cessation ignore the psychological benefit of empowering women and facilitating positive changes in smoking behaviours. Our smoking cessation intervention supported pregnant women and their SOs to manage these stressors and challenges, thereby enabling them to develop a solid foundation from which they could address their smoking. A broad definition of success in this space is required: one that celebrates positive smoking behaviour changes in addition to cessation.
Assuntos
Havaiano Nativo ou Outro Ilhéu do Pacífico/psicologia , Gestantes/etnologia , Prevenção do Hábito de Fumar/métodos , Fumar/etnologia , Adulto , Administração de Caso , Feminino , Serviços de Saúde do Indígena , Humanos , Motivação , Havaiano Nativo ou Outro Ilhéu do Pacífico/estatística & dados numéricos , Gravidez , Gestantes/psicologia , Atenção Primária à Saúde , Queensland , Fumar/psicologia , Abandono do Hábito de Fumar/etnologia , Abandono do Hábito de Fumar/psicologia , Serviços Urbanos de Saúde , Adulto JovemRESUMO
The first antenatal visit is a valuable opportunity to influence the health and well-being of the mother and child during pregnancy, birth and beyond. Our primary-care-based cross-sectional study of urban Aboriginal and Torres Strait Islander women found that 81% presented for their first antenatal visit within the first 10 weeks. Consequently, there can be up to 30 weeks in which health professionals can provide lifestyle and parenting education and psychosocial support.
Assuntos
Nível de Saúde , Havaiano Nativo ou Outro Ilhéu do Pacífico , Cuidado Pré-Natal , Adulto , Consumo de Bebidas Alcoólicas/etnologia , Austrália/epidemiologia , Índice de Massa Corporal , Infecções por Chlamydia/etnologia , Estudos Transversais , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Paridade , Gravidez , Fumar/etnologia , População Urbana , Vitaminas/uso terapêutico , Adulto JovemRESUMO
BACKGROUND: Studies show that patients are significantly less satisfied with torso scars than scars elsewhere. Though not an uncommon practice, it is unknown if application of adhesive tapes following dermatological surgery help improve cosmesis. OBJECTIVE: To determine the effect of taping sutured torso wounds on overall scar appearance, scar width and patient satisfaction with the scar. PATIENTS/METHODS: Participants having elliptical torso skin excisions in a primary care setting in regional Australia were randomized in a single-blinded, controlled trial to 12 weeks taping (intervention) or usual care (control) following deep and subcuticular suturing. A blinded assessor reviewed scars at three and six months. RESULTS: Of 195 participants recruited, 136 (63 taped, 73 controls) completed six months of follow-up. Independent blinded assessment of overall scar appearance was significantly better in taped participants (p= 0.004). Taping reduced median scar width by 1 mm (p=0.02) and when stratified by gender, by 3.0 mm in males (p=0.04) and 1.0 mm in females (p=0.2). High participant scar satisfaction was not further improved by taping. CONCLUSION: Taping elliptical torso wounds for 12 weeks after dermatologic surgery improved scar appearance at six months.
Assuntos
Otopatias/etnologia , Havaiano Nativo ou Outro Ilhéu do Pacífico/estatística & dados numéricos , Adolescente , Austrália/epidemiologia , Criança , Pré-Escolar , Otopatias/diagnóstico , Orelha Média , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Otoscopia , Prevalência , Fatores de Risco , População Rural , Poluição por Fumaça de Tabaco/efeitos adversos , População UrbanaRESUMO
OBJECTIVE: We aimed to determine the impact of clinic based retinal photography on access to appropriate screening for diabetic retinopathy (DR). DESIGN, SETTING AND PARTICIPANTS: We opportunistically recruited patients undergoing their annual diabetic cycle of care over a two year period in the urban Indigenous primary health care clinic. Data were collected on retinal outcomes, health variables and referral patterns. MAIN OUTCOME MEASURES: Access to appropriate screening and ophthalmic follow up, prevalence of DR, acceptability and feasibility of clinic-based retinal photography were the main outcome measures of this study. RESULTS: One hundred and thirty-two of a possible 147 patients consented to participate. 30% of participants had DR. Appropriate screening and ophthalmic follow up increased six fold, from 20 to 124 participants, following the introduction of the retinal camera. Most participants felt very positive about DR screening. CONCLUSIONS: Primary care DR screening using retinal photography can improve access to DR screening for indigenous patients, reduce the burden on busy outpatient departments and should reduce visual loss. Policy-makers could contribute to screening sustainability by funding a medicare item-number for primary care based DR screening associated with the annual diabetic cycle of care. An upfront Practice Incentive Program (PIP) payment could offset set up costs.
Assuntos
Retinopatia Diabética/diagnóstico , Programas de Rastreamento/métodos , Havaiano Nativo ou Outro Ilhéu do Pacífico/estatística & dados numéricos , Fotografação , Atenção Primária à Saúde/organização & administração , Adulto , Idoso , Austrália/epidemiologia , Complicações do Diabetes/etnologia , Retinopatia Diabética/complicações , Retinopatia Diabética/etnologia , Feminino , Seguimentos , Acessibilidade aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Prevalência , Encaminhamento e Consulta/estatística & dados numéricos , Sensibilidade e Especificidade , População Urbana , Adulto JovemRESUMO
BACKGROUND: Type 2 Diabetes Mellitus is one of the most disabling chronic conditions worldwide, resulting in significant human, social and economic costs and placing huge demands on health care systems. The Inala Chronic Disease Management Service aims to improve the efficiency and effectiveness of care for patients with type 2 diabetes who have been referred by their general practitioner to a specialist diabetes outpatient clinic. Care is provided by a multidisciplinary, integrated team consisting of an endocrinologist, diabetes nurse educators, General Practitioner Clinical Fellows (general practitioners who have undertaken focussed post-graduate training in complex diabetes care), and allied health personnel (a dietitian, podiatrist and psychologist). METHODS/DESIGN: Using a geographical control, this evaluation study tests the impact of this model of diabetes care provided by the service on patient outcomes compared to usual care provided at the specialist diabetes outpatient clinic. Data collection at baseline, 6 and 12-months will compare the primary outcome (glycaemic control) and secondary outcomes (serum lipid profile, blood pressure, physical activity, smoking status, quality of life, diabetes self-efficacy and cost-effectiveness). DISCUSSION: This model of diabetes care combines the patient focus and holistic care valued by the primary care sector with the specialised knowledge and skills of hospital diabetes care. Our study will provide empirical evidence about the clinical effectiveness of this model of care. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12608000010392.
Assuntos
Diabetes Mellitus Tipo 2/terapia , Serviços Preventivos de Saúde/métodos , Idoso , Doença Crônica , Protocolos Clínicos , Assistência Integral à Saúde/organização & administração , Coleta de Dados , Prestação Integrada de Cuidados de Saúde , Complicações do Diabetes/diagnóstico , Diabetes Mellitus Tipo 2/complicações , Gerenciamento Clínico , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Avaliação de Programas e Projetos de Saúde , Queensland , Autocuidado , Fumar/epidemiologiaRESUMO
The Primary Health Care Research, Evaluation and Development (PHCRED) Strategy aims to improve Australia's output of high-quality research from primary care. We compared publication rates from general practice, medicine and surgery for the period 2000-2007, and found that general practice publications increased since 1990-1999 from 1.0 to 3.0 publications per 1000 general practitioners per year. However, general practice publication rates have plateaued since 2000, and represent only 2%-5% of the equivalent rates for medicine and surgery. This finding suggests that more time and sustained investment in PHCRED are essential to see tangible outputs from funded research in general practice.
Assuntos
Pesquisa Biomédica/tendências , Medicina de Família e Comunidade/estatística & dados numéricos , Editoração/tendências , Austrália , Eficiência , Medicina de Família e Comunidade/tendências , Publicações Periódicas como Assunto/estatística & dados numéricos , Publicações Periódicas como Assunto/tendênciasRESUMO
OBJECTIVE: To describe changing patterns of skin cancer surgery by Australian general practitioners and make comparisons with specialists. DESIGN AND SETTING: Analysis of Medicare Australia item number reports for skin cancer excisions and for flap and graft repairs between 2001 and 2005. MAIN OUTCOME MEASURES: GPs' and specialists' rates of non-melanoma skin cancer (NMSC) excisions, melanoma excisions, flap repairs and graft repairs; excision to flap ratios. RESULTS: NMSC excisions in Australia increased from 338 712 (2001) to 451 628 (2005), a mean annual increase of 1.11/1000 population (P = 0.04); GPs did 51.1% of excisions in 2001, increasing to 54.4% in 2005, representing a higher mean annual rate increase than in specialists (P = 0.003). Nationally, melanoma excisions increased from 20 414 (2001) to 25 580 (2005); GPs did 34.3% of excisions in 2001, increasing to 35.8% in 2005--a similar mean annual rate increase to that in specialists (P = 0.25). Total flap repairs increased from 58 550 (2001) to 80 742 (2005); GPs did 21.3% of flap repairs in 2001, increasing to 26.9% in 2005--a similar mean annual rate increase to that in specialists (P = 0.83). Nationally, the excision to flap ratio for GPs fell from 14 : 1 (2001) to 12 : 1 (2005); in Queensland the ratio fell from 14 : 1 to 9 : 1 over the same period. CONCLUSION: GPs excise the majority of skin cancers, and the proportion excised by GPs is increasing. GPs are increasingly using skin flaps for repair, suggesting substantial changes to patterns of treatment, especially in Queensland.
Assuntos
Dermatologia/tendências , Medicina de Família e Comunidade/tendências , Melanoma/cirurgia , Neoplasias Cutâneas/cirurgia , Transplante de Pele/estatística & dados numéricos , Retalhos Cirúrgicos/estatística & dados numéricos , Austrália , Humanos , Melanoma/patologia , Papel do Médico , Neoplasias Cutâneas/patologia , Transplante de Pele/tendências , Retalhos Cirúrgicos/tendênciasAssuntos
Instituições de Assistência Ambulatorial/organização & administração , Institutos de Câncer/organização & administração , Atenção Primária à Saúde/organização & administração , Neoplasias Cutâneas/terapia , Austrália , Humanos , Indicadores de Qualidade em Assistência à Saúde , Carga de TrabalhoRESUMO
OBJECTIVE: The study aimed to identify wound sites/procedures where infection incidence was over 5%, such that these circumstances may warrant wound infection antibiotic prophylaxis. METHOD: We undertook a 3-year prospective study of 5,091 lesions (predominantly nonmelanoma skin cancer) treated on 2,424 patients from July 2002 to June 2005. No patient was given prophylactic antibiotics, and no patient ceased warfarin or aspirin. RESULTS: Overall infection incidence was 1.47%. Individual procedures had the following infection incidence: curettage 0.73% (3/412); skin flap repairs 2.94% (47/1601); simple excision and closure 0.54% (16/2974); skin grafts 8.70% (6/69); and wedge excision 8.57% (3/35). Analysis of regions of the body demonstrated that surgery below the knee (n = 448) had an infection incidence of 6.92% (31/448) (p < .0001). Subanalysis demonstrated that all regions below the knee were at high infection risk. Elsewhere, groin excisional surgery had an infection incidence of 10% (1/10) (p = .027). No other body site demonstrated an infection incidence beyond 5% of statistical significance. Procedures on the face demonstrated an infection incidence of 0.81% (18/2,209). Diabetic patients, those on warfarin and/or aspirin, and smokers showed no difference in infection incidence. CONCLUSION: Based on a prediction of infection incidence over 5%, the following cutaneous oncologic procedures warrant consideration of oral antibiotic wound infection prophylaxis: all procedures below the knee, wedge excisions of lip and ear, all skin grafts, and lesions in the groin. Other than under these circumstances, surgery to the nose, ear, fingers, lips, skin flap surgery, and surgery on diabetics, smokers, and those on anticoagulants have previously been considered for wound infection prophylaxis but do not warrant such intervention based on our data. The authors have indicated no significant interest with commercial supporters.
Assuntos
Antibacterianos/uso terapêutico , Neoplasias Cutâneas/cirurgia , Infecções Cutâneas Estafilocócicas/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Austrália/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Infecções Cutâneas Estafilocócicas/microbiologia , Staphylococcus aureus/isolamento & purificação , Infecção da Ferida Cirúrgica/microbiologia , Infecção da Ferida Cirúrgica/prevenção & controleRESUMO
OBJECTIVE: To describe the workload profile in a network of Australian skin cancer clinics. DESIGN AND SETTING: Analysis of billing data for the first 6 months of 2005 in a primary-care skin cancer clinic network, consisting of seven clinics and staffed by 20 doctors, located in the Northern Territory, Queensland and New South Wales. MAIN OUTCOME MEASURES: Consultation to biopsy ratio (CBR); biopsy to treatment ratio (BTR); number of benign naevi excised per melanoma (number needed to treat [NNT]). RESULTS: Of 69 780 billed activities, 34 622 (49.6%) were consultations, 19 358 (27.7%) biopsies, 8055 (11.5%) surgical excisions, 2804 (4.0%) additional surgical repairs, 1613 (2.3%) non-surgical treatments of cancers and 3328 (4.8%) treatments of premalignant or non-malignant lesions. A total of 6438 cancers were treated (116 melanomas by excision, 4709 non-melanoma skin cancers [NMSCs] by excision, and 1613 NMSCs non-surgically); 5251 (65.2%) surgical wounds were repaired by direct suture, 2651 (32.9%) by a flap (of which 44.8% were simple flaps), 42 (0.5%) by wedge excision and 111 (1.4%) by grafts. The CBR was 1.79, the BTR was 3.1 and the NNT was 28.6. CONCLUSIONS: In this network of Australian skin cancer clinics, one in three biopsies identified a skin cancer (BTR, 3.1), and about 29 benign lesions were excised per melanoma (NNT, 28.6). The estimated NNT was similar to that reported previously in general practice. More data are needed on health outcomes, including effectiveness of treatment and surgical repair.
Assuntos
Institutos de Câncer/estatística & dados numéricos , Carcinoma de Células Escamosas/terapia , Melanoma/terapia , Nevo/terapia , Neoplasias Cutâneas/terapia , Austrália , Biópsia , Carcinoma Basocelular/patologia , Carcinoma Basocelular/cirurgia , Carcinoma Basocelular/terapia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Crioterapia , Curetagem , Coleta de Dados , Humanos , Medicare , Melanoma/patologia , Melanoma/cirurgia , Nevo/patologia , Nevo/cirurgia , Pele/patologia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgia , Retalhos Cirúrgicos , Técnicas de Sutura , Resultado do Tratamento , Carga de TrabalhoRESUMO
There is a long tradition of some general practitioners developing areas of special interest within their mainstream generalist practice. General practice is now becoming increasingly fragmented, with core components being delivered as separate and standalone services (eg, travel medicine, skin cancer, women's health). Although this fragmentation seems to meet a need for some patients and doctors, potential problems need careful consideration and response. These include loss of generalist skills among GPs, fewer practitioners working in less well-remunerated areas, such as nursing home visits, and issues related to standards of care and training.