Health related migration: evidence of reduced "urban-drift".

The aim of this study was to determine if the onset of serious disease triggers a different intra-state migratory response from patterns observed in the healthy population. The analysis was carried out using linked administrative data. The onset of serious disease triggered a reduction in the rate of endocentric migration in remote and rural populations. Urban drift occurred only in people with mental illness in rural locations. Rural and remote communities appear to suffer from an unhealthy selection force, with persons unable to migrate centrally to access services due to the onset of the physical illness they require treatment for.

People with dementia and their relatives: personal experiences of Alzheimer's and of the provision of care.

Little is known about the experiences of people with dementia, as there has been relatively little research carried out that includes their perspectives. In the past, user perspectives on experiences of dementia and on services have mostly been solicited from family carers, rather than from people with dementia themselves. It has been suggested that these studies may lack information and insight into the experiences of people with dementia. This study aimed at eliciting the views and feelings of people in all stages of dementia, as well as those of their relatives, on care services and on experiences of dementia. Twenty-seven people with dementia from residential and day care settings were interviewed and their daily lives videotaped. Interviews were also conducted with next of kin. This article reports on findings and issues arising from the study.

Cumulative mortality in children aged 1 to 6 years born in Western Australia from 1980-89.

PURPOSE: To investigate cumulative mortality for children aged 1-6 years born in Western Australia from 1980 to 1989. STUDY DESIGN: Births and deaths were ascertained from a linked total population database supplemented by information from postmortem records. Deaths were classified according to the underlying cause, and mortality rates, including factor specific rates, were calculated. Trends were investigated and comparisons were made using relative risks with 95% confidence intervals. RESULTS: Cumulative mortality was 2.2/1000 infant survivors, with a significant decrease during the years studied. Mortality was almost four times higher for Indigenous children, with no decrease. Accidents comprised 45.6% of all deaths, birth defects 17.3%, cancer and leukaemias 12.5%, and infections 11.0%. Low birth weight, preterm birth, and young maternal age significantly increased the risk of death in both Indigenous and non-Indigenous children; single marital status was also a significant risk factor for non-Indigenous children. CONCLUSION: High quality data and appropriate classification systems are essential to enable effective monitoring of childhood deaths and the planning of preventive programmes. Further decreases in mortality rates might be dependent on ensuring that resources are directed towards improving social and economic conditions for Indigenous and other disadvantaged families.

Wisdom circles.

King Arthur had the right idea all along--to get the key stakeholders around a table and address the vital issues. The author describes his concept of a "wisdom circle," a gathering of people who speak candidly and from the heart, listen intently to the wisdom of other people, and honor the wisdom and intelligence we all possess to meet both individual and collective needs.

Mental health training and the hospice community: a national survey.

This article summarizes a national survey of the hospice community. Respondents provided detailed information in the following areas: (a) What formal mental health training is provided for staff members? (b) Who conducts this training? (c) What areas are covered and where would more training be useful? (d) How is the training conducted--what formats and teaching materials are used? and (e) How much training do staff members receive? The results of the survey indicate that the hospice community is making a concerted effort to meet the mental health training needs of its paid staff members and volunteers. However, more than half of the hospices surveyed expressed a need for further training in 26 of the 33 issues and skills covered in the questionnaire, and many reported a need for a more systematic and comprehensive mental health curriculum. The findings point to several areas of particularly great need and provide a basis for the development of future mental health training in the hospice community.

Serological and epidemiological considerations of the role of herpes simplex virus type 2 in cervical cancer.

To assess the possible biological significance of the observations that women with cervical cancer tend to be younger at first intercourse than control women, data from 1823 women were analyzed for the relationship between age at 1st intercourse and number of sex partners. Women who were younger at first intercourse had more sex partners than did women who were older at first intercourse. The interdependence of age at first intercourse and number of sex partners does not exlude the possibility that intercourse at an early age represents a biologically significant event in which the neoplastic process is initiated. However, it is equally possible that younger women at first intercourse may have multiple sex partners and be at greater risk of coming in contact with a putative oncogenic agent later in life. In addition, sera from patients with herpesvirus infections were assayed for cross-reacting and type-specific antibodies. Approximately 80% of the total antibody activity was to the cross-reacting antigen and only 20% was to the type-specific antigens in the sera of patients infected with either type 1 or type 2 virus. Among patients infected with both types of virus, less antibody activity to the type-specific antigens and more antibody activity to the cross-reacting antigens were found. These observations are discussed with respect to case-control seroepidemiological studies.