Alison Rutherford

Violence: a priority for public health? (part 2)

Violence continues to grow as a priority for public health practitioners, particularly as its causes and consequences become better understood and the potential roles for public health are better articulated. This article provides the context to “Violence: a glossary (part 1)” published in the last issue of this journal, and updates some of the data, concepts and population approaches presented in the 2002 World report on violence and health. The paper addresses the following questions: What is the magnitude and global burden of injury from violence? What causes violence? Is resilience important? What is the role for public health? What are the key challenges and opportunities? We aim to engage the general reader and to increase understanding of violence as a potentially preventable issue.

The effect of increasing rates of nitrogen fertiliser and a nitrification inhibitor on nitrous oxide emissions from urine patches on sheep grazed hill country pasture

Urine deposited by grazing animals represents the largest source of N2O emissions in New Zealand. Sheep-grazed hill pastures are an important component of New Zealand pastoral land, but information on N2O emissions from these areas is limited. The purpose of this study was to investigate the effect of increasing rates of fertiliser nitrogen and of a nitrification inhibitor on N2O emissions from urine patches. The study was carried out in grazed paddock-scale trials at the Ballantrae and Invermay Research Stations, New Zealand. The fertiliser N treatments were 0, 100, 300 and 750 (500 for Invermay) kg N/ha.year. Nitrous oxide measurements were conducted in the spring of 2005 and 2006, following applications of synthetic sheep urine with or without dicyandiamide (DCD) in these four N treatments. In both years and at both sites, N2O emissions increased with N fertiliser application rate in both urine and non-urine affected areas. The addition of DCD to the synthetic urine reduced N2O emissions from the urine affected areas during the measurement period by 60–80% at Ballantrae and by 40% at Invermay. The N2O emission factors for the artificial sheep urine (expressed as N2O-N lost as % of N applied) ranged from 0.01 to 1.06%, with the higher values generally found in the high N fertiliser treatments. The N2O emission factors were generally less than or similar to those from sheep urine applied to flat land pasture.

Violence: a glossary

Violence has been explicitly identified as a significant public health problem. This glossary clarifies widely used definitions and concepts of violence within the public health field, building on those promoted through the 2002 World Report on Violence and Health. We provide definitions and concepts that can be usefully applied to identify points for public health intervention to prevent the social and health impacts of violence.

Factors associated with low immunity to rubella infection on antenatal screening

Background:  Rubella infection during the first trimester results in congenital rubella syndrome. There has been little recent published evidence identifying those at‐risk of infection in the first trimester of pregnancy. This study examined the level of rubella immunity in pregnant women in a part of Sydney and risk factors for non‐immunity.

Short-term measurement of N2O emissions from sheep-grazed pasture receiving increasing rates of fertiliser nitrogen in Otago, New Zealand

The purpose of this short-term study was to investigate the effect of increasing fertiliser nitrogen (N) application rates on nitrous oxide (N2O) emissions over the late winter/early spring period from sheep-grazed pasture in Otago rolling hill country. We measured N2O gas emissions from plots on a mottled Fragic Pallic hill soil receiving 0, 100 and 500 kg N/ha.year for 2 years. Plots were sampled weekly for 10 weeks over the 2006 winter/spring period using a static chamber method. Increased N fertiliser rate and the attendant increase in stocking rate significantly increased total N2O emissions (P < 0.05). Total N2O emissions for the measurement period were estimated to be 0.08, 0.13 and 1.36 kg N2O-N/ha (s.e.m, 0.1, 0.18 and 0.45) for the 0, 100 and 500 N treatments, respectively. Our results suggest that high application rates of fertiliser N (i.e. 500 kg N/ha.year) and attendant increased stocking rates may significantly increase emissions of N2O even in dry winter/spring conditions in Otago rolling hill country. These results will assist in the development of best management guidelines for reducing N2O emissions from fertiliser N in hill country.

Managing pollutant inputs from pastoral dairy farming to maintain water quality of a lake in a high-rainfall catchment

A study (2004–11) of a dairy catchment stream entering an oligotrophic lake in an area of very high rainfall (~5 m year–1) yielded median concentrations of total nitrogen (TN), total phosphorus (TP), suspended sediment (SS) and Escherichia coli (E. coli) of 0.584, 0.074 and 3.7 g m–3, and 405/100 mL (most probable number method), respectively. Trend analysis indicated significant (P < 0.01) decreases for TN (–0.08 ± 0.02 g m–3 year–1), TP (–0.01 ± 0.005 g m–3 year–1) and SS (–0.45 ± 0.14 g m–3 year–1) and were partly attributable to improved exclusion of cattle from the stream. Water balance calculations indicated that approximately one-half the rainfall left as deep drainage that by-passed catchment outlet flow recorders. Estimates of catchment yields for TN were improved by taking into account groundwater hydrology and concentrations from well samples. Storm-flow monitoring inflows exceeding the 97.5th percentile contributed ~40% of total loads leaving the catchment so that specific yields for SS, TN and TP augmented by groundwater inputs and storm flows were ~960, 45 and 7 kg ha–1 year–1, respectively. These compared well with modelled results for losses from dairy farms in the catchment of 40–60 kg N ha–1 year–1 and 5–6 kg P ha–1 year–1 and indicated that attenuation losses were relatively small.

Performing (heterosexual) femininity: female agency and role in sexual life and contraceptive use – a qualitative study in Australia

Abstract Women’s liberation and the sexual revolution have changed the social landscape for heterosexual women in the West over the past 50 years, but exploration of women’s lived experiences of contraceptive use in the context of their sexual lives is comparatively recent. We conducted 94 in-depth open-ended interviews with women of reproductive age (16–49 years) living in New South Wales, Australia. Interviews were audio-recorded, transcribed verbatim and analysed using an inductive thematic approach. Four major themes are explored here: (1) what women do and do not do: unspoken gendered assumptions; (2) focus on partner’s pleasure; (3) juggling responsibilities: sex as a chore; and (4) women’s sexual motivations. Findings suggest sexual double standards and gender expectations continue to pervade women’s sexual and contraceptive practices. We found that women performed their femininity by focusing on enabling their male partner’s pleasure, while simultaneously ignoring their own sexual desires, wishes or interests. Accompanying new-found freedoms are new-found responsibilities, as women now add managing modern contraceptives and a good sex life to their list of tasks alongside paid employment, domestic labour and childrearing. Our research findings suggest that women may derive different pleasures from sex, including what we term ‘connection pleasure’.This monograph examines various aspects of the HIV-AIDS epidemic from a sociological perspective. The first part is concerned with the social etiology of the disease. It discusses high-risk groups in the United States the origin of HIV AIDS in Africa and trends in HIV-AIDS preventive behavior. The second part considers societal reactions to the disease. It covers such topics as fear of contagion moralizing and scapegoating the role of science in societal reactions the problem of personal responsibility treatment and prevention and problems in the eradication and control of HIV-AIDS.

‘They aren't really black fellas but they are easy to talk to’: Factors which influence Australian Aboriginal women's decision to disclose intimate partner violence during pregnancy

OBJECTIVES intimate partner violence is a significant global health problem but remains largely hidden. Understanding decisions about whether or not to disclose violence in response to routine enquiry in health settings can inform safe and responsive systems. Elevated rates of violence and systematic disadvantage found among Indigenous women globally, can impact on their decisions to disclose violence. This study aimed to test, among Indigenous women, a model for decisions on whether to disclose intimate partner violence in the context of antenatal routine screening. DESIGN we employed Qualitative Configurative Analysis, a method developed for the social sciences to study complex phenomena with intermediate sample sizes. Data were drawn from single semi- structured interviews with Indigenous women 28+ weeks pregnant attending antenatal care. Interviews addressed decisions to disclose recent intimate partner violence in the context of routine enquiry during the antenatal care. Interview transcripts were binary coded for conditions identified a priori from the model being tested and also from themes identified within the current study and analysed using Qualitative Configurative Analysis to determine causal conditions for the outcome of disclosure or non-disclosure of violence experienced. SETTINGS five Aboriginal and Maternal Infant Health Services (two urban and three regional), and one mainstream hospital, in New South Wales, Australia. PARTICIPANTS indigenous women who had experienced partner violence in the previous year and who had been asked about this as part of an antenatal booking-in visit. Of the 12 participants six had elected to disclose their experience of violence to the midwife, and six had chosen not to do so. FINDINGS pathways to disclosure and non-disclosure were mapped using Qualitative Configurative Analysis. Conditions relevant to decisions to disclose were similar to the conditions for non-Aboriginal women found in our earlier study. Unique to Aboriginal womens decisions to disclose abuse was cultural safety. Cultural safety included elements we titled: Borrowed trust, Build the relationship first, Come at it slowly and People like me are here. The absence of cultural safety Its absence was also a factor in decisions not to disclose experiences of violence by this group of women. KEY CONCLUSIONS cultural safety was central to Indigenous womens decision to disclose violence and processes for creating safety are identified. Other forms of safety which influenced disclosure included: safety from detection by the abuser; safety from shame; and safety from institutional control. Disclosure was promoted by direct asking by the midwife and a perception of care. Non-disclosure was associated with a lack of care and a lack of all four types of safety. Experiences of institutional racism were associated with Indigenous womens perceived risk of control by others, particularly child protection services. IMPLICATIONS FOR PRACTICE policies to ask abuse questions at first visits and models where continuity of care is not maintained, are problematic for Aboriginal women, among whom relationship building is important as is ample warning about questions to be asked. Strategies are needed to build cultural safety to counter widespread racism and promote safe opportunities for Indigenous women to disclose intimate partner violence and receive support. Elements of cultural safety are necessary for vulnerable or marginalised populations to fully utilise available health services.

Blood dioxin biomonitoring to assess local residents’ exposure from a large urban remediation project☆

BACKGROUND A total of 265000 m(3) of dioxin contaminated soil and sediments from past industrial activity was treated on site in an urban setting in Sydney, Australia. To respond to local community concerns about potential dioxin exposure from fugitive emissions a human biomonitoring study was undertaken. OBJECTIVE To determine whether local residents were exposed to significant amounts of dioxin from the remediation process. METHODS Blood samples were collected from local residents around the site and a representative metropolitan control group. They were pooled within age and sex strata and the change in dioxin concentrations over the remediation period and a summary of the mid point and post remediation dioxin concentrations were compared between groups. Information on dietary intake was collected to look for possible confounding. RESULTS The mean dioxin Toxic Equivalent concentrations (TeQ) decreased among both the local resident and control groups over the remediation period by 1.9 and 2.1 pg gm(-1) lipid respectively. Modelled blood concentrations adjusting for age and sex did not detect a significant difference between groups for changes in either TeQ or 2,3,7,8-tetrachlorodibenzo-p-dioxin (2,3,7,8 TCDD). The summary measure approach did however demonstrate that the 2,3,7,8 TCDD concentrations among the local resident group was approximately 0.7 pg g(-1) lipid higher compared to the control group post remediation. There were no significant changes in dietary intake sources of dioxin. CONCLUSION Biomonitoring demonstrated that local residents were not exposed to significant quantities of dioxin. Large scale remediation of dioxin contaminated land can be safely undertaken in an urban setting.

Australian women's attitudes towards and understandings of the subdermal contraceptive implant: a qualitative study of never-users

Objective Few studies have explored Australian womens understandings of contraception. This study examined the attitudes towards, and understandings of, the subdermal contraceptive implant expressed by women living in New South Wales (NSW), Australia. Study design As part of a larger qualitative study using in-depth, open-ended interviews in 2012–2013 with women aged 16–49 years who had ever used contraception (n=94), 65 interviews from women who discussed or mentioned the subdermal implant, but had not previously used the device, were examined and analysed using thematic analysis. Results The emergent themes were: satisfaction with current method; weak personal opinions and ambivalence; uncertainty due to specific concerns; and strong negative reactions – fear and dislike. Although there were a few positive perceptions expressed by women who had never used the subdermal implant, for the majority of women the perception was predominantly negative. Discussion and conclusion Women tended to form negative impressions from the stories of other women about the subdermal implant. Interventions to enhance evidence-informed awareness of the relative advantages and disadvantages of the implant – for example, improved access to supportive contraceptive counselling – need investigation in the Australian context. Avenues to improve womens perceived control over the device could also be usefully investigated.