Anna Whelan

The role of diet and other environmental factors in the causation of gastric cancer in Iran—A population based study

Despite a declining trend in the incidence of gastric cancer (GC), it is still a major global public health concern of the 21st century. The rates of GC reported from Ardabil Province, Iran, are among the highest in the world. To investigate risk factors for GC in Ardabil, we undertook a population‐based case‐control study. The study aimed to recruit all Ardabil residents newly diagnosed with GC in the time period of 2004–2005, and 2 controls per case. Participants were interviewed using a structured questionnaire. Ten milliliters of blood was collected for blood grouping and investigating the presence of IgG antibodies against Helicobacter pylori. During the study period, 217 people with GC and 394 controls were recruited. In multivariate analysis, diet and Helicobacter pylori infection (OR = 2.41; 95% CI: 1.35–4.32) were found to be the factors that were most strongly related to GC. High intake of Allium vegetables (OR = 0.35) and fruit, especially citrus fruit (OR = 0.31) and consumption of fresh fish (OR = 0.37) were significantly protective. On the other hand, consumption of red meat (OR = 3.40) and dairy products (OR = 2.28) were positively associated with the risk of GC. People who had a preference for higher salt intake (OR = 3.10) and drinking strong and hot tea (OR = 2.64 and 2.85, respectively) were at higher risk. In conclusion, Helicobacter pylori infection as measured by serum IgG as well as the consumption of red meat and dairy products increases the risk of GC in Ardabil, while the intake of fresh fruit and fresh fish decrease the risk.

What do non-English-speaking patients value in acute care? Cultural competency from the patient's perspective: a qualitative study

Objective. The purpose of this research was to locate cultural competence within the experiential domain of the non-English-speaking patient. Design. Seven language-specific focus groups were held with 59 hospital patients and carers of patients with limited English to better understand their experience and to identify critical factors leading to their constructions of care. Grounded theory analysis within a constructivist perspective was undertaken. Results. While the majority of patients were positive about their hospital experience, the theme of powerlessness appeared central to many patient experiences. Language facilitation was the most common issue. Inattention to specific cultural mores and racism in some instances contributed to negative experiences. Patients primarily valued positive engagement, information and involvement, compassionate, kind and respectful treatment, and the negotiated involvement of their family. Conclusion. Because of the specific nature of each patient–provider interaction within its particular social and political environment, culturally competent behaviour in one context may be culturally incompetent in another. We propose a model of cultural empowerment that reflects the phenomenological basis of cultural competence in that cultural competence must be consistently renegotiated with any particular patient in a particular healthcare context. Similarly, ongoing community consultations are needed for health services and organisations to retain cultural competence.

International and indigenous diagnoses of mental disorder among Vietnamese living in Vietnam and Australia

BACKGROUND Whether the prevalence rates of common mental disorders can be compared across countries depends on the cultural validity of the diagnostic measures used. AIMS To investigate the prevalence of Western and indigenously defined mental disorders among Vietnamese living in Vietnam and in Australia, comparing the data with an Australian-born sample. METHOD Comparative analysis of three multistage population surveys, including samples drawn from a community living in the Mekong Delta region of Vietnam (n=3039), Vietnamese immigrants residing in New South Wales, Australia (n=1161), and an Australian-born population (n=7961). Western-defined mental disorders were assessed by the Composite International Diagnostic Interview (CIDI) 2.0 and included DSM-IV anxiety, mood and substance use disorders as well as the ICD-10 category of neurasthenia. The Vietnamese surveys also applied the indigenously based Phan Vietnamese Psychiatric Scale (PVPS). Functional impairment and service use were assessed. RESULTS The prevalence of CIDI mental disorders for Mekong Delta Vietnamese was 1.8% compared with 6.1% for Australian Vietnamese and 16.7% for Australians. Inclusion of PVPS mental disorders increased the prevalence rates to 8.8% for Mekong Delta Vietnamese and 11.7% for Australian Vietnamese. Concordance was moderate to good between the CIDI and the PVPS for Australian Vietnamese (area under the curve (AUC)=0.77) but low for Mekong Vietnamese (AUC=0.59). PVPS- and CIDI-defined mental disorders were associated with similar levels of functional impairment. CONCLUSIONS Cultural factors in the expression of mental distress may influence the prevalence rates of mental disorders reported across countries. The findings have implications for assessing mental health needs at an international level.

“The Happy Migrant Effect”: perceptions of negative experiences of healthcare by patients with little or no English: a qualitative study across seven language groups

Background: The subjective experiences of patients with little or no English who either attended the Emergency Department or were admitted to the wards of a tertiary referral hospital were explored. Setting and methods: The reports of experiences from 49 patients of a tertiary referral hospital were analysed using grounded theory methods applied to translated transcriptions from focus groups held with discharged patients in seven languages. Results: Inability to communicate in English, poor patient and family involvement with staff, a lack of control or powerlessness, staff shortages, staff negligence or incompetence, and treatment delays were reported by some patients. Others tended to discount or minimise the significance of similar experiences, suggesting a construct, “The Happy Migrant Effect,” in which there is reluctance to assert healthcare rights. Patients appear “happy” and satisfied, despite problems with their hospital care. Explanatory factors for the construct include extreme powerlessness related to being unable to communicate, a positive comparison of healthcare in the new country compared with the old, patriotism for the new country, cultural norms that proscribe acceptance, politeness or social desirability, self-denigration for not having learnt English and, for a few, a fear of reprisals if they spoke out in complaint. Conclusions: Some immigrant patients with poor language skills might not report serious problems with healthcare delivery. In all patients in this study where problems with healthcare were reported, the events were considered to be largely preventable by appropriate language facilitation, patient and family involvement, and provider respect and compassion.

Beliefs, attitudes and behaviours of pregnant women in Bali

OBJECTIVE To explore beliefs, attitudes and behaviours of pregnant women in Bali, Indonesia. DESIGN Descriptive qualitative study using in-depth interviews. SETTING Community health-care centre in South Kuta, Bali, Indonesia. PARTICIPANTS 18 Pregnant women aged 20-35 years. FINDINGS Insights into beliefs and attitudes regarding pregnancy emerged from the analysis. Participants believed that some foods should or should not be eaten by pregnant women. They believed that vegetables are better than meat during pregnancy. Strong beliefs about traditional herbal remedies also emerged. Complex beliefs on locus of control were also expressed by the majority of the respondents regarding who was responsible for the health and well-being of their infant. Women maintained that they themselves, health-care professionals, nature and God were all responsible for the health of their infant. In addition, some respondents acknowledged the crucial role of the family for support and advice during pregnancy. IMPLICATIONS FOR PRACTICE Interventions to improve the quality of antenatal care and pregnancy outcomes in Indonesia should consider these beliefs and attitudes. Counselling by health-care workers, for example, might explicitly seek womens complex beliefs on locus of control, and views on preferences for traditional remedies and food, especially low meat intake. Involvement of husbands and other family members during pregnancy and birth should also be encouraged and re-inforced by health promotion programmes. Community and religious leaders should be engaged to support key messages.

Approaches to improving the contribution of the nursing and midwifery workforce to increasing universal access to primary health care for vulnerable populations: a systematic review

BackgroundDespite considerable evidence showing the importance of the nursing and midwifery workforce, there are no systematic reviews outlining how these cadres are best supported to provide universal access and reduce health care disparities at the primary health care (PHC) level. This review aims to identify nursing and midwifery policy, staffing, education and training interventions, collaborative efforts and strategies that have improved the quantity, quality and relevance of the nursing and midwifery workforce leading to health improvements for vulnerable populations.MethodsWe undertook a structured search of bibliographic databases for peer-reviewed research literature using a focused review question and inclusion/exclusion criteria. The quality of retrieved papers was appraised using standard tools. The characteristics of screened papers were described, and a deductive qualitative content analysis methodology was applied to analyse the interventions and findings of included studies using a conceptual framework.ResultsThirty-six papers were included in the review, the majority (25) from high-income countries and nursing settings (32). Eleven papers defined leadership and governance approaches that had impacted upon the health outcomes of disadvantaged groups including policies at the national and state level that had led to an increased supply and coverage of nursing and midwifery staff and scope of practice. Twenty-seven papers outlined human resource management strategies to support the expansion of nurse’s and midwives’ roles that often involved task shifting and task sharing. These included approaches to managing staffing supply, distribution and skills mix; workloads; supervision; performance management; and remuneration, financial incentives and staffing costs. Education and training activities were described in 14 papers to assist nurses and midwives to perform new or expanded roles and prepare nurses for inclusive practice. This review identified collaboration between nurses and midwives and other health providers and organizations, across sectors, and with communities and individuals that resulted in improved health care and outcomes.ConclusionsThe findings of this review confirm the importance of a conceptual framework for understanding and planning leadership and governance approaches, management strategies and collaboration and education and training efforts to scale up and support nurses and midwives in existing or expanded roles to improve access to PHC for vulnerable populations.

Practices of skilled birth attendants during labour, birth and the immediate postpartum period in Cambodia

OBJECTIVE maternal and perinatal morbidity and mortality rates in Cambodia are high. The provision of quality care by skilled birth attendants (SBAs) in a supportive working environment is an important strategy to reduce morbidity and mortality. There has been little emphasis on examining this issue in Cambodia. The objective of this study was to establish SBA reported practices during labour, birth and the immediate postpartum periods and the factors affecting this. METHODS a descriptive qualitative design was employed using in-depth interviews and focus group discussions with midwives, nurses and doctors with midwifery skills in two health centres and three referral hospitals in one province of Cambodia. Data were analysed using a thematic framework. FINDINGS SBA practice is not always consistent with evidence-based standards known to reduce morbidity and mortality. Ten inter-related themes emerged, which described patterns of SBA practice, were identified. These were: skills in the care of labouring women; provision of support in labour; interventions in the second stage of labour; management of the third stage of labour; cleanliness during birth; immediate care of the newborn infant and immediate postnatal care; lack of policy and authority; fear of litigation; workload and lack of human resources; and financial incentives and socio-economic influences. CONCLUSIONS a gap exists between evidence-based standards and current SBA practice during labour, birth and the immediate postpartum care. This is largely driven by the lack of a supportive working environment. IMPLICATIONS FOR PRACTICE the findings of this research provide maternal health services, workforce planners and policy makers with valuable information to contribute to the continuous quality improvement of maternity care. The findings highlight implications for practice that may improve the quality of maternal health care. Recommendations for decision makers were made and further research is needed in order to develop theories and recommendations to improve SBA practice in Cambodia, to the benefit of the Cambodia women and newborn babies.

Determinants of intention to quit: Confirmation and extension of western theories in male chinese smokers

Constructs from the Health Beliefs Model and Social Cognitive theory were used to predict intentions to quit in three disparate sub-samples (medical workers, teachers and factory workers) of male Chinese smokers (n = 631). The intention to quit smoking was directly predicted by the importance the smoker places in quitting (change incentive) and their self-efficacy (accounting for 74% of the variance). Self-efficacy, in turn, was predicted by perceived barriers and by change incentive. Change incentive was predicted by self-efficacy, outcome expectancy and importance of benefits of quitting (outcome incentive). Health belief model variables susceptibility and severity were predictors of both outcome expectancy and outcome incentive. The results were largely replicated with each of the three sub-samples. We conclude that these models of health behaviour apply to Chinese smokers, with constructs from the Social Cognitive theory being primary.

Conflict and Development: Challenges in Responding to Sexual and Reproductive Health Needs in Timor-Leste

In April and May 2006, internal conflict in Timor-Leste led to the displacement of approximately 150,000 people, around 15% of the population. The violence was most intense in Dili, the capital, where many residents were displaced into camps in the city or to the districts. Research utilising in-depth qualitative interviews, service statistics and document review was conducted from September 2006 to February 2007 to assess the health sector’s response to reproductive health needs during the crisis. The study revealed an emphasis on antenatal care and a maternity waiting camp for pregnant women, but the relative neglect of other areas of reproductive health. There remains a need for improved coordination, increased dialogue and advocacy around sensitive reproductive health issues as well as greater participation of the health sector in response to gender-based violence. Strengthening neglected areas and including all components of sexual and reproductive health in coordination structures will provide a stronger foundation through which to respond to any future crises in Timor-Leste. Résumé En avril et mai 2006, le conflit interne au Timor-Leste a déplacé près de 150 000 personnes, environ 15% de la population. La violence était particulièrement intense à Dili, la capitale, où beaucoup d’habitants ont été placés dans des camps en ville ou dans des districts. Une recherche utilisant des entretiens qualitatifs approfondis, les statistiques des services et une étude de documents, menée de septembre 2006 à février 2007, a évalué la réponse du secteur de la santé aux besoins de santé génésique pendant la crise. L’étude a révélé une priorité aux soins prénatals et à un camp où les femmes enceintes attendaient leur accouchement, mais une relative inattention à d’autres domaines de la santé génésique. Il faut améliorer la coordination, accroître le dialogue et le plaidoyer autour de questions sensibles de santé génésique tout en relevant la participation du secteur de la santé en réaction à la violence sexiste. Le renforcement des domaines négligés et l’inclusion de toutes les composantes de la santé génésique dans les structures de coordination constitueront un fondement plus solide à partir duquel répondre à toute crise future au Timor-Leste. Resumen En abril y mayo de 2006, el conflicto interno en Timor-Leste llevó al desplazamiento de aproximadamente 150,000 personas, un 15% de la población. La violencia fue más intensa en Dili, la capital, donde muchos residentes fueron desplazados a campamentos en la ciudad o a los distritos. Desde septiembre de 2006 hasta febrero de 2007, se realizaron investigaciones con entrevistas cualitativas a profundidad, estadísticas de servicios y revisión de documentos, a fin de evaluar la respuesta del sector salud a las necesidades de salud reproductiva durante la crisis. El estudio reveló énfasis en la atención antenatal y un campo maternidad de espera para las mujeres embarazadas, pero el relativo descuido de otras áreas en salud reproductiva. Aún existe la necesidad de mejorar la coordinación y ampliar el diálogo y las actividades de promoción y defensa en torno a los aspectos delicados de la salud reproductiva, así como incrementar la participación del sector salud en respuesta a la violencia basada en género. Al fortalecer las áreas desatendidas e incluir todos los elementos de la salud sexual y reproductiva en las estructuras de coordinación, se creará una base más sólida a partir de la cual se pueda responder a toda crisis futura en Timor-Leste.

‘Halfway people’: Refugee views of reproductive health services

Abstract The objective of this study was to identify factors that facilitate or hinder access to, use of, and satisfaction with reproductive health services in refugee settings, from the perspective of beneficiaries. Rapid appraisal methods included 46 focus group discussions and interviews with over 800 refugees, audits of 14 health facilities, referral hospital reviews, exit interviews with clients, and interviews with health workers. The study was conducted between February and April 2004 in 11 sites in Uganda, Republic of Congo, and Yemen. Reproductive health was clearly on the policy agenda in all countries with stable refugee sites, but problems with implementation and resources were identified. The quality of services was variable, with high staff turnover in some areas affecting relationships with refugee clients. Referral hospitals in host countries were not all equipped to deal with obstetric and other emergencies of either local or refugee populations, including deficiencies in safe blood supplies and antibiotics. Diagnosis and treatment of STIs and HIV/AIDS was frequently inadequate. Gender based violence was the least well addressed aspect of reproductive health. Interest and knowledge about family planning was high, but acceptance was low. It was concluded that progress has been made in reproductive health services for refugees since 1994, however, urgent advocacy and action is required to sustain and improve the situation. Local implementing partners need more support and supervision to develop appropriate service models and to maintain an acceptable standard of care.