Common factors that enhance the quality of life for women living in their own homes or in aged care facilities.

A qualitative study of older women living in their own homes and older women living in aged care facilities found that the concerns of the women living in their own homes were the realities of life for the residents in the aged care facilities. Twenty-five female residents across two facilities and 11 older women living in their own homes were interviewed. The positive outcomes of aging at home are relevant and desirable for residents of aged care facilities. A smooth transition from community living to residential aged care involves retaining some of these positive aspects of their lives.

Assessing quality of life in paediatric clinical practice.

The rising prevalence of children with chronic conditions has made quality of life an increasingly important outcome measure in paediatric practice. The discrepancy between doctors' and patients' perceptions of quality of life makes formal assessment necessary. In this paper we use a case scenario to answer commonly asked questions. What is quality of life and who can assess it? Why assess quality of life in the clinical setting? Is it feasible to measure in routine clinical practice? How is quality of life formally assessed? We provide a basic outline of the language and methods of quality of life assessment and use the case scenario to discuss the process of choosing an appropriate instrument. We conclude that quality of life assessment in clinical practice is feasible and provides benefits for both patients and doctors. The benefits include better informed doctors, improved patient doctor communication and a means to effectively monitor quality of life as a treatment outcome.

The role of a community kitchen for clients in a socio-economically disadvantaged neighbourhood.

ISSUE ADDRESSED: To investigate the role of a community kitchen for clients living in a socio-economically disadvantaged neighbourhood. METHODS: In 2005, semi-structured interviews were conducted with 21 clients attending a community kitchen located in a socio-economically disadvantaged neighbourhood in New South Wales. Participants were asked their reasons for attending the kitchen. Qualitative content analysis was used to categorise verbatim responses to the open-ended questions. RESULTS: The main reasons participants attended the community kitchen were to alleviate food insecurity and the opportunity to interact socially in a safe place, followed by obtaining advice on a broad range of services to address health and social problems. CONCLUSIONS: The community kitchen had a positive effect on the lives of socially isolated people who are usually hard to reach, by providing meals, and facilitating social interaction and access to a wide range of services.

Sleeping infants safely - considerations for GPs.

The sudden death of an infant is a traumatic experience for both families and health practitioners. The most common cause of sudden infant death is SIDS, defined as 'the sudden and unexpected death of an infant under 1 year of age, with onset of lethal episode apparently occurring during sleep, that remains unexplained after a thorough investigation including performance of a complete autopsy review of the circumstances of death and clinical history'. In 2004, SIDS accounted for 4.5% of deaths in infants aged less than 1 year in New South Wales. Evidence suggests the most common age of death from SIDS is 2-5 months, with a peak incidence at around 3-4 months.

'Is it normal to feel these questions ...?': a content analysis of the health concerns of adolescent girls writing to a magazine.

BACKGROUND: There is a mismatch between presenting concerns of adolescents to GPs and behaviours that lead to adolescent morbidity and mortality. Better understanding of health concerns of this target group would enhance communication between health professionals and adolescent patients. OBJECTIVE: To explore and categorize the health concerns of adolescent girls sending unsolicited emails to a teenage girls' magazine. METHOD: We conducted a content analysis of 1000 systematic randomly selected unsolicited emails submitted to the health column of an Australian adolescent girls' magazine over a 6-month period. RESULTS: Three main foci of concern were identified: Context of Concern, Health Issue of Concern and Advice Sought for Concern. Within Health Issue of Concern, there were five categories: body (47.5%), sex (31.9%), relationship (14.7%), mind (4.7%) and violence and/or safety (1.2%). Concerns within the body and sex categories ranged enormously, but frequently expressed intimate descriptions of anatomy, feelings, sexual practices and relationships. Many concerns occurred in the context of adolescents' relationships with others. The proportion of concerns about physical or psychological symptoms or health issues commonly associated with the adolescent age group (such as health risk behaviours, mental health, pregnancy and sexually transmitted infections) was relatively small. CONCLUSIONS: GPs and other health professionals might engage more readily with adolescent patients with a deeper understanding of the concerns that adolescents have about their bodies, relationships and overall health. Seemingly 'trivial' issues, such as normal puberty, could be used as discussion triggers in health consultations to help alleviate anxiety and build rapport.

Acculturation, sexual behaviour, risk and knowledge in Vietnamese men living in metropolitan Sydney.

OBJECTIVES: To describe the relationship between acculturation, sexual risk and sexually transmissible infections (STIs) and blood borne viruses (BBVs) knowledge among Vietnamese men living in inner Sydney and to compare this prevalence with national data. METHOD: Telephone interviews were completed with a random sample of Vietnamese men, selected from the electronic phone book using a list of common Vietnamese surnames. RESULTS: Of the 761 eligible men contacted, data were obtained from 499 men, giving a response rate of 66%. There was an association between lower acculturation scores and having more than 10 lifetime sexual partners, more than 50 lifetime sexual partners, never using a condom, ever or recently having commercial sex, ever having an STI, being hepatitis B carriers or ever being imprisoned. CONCLUSION: There is an association between acculturation and many aspects of sexual behaviour.

Palliative care: a public health priority in developing countries.

Palliative care is an emerging specialist discipline worldwide with the majority of services located in developed countries. Developing countries, however, have higher incidences of cancer and AIDS and most of these patients would benefit from palliative care. While there is prominent coverage of this issue in the palliative care literature, there is limited coverage in the specialist public health literature, which suggests that the challenges of palliative care may not yet have been generally recognized as a public health priority, particularly in developing countries. The aim of this article is to introduce the topic of "Palliative care in developing countries" into the specialist public health literature to raise awareness and stimulate debate on this issue among public health professionals and health policy makers, thereby potentially facilitating establishment of palliative care services in developing countries.

Knowledge of STIs and blood-borne viruses among Vietnamese men in metropolitan Sydney.

OBJECTIVE: To describe the sexual health knowledge of a group of Vietnamese men living in inner urban Sydney in order to assist with future program planning. METHOD: Data were collected through telephone interviews conducted in Vietnamese using a structured questionnaire. Data were obtained from 499 of 761 eligible men contacted, giving a response rate of 66%. The data were weighted to be consistent with the age distribution of Vietnamese males in the area. A comparison was done with a published national telephone study of sexual behaviour and knowledge. RESULTS: Low knowledge levels about sexually transmitted infections (STIs) and blood-borne viruses were found, compared with data from a published national telephone study. The factors associated with higher mean knowledge scores on multiple regression were: having 10 or more lifetime female sexual partners, being hepatitis B vaccinated, knowing someone with HIV, having received information about HIV in Vietnam in the past 12 months, having received information about HIV or STIs in the past 12 months from a GP. Knowledge about chlamydia was particularly poor. CONCLUSION: Targeted, community-wide, awareness-raising campaigns and health care worker education is required to improve the Vietnamese community's knowledge of STIs, with particular emphasis on improving chlamydia knowledge.

Fear of loss of independence and nursing home admission in older Australians.

A prerequisite for the success of any health or social care policy is the ability to address the concerns of the target group. The findings described in the present paper form part of a larger study of the hopes and fears that older people hold for their future. Data were collected through a cross-sectional, population-based telephone interview survey conducted in New South Wales, Australia, from 1999 to 2000. The participants (n = 8881) were randomly selected, community-dwelling older people (>/= 65 years). Survey weights were used for estimating proportions and for all statistical inferences. The prevalence of expressing fears for the future was estimated, and analyses of selected predictors of specific fears for self were conducted by logistic regression modelling, with males and females modelled separately. The present paper focuses on two of the reported fears for self: loss of independence and nursing home admission, which have implications for healthcare and service use; and the authors identify the extent of their association with sociodemographic, health and lifestyle factors. Apart from the fear of losing one's physical health, the participants' main fear for self was of losing their independence [20.4% of males, 95% confidence interval (CI) = 18.5-22.3%; 34.5% of females, 95% CI = 32.3-36.4%], with a specific fear of nursing home admission (4.9% of males, 95% CI = 3.9-5.9%; 9.5% of females, 95% CI = 8.3-10.6%), with confidence intervals indicating a significantly higher prevalence of both in females. Living alone was significantly associated with fear of loss of independence in females only [odds ratio (OR) = 1.62, 95% CI = 1.38-1.90], and with fear of admission to a nursing home in both males and females (OR = 1.82, 95% CI = 1.16-2.85 in males; OR = 1.42, 95% CI = 1.08-1.89 in females). This is the first population-based survey that has elicited fears for the future in older Australians. The findings presented here provide quantitative evidence to support policies and expansion of practices that enable older people to remain in the community for as long as possible, rather than enter institutional care prematurely. They also emphasise that, while a large proportion of older people are concerned about losing their independence, only a small minority have specific concerns about nursing home admission.

Experiences of food insecurity among urban soup kitchen consumers: insights for improving nutrition and well-being.

Adequate nutrition is an essential determinant of health. Disadvantaged individuals within the cities of developed countries continue to have poor health, yet the role of food insecurity in such groups is poorly understood. This cross-sectional study describes such experiences among 22 randomly selected participants who participated in interviews at a charity-run soup kitchen in urban Sydney, Australia. Interviews explored four constructs of food insecurity (quantitative, qualitative, psychological, and social), identifying related barriers and coping strategies. Reliable access to food was limited. Low income; high rents; poor health; and addictions to cigarettes, alcohol, illicit drugs, and gambling were associated with dependence on charities. Poor dentition and lack of food storage and cooking facilities were important barriers to adequate nutrition. Meals were missed and quantities restricted as a coping strategy. Participants demonstrated adequate knowledge and a desire to eat healthful food. Opportunities for social interaction and trust in soup kitchen staff were important motivators of attendance. Strategies to reduce food insecurity among seriously disadvantaged city dwellers should focus less on education and more on practical solutions, such as accessing affordable healthful food for those without kitchen facilities, improving dentition, and reducing addictions. It is also important to facilitate social networks with trusted support organizations.

Towards better practice in primary health care settings for young people.

ISSUE ADDRESSED: To identify and describe elements of accessibility and other dimensions of quality of primary health care for Australian young people. METHODS: Five sampling frames identified relevant services and programs across New South Wales (NSW) which were then selected using purposive, convenience or snowball sampling. In-depth interviews were conducted with senior staff members, tape-recorded, transcribed, entered into the qualitative software package NUD*IST and coded under seven theme headings. RESULTS: Interviews with 77 services across five sectors in NSW identified seven principles of better practice in youth health. These were: accessibility, evidence-based practice, youth participation, collaboration, professional development, sustainability and evaluation. Accessibility was the principle most frequently addressed and evaluation was the least frequently addressed. Many seemingly effective programs and services had been minimally evaluated for impact or outcome related to young people's access or health. CONCLUSIONS: Principles of better practice in promoting or delivering adolescent health care have strong face validity across a range of sectors and service types in a heterogeneous primary health care system. These principles are applied to varying degrees in a vast array of health and health promotion programs. Despite this, there is a clear need for impact and outcome evaluation among the majority of programs.

'They never talked to me about... ': Perspectives on aged care resident transfer to emergency departments.

AIMS: To explore perspectives of three groups concerning transfers from aged care facilities to emergency departments. We sought to reveal factors influencing transfer decisions; how active each group was in making decisions; and to what extent groups ceded decision-making to others. METHODS: Semi-structured interviews of 11 residents, 14 relatives and 17 staff with content analysis of interview transcripts. RESULTS: The three groups substantially differed in their involvement with initiating, and attitudes towards, transfer. Residents were least likely to be involved in the decision, yet most likely to support transfer. Staff felt conflicted between their desire to provide optimal treatment for one ill resident, and their obligations to other residents under care. Staff perspectives were largely consistent with published data, but we describe new results for other informant groups. CONCLUSIONS: Group expectations and preferences differ substantially. Service delivery to meet all preferences presents a challenge for health service design.

Predictors of adherence with the recommended use of hip protectors.

BACKGROUND: Hip protectors can prevent many hip fractures in older persons at high risk for falling. Few published studies have investigated the use of hip protectors in community-dwelling older persons, and the level of adherence with their use, and predictors of adherence in this setting, are not clear. The aim of this study was to report the predictors of adherence and the level of adherence with the use of hip protectors in frail community-dwelling older women. METHODS: This cohort study of the intervention group of a randomized, controlled trial recruited participants from aged care health services in urban areas of northern Sydney, Australia. Participants were 302 women who were 74 years or older (mean age, 83 years) and who had 2 or more falls or 1 fall requiring hospital admission in the previous year and who lived in their own homes. The main outcome measure was adherence with the use of hip protectors. RESULTS: Adherence was approximately 53% during the 2 years of the study, and hip protectors were worn at the time of 51% of falls. The significant independent predictors of nonadherence with hip protector use were lower self-efficacy for hip protector use (odds ratio [OR], 0.51; 95% confidence interval [CI],.33 to.79), higher number of perceived barriers to hip protector use (OR, 0.52; 95% CI, .38 to.72), and lower self-rated health (OR, 0.71; 95% CI, .55 to.93). CONCLUSIONS: Three easily measured factors independently predicted subsequent adherence with hip protector use. These findings may form the basis for strategies to improve adherence with the use of hip protectors and with other types of treatment or preventive strategies in older persons.

Access to primary health care for Australian young people: service provider perspectives.

BACKGROUND: To adequately address the complex health needs of young people, their access to services, and the quality of services received, must be improved. AIMS: To explore the barriers to service provision for young people and to identify the training needs of primary healthcare service providers in New South Wales (NSW), Australia. DESIGN OF STUDY: A cross-sectional, qualitative study of the perspectives of a range of health service providers. SETTING: A range of primary healthcare organisations across NSW. METHODS: Samples of general practitioners (GPs), youth health workers, youth health coordinators, and community health centre staff were drawn from urban and rural clusters across NSW. Focus groups and interviews were used to identify barriers to service provision and the training needs of service providers. Data were tape recorded, transcribed, and analysed. RESULTS: Barriers to service provision among GPs and community health centre staff included inadequate time, flexibility, skills, and confidence in working with young people, and poor linkages with other relevant services. Training needs included better knowledge of and skills in adolescent health requirements, working with adolescents, and working with other services. Barriers to service provision for youth health workers and coordinators included lack of financial resources and infrastructure. There were few linkages between groups of service providers. CONCLUSION: Models of service provision that allow stronger linkages between service providers, sufficient time for consultation with young people, adequate training and support of health professionals, and flexibility of service provision, including outreach, should be explored and evaluated.

Access to health care among Australian adolescents young people's perspectives and their sociodemographic distribution.

PURPOSE: To identify the health concerns for which adolescent residents in New South Wales, Australia, do not receive health care, and the associated factors, including their sociodemographic distribution. METHODS: Purposive sampling was used to recruit school students who were stratified by gender and age (12-14, 14-16 and 16-17 years), from schools stratified by socioeconomic status and urban/rural location. Out-of-school young people were recruited through youth health services. Qualitative methods were used to collect and analyze data. RESULTS: Eighty-one focus groups were conducted. Most young people defined health solely in terms of their physical well-being, but still identified a broad range of situations, conditions, or behaviors which they believed might affect their health. One-third of females and two-thirds of males said they would not seek help for their health concerns, and when they did, were most likely to seek help from family, friends, or others they trusted. When professional help was sought, young people again preferred someone they knew and trusted. The three groups of barriers to accessing health care were: concerns about confidentiality, knowledge of services and discomfort in disclosing health concerns, and accessibility and characteristics of services. Factors related to use of health care services were associated with age, gender, and location, but rarely with socioeconomic status. CONCLUSIONS: The majority of these young people in New South Wales (particularly males) do not seek health care despite identifying a broad range of issues that affect their health.

Socio-economic mortality differentials in Sydney over a quarter of a century, 1970-94.

OBJECTIVE: To examine trends in socio-economic differentials in all-cause mortality in Sydney over a 25-year period (1970-94). METHODS: Five measures of single indicators (two for occupation, two for education and one for income) and a composite measure of socio-economic disadvantage based on Census data (the Australian Bureau of Statistics' Index of Relative Socio-Economic Disadvantage) were used as indicators of socio-economic status by local govemment area. The relationship between mortality and socio-economic status was examined using quintiles based on these six measures of socio-economic status. RESULTS: Socio-economic differentials in mortality were evident for males and females for all periods, and over the 25-year period the relative socio-economic differentials did not decline. For males, the socio-economic status differential in mortality widened, irrespective of socio-economic status indicator used, whereas for females it widened only when certain socio-economic indicators were used: occupation (unemployment measure) and income, but was not significant for the other single indicators or for the composite indicator. CONCLUSIONS: Sydney trends of widening inequalities are generally similar to those reported for Britain and for other industrialised countries, suggesting that this is a common phenomenon and that policies to reduce health inequalities over the past quarter of a century have not been effective.

Access to primary health care for Australian adolescents: how congruent are the perspectives of health service providers and young people, and does it matter?

OBJECTIVE: To explore the extent of congruence between the views of service providers and young people (on adolescents' health concerns, barriers to accessing health services and ideal service model) in order to improve and increase the appropriateness, quality and usage of primary health care services. METHODS: A qualitative data collection technique was used. During 2001/02, focus groups were conducted in urban and rural locations with adolescents (in and out of mainstream education), general practitioners, community health staff and youth health workers. RESULTS: Service providers and young people identified a similar range of health concerns for young people, with young people adding additional issues of great importance to them that service providers felt were not in their 'domain of treatment'. There was reasonable congruence in regard to 'ideal service model' with some differences relating to methods of information delivery. However, for 'barriers to accessing services' there were major discrepancies. CONCLUSIONS: While there is some common understanding between young people and service providers on certain aspects of health services, there are clearly areas where perceptions differ. This discrepancy matters because it may adversely affect the quality of provider-adolescent interaction and the willingness of adolescents to access services. IMPLICATIONS: To deliver optimal health services to young people, the differences in understanding regarding services need to be addressed. Strategies could include promotion to, and encouragement of, young people to seek help, continuing professional education of providers and changes in remuneration policies.

Participation in treatment decision-making by women with early stage breast cancer.

OBJECTIVE: This study aimed to assess the way women treated for early stage breast cancer perceived the treatment selection process. The purpose was to understand more fully patients' experiences of the decision process and their preferences for participation in treatment decisions. SETTING AND PARTICIPANTS: The study informants were 40 women, treated at a teaching hospital in Sydney Australia, who were interviewed face to face 1 year after their first treatment for stage I or stage II breast cancer. METHODS: This study used a qualitative approach, based on the analysis of interview transcripts. The main areas covered were how the informants' treatment decisions were made and their preferences for participation in treatment decisions. Content and thematic analyses were conducted with findings presented using verbatim quotations for illustration. RESULTS AND CONCLUSIONS: Many of the informants who preferred not to participate in decisions also failed to recognize the need for value judgements (as well as medical expertise) in the decision-making process. Some informants believed they ought to be responsible for the consequences whilst others did not. Difficulties were identified in patient utilization of medical information for treatment decision-making, and also in establishing preferences for the risks and benefits of treatments where few patients had prior experience of the potential outcomes. The findings indicate that patient participation in treatment decision-making is a more complex issue than simply giving patients information and choices. Ways of enhancing patients' involvement in the treatment selection process are discussed.