Suchergebnisse

Abstract. Background: Indigenous Australians experience a suicide rate over twice that of the general population. With nonfatal deliberate self-harm (DSH) being the single most important risk factor for suicide, characterizing the incidence and repetition of DSH in this population is essential. Aims: To investigate the incidence and repetition of DSH in three remote Indigenous communities in Far North Queensland, Australia. Method: DSH presentation data at a primary health-care center in each community were analyzed over a 6-year period from January 1, 2006 to December 31, 2011. Results: A DSH presentation rate of 1,638 per 100,000 population was found within the communities. Rates were higher in age groups 15–24 and 25–34, varied between communities, and were not significantly different between genders; 60% of DSH repetitions occurred within 6 months of an earlier episode. Of the 227 DSH presentations, 32% involved hanging. Limitations: This study was based on a subset of a larger dataset not specifically designed for DSH data collection and assesses the subset of the communities that presented to the primary health-care centers. Conclusion: A dedicated DSH monitoring study is required to provide a better understanding of DSH in these communities and to inform early intervention strategies.

Background: Alcohol Management Plans (AMPs) were first implemented by the Queensland Government a decade ago (2002–03). In 2008, further stringent controls were implemented and alcohol was effectively prohibited in some of the affected remote Indigenous communities. With the Queensland Government currently reviewing AMPs, prohibitions may be lifted making alcohol readily available once more in these communities. As yet no work explores the impact of alcohol related injuries in relation to individual, family and community resilience in Indigenous Australians. A resilience model recognises individuals and families for their strengths rather than their deficits. By revealing how some individuals and families survive and thrive, new ways of working with families who need support may be identified and adopted. The research will explore in detail the long-term impact of this kind of injury on individuals, families and communities. Methods/design: This project will use a sequential explanatory mixed method design. Four discrete Indigenous communities in Cape York, far north Queensland are included in this program of research, chosen because there is previous data available regarding injury and alcohol related injuries. Four sequential studies will be conducted in order to address the research questions and provide a rich description of the impact of alcohol related injuries and resilience in these populations. The time period January 2006 to December 2011 was chosen because it captures the three years before and three years after 2008 when tight alcohol restrictions were implemented in the four communities. Discussion: Long term effects of the AMPs are as yet unknown and only fragmented attempts to look at the impact of injury related to alcohol have been conducted. A well-structured research program that explores the long-term impact of alcohol related injuries in these communities will help inform policy development to capture the current situation and so that appropriate benchmarking can occur.

The aim of this study was to explore the experiences of people who lived through Cyclone Yasi on 3 February 2011. Data from two open-ended questions (Q1: n=344; and Q2: n=339) within a survey completed by 433 residents of cycloneaffected areas between Cairns and Townsville, Australia, were analysed using a qualitative, thematic approach. Experiences were portrayed in three main themes: (1) living in the mode of existential threat describes survivors' sense of panic and feeling at the mercy of nature as they feared for their life; (2) unforgettable memories describe feelings of emotional helplessness and the unimaginable chaos that the cyclone wrought; and (3) centrality of others shows how community support and closeness helped alleviate losses and uncertainty. A critical finding from this study was the negative role of the media in escalating fears for life prior to and during the cyclone, highlighting the need for government, community leaders, and health professionals to have a media plan in place to ensure that disaster warnings are taken seriously without inciting unnecessary panic. Although survivors experienced extreme vulnerability and a threat to life, the disaster also brought communities closer together and connected family, friends, and neighbours through the caring, support, and help they offered each other. This highlights the central role of others during the recovery process and underlines the importance of promoting and facilitating social support to aid recovery post disaster.

Implementing sustainable infection prevention and control (IP&C) programs in developing countries is challenging. Many developing countries experience high burdens of disease and political instability. In addition, they are affected by geographical and climatic challenges, and have unique social, cultural and spiritual beliefs, all of which contribute to a higher prevalence of infections. The aim of this integrative review is to identify existing solutions to the challenges faced by developing countries when implementing IP&C programs. An extensive literature review was conducted to explore improvements in infection control in rural hospitals in developing countries. Three electronic databases were searched for relevant articles written between 1980 and 2018, published in peer reviewed English language journals, and relating to hospitals, not community settings. The findings indicate that developing countries continue to face many challenges in implementing IP&C programs. Limited success has been described with some IP&C program components but it is clear that little original research on the topic exists. Notably scarce are studies on the influences that culture, religious and spiritual beliefs have on IP&C program implementation. This review highlights opportunities for further research into healthcare workers perceptions of disease causation and infection transmission, and the role this plays in the effective implementation of an IP&C program. By exploring these opportunities appropriate and culturally sensitive solutions may be identified, which can assist with the design and implementation of culturally relevant IP&C programs in these settings.

Timor-Leste faces many challenges implementing quality maternal, newborn and child health (MNCH) services due to resource constraints and socio-cultural factors that disproportionately affect the health of women and children. A scoping review was conducted to map the quality of MNCH services against WHO quality standards on: 1. Provision of care, 2. Experiences of care, and 3. Cross-cutting standards. The literature search identified 1058 citations, from which 28 full-text articles met the inclusion criteria. The findings highlight health workers' limited capacity to provide quality services and referrals. The major reasons for this are: a lack of essential supplies, poor infrastructure and transport, limited opportunities for ongoing learning, and gaps in health information systems. Provision of care standards and cross-cutting standards require attention at a broad systems level. Findings related to experiences of care highlight the importance of effective communication, respect, and emotional support, particularly for vulnerable women and children who have difficulty accessing services, and for those who have experienced violence. These experience-related standards could be addressed at an individual health worker and health service level, as well as at a systems level. This review provides direction to focus quality-improvement initiatives within local health facilities, as well as at municipal and national level.

After traumatic events such as emergencies and disasters, there is often an increase in psychosocial distress among communities. As a result, there may be an increase in the prescription and use of psychotropic medications as one way to help manage the symptoms of this distress in individuals. Few studies have considered changes in psychotropic medication usage following a disaster as a proxy measure of the extent of mental health distress in the community. A pharmaco-epidemiological design compared de-identified government prescribing databases for anxiolytic, antidepressant and a control prescription for a 6 month period after the cyclone for all affected North Queensland communities and compared the data with a similar data set from the same time period in the previous year. The results indicate a significant increase in the prescription of antidepressant medications compared to the control drug and the previous year. Determining changes in psychotropic prescribing patterns following a disaster provide evidence to inform post-disaster public health response, planning, and funding. As an increase in antidepressant medications is an indicator of distress in the community, the data from this study provided community mental health nurses with evidence to support funding requests for additional resources (human resources and other) to support post disaster response activities in the local area. Learning Objectives: 1. Increased understanding of the link between emergencies and disasters, and psychosocial response. 2. Recognition that general practitioners prescribe antidepressants as a way of managing distress following traumatic events. 3. Awareness of how sharing research findings can be used to support applications for post disaster response activities.

Abstract Background In Australia, 'Alcohol Management Plans' (AMPs) provide the policy infrastructure for State and Commonwealth Governments to address problematic alcohol use among Aboriginal and Torres Strait Islanders. We report community residents' experiences of AMPs in 10 of Queensland's 15 remote Indigenous communities. Methods This cross-sectional study used a two-stage sampling strategy: N = 1211; 588 (48%) males, 623 (52%) females aged ≥18 years in 10 communities. Seven propositions about 'favourable' impacts and seven about 'unfavourable' impacts were developed from semi-structured interviews. For each proposition, one-sample tests of proportions examined participant agreement and multivariable binary logistic regressions assessed influences of gender, age (18–24, 25–44, 45–64, ≥65 years), residence (≥6 years), current drinking and Indigenous status. Confirmatory factor analyses estimated scale reliability ( ρ ), item loadings and covariances. Results Slim majorities agreed that: AMPs reduced violence (53%, p = 0.024); community a better place to live (54%, 0.012); and children were safer (56%, p < 0.001). More agreed that: school attendance improved (66%, p < 0.001); and awareness of alcohol's harms increased (71%, p < 0.001). Participants were equivocal about improved personal safety (53%, p = 0.097) and reduced violence against women (49%, p = 0.362). The seven 'favourable' items reliably summarized participants' experiences of reduced violence and improved community amenity ( ρ = 0.90). Stronger agreement was found for six 'unfavourable' items: alcohol availability not reduced (58%, p < 0.001); drinking not reduced (56%, p < 0.001)); cannabis use increased (69%, p < 0.001); more binge drinking (73%, p < 0.001); discrimination experienced (77%, p < 0.001); increased .

Background: In 2002/03 the Queensland Government responded to high rates of alcohol-related harm in discrete Indigenous communities by implementing alcohol management plans (AMPs), designed to include supply and harm reduction and treatment measures. Tighter alcohol supply and carriage restrictions followed in 2008 following indications of reductions in violence and injury. Despite the plans being in place for over a decade, no comprehensive independent review has assessed to what level the designed aims were achieved and what effect the plans have had on Indigenous community residents and service providers. This study will describe the long-term impacts on important health, economic and social outcomes of Queensland's AMPs. Methods/Design: The project has two main studies, 1) outcome evaluation using de-identified epidemiological data on injury, violence and other health and social indicators for across Queensland, including de-identified databases compiled from relevant routinely-available administrative data sets, and 2) a process evaluation to map the nature, timing and content of intervention components targeting alcohol. Process evaluation will also be used to assess the fidelity with which the designed intervention components have been implemented, their uptake and community responses to them and their perceived impacts on alcohol supply and consumption, injury, violence and community health. Interviews and focus groups with Indigenous residents and service providers will be used. The study will be conducted in all 24 of Queensland's Indigenous communities affected by alcohol management plans. Discussion: This evaluation will report on the impacts of the original aims for AMPs, what impact they have had on Indigenous residents and service providers. A central outcome will be the establishment of relevant databases describing the parameters of the changes seen. This will permit comprehensive and rigorous surveillance systems to be put in place and provided to communities empowering them with the best ...

Background: In Australia, 'Alcohol Management Plans' (AMPs) provide the policy infrastructure for State and Commonwealth Governments to address problematic alcohol use among Aboriginal and Torres Strait Islanders. We report community residents' experiences of AMPs in 10 of Queensland's 15 remote Indigenous communities. Methods: This cross-sectional study used a two-stage sampling strategy: N = 1211; 588 (48%) males, 623 (52%) females aged ≥18 years in 10 communities. Seven propositions about 'favourable' impacts and seven about 'unfavourable' impacts were developed from semi-structured interviews. For each proposition, one-sample tests of proportions examined participant agreement and multivariable binary logistic regressions assessed influences of gender, age (18–24, 25–44, 45–64, ≥65 years), residence (≥6 years), current drinking and Indigenous status. Confirmatory factor analyses estimated scale reliability (ρ), item loadings and covariances. Results: Slim majorities agreed that: AMPs reduced violence (53%, p = 0.024); community a better place to live (54%, 0.012); and children were safer (56%, p < 0.001). More agreed that: school attendance improved (66%, p < 0.001); and awareness of alcohol's harms increased (71%, p < 0.001). Participants were equivocal about improved personal safety (53%, p = 0.097) and reduced violence against women (49%, p = 0.362). The seven 'favourable' items reliably summarized participants' experiences of reduced violence and improved community amenity (ρ = 0.90). Stronger agreement was found for six 'unfavourable' items: alcohol availability not reduced (58%, p < 0.001); drinking not reduced (56%, p < 0.001)); cannabis use increased (69%, p < 0.001); more binge drinking (73%, p < 0.001); discrimination experienced (77%, p < 0.001); increased fines, convictions and criminal records for breaching restrictions (90%, p < 0.001). Participants were equivocal (51% agreed, p = 0.365) that police could enforce restrictions effectively. 'Unfavourable' items were not ...