Anske Robinson

Infantile colic: A systematic review of medical and conventional therapies

Aim:  Infantile colic is a prevalent and distressing condition for which there is no proven standard therapy. The aim of this paper is to review medical and conventional treatments for infantile colic.

Adverse Events Due to Chiropractic and Other Manual Therapies for Infants and Children: A Review of the Literature

OBJECTIVE The purpose of this study was to review the literature for cases of adverse events in infants and children treated by chiropractors or other manual therapists, identifying treatment type and if a preexisting pathology was present. METHOD English language, peer-reviewed journals and non-peer-reviewed case reports discussing adverse events (ranging from minor to serious) were systematically searched from inception of the relevant searchable bibliographic databases through March 2014. Articles not referring to infants or children were excluded. RESULTS Thirty-one articles met the selection criteria. A total of 12 articles reporting 15 serious adverse events were found. Three deaths occurred under the care of various providers (1 physical therapist, 1 unknown practitioner, and 1 craniosacral therapist) and 12 serious injuries were reported (7 chiropractors/doctors of chiropractic, 1 medical practitioner, 1 osteopath, 2 physical therapists, and 1 unknown practitioner). High-velocity, extension, and rotational spinal manipulation was reported in most cases, with 1 case involving forcibly applied craniosacral dural tension and another involving use of an adjusting instrument. Underlying preexisting pathology was identified in a majority of the cases. CONCLUSION Published cases of serious adverse events in infants and children receiving chiropractic, osteopathic, physiotherapy, or manual medical therapy are rare. The 3 deaths that have been reported were associated with various manual therapists; however, no deaths associated with chiropractic care were found in the literature to date. Because underlying preexisting pathology was associated in a majority of reported cases, performing a thorough history and examination to exclude anatomical or neurologic anomalies before applying any manual therapy may further reduce adverse events across all manual therapy professions.

Health promoting health services: a review of the evidence

In the last 20 years, there have been many developments in health promoting hospitals and health services (HPH), particularly in Europe. In Australia, health promotion (HP) programs are being conducted in the hospital setting; however, developments related to the HPH concept have been slower. To identify the effects and benefits of a health service working under the HPH banner, and to assist HP practitioners in advocacy and planning for their health service to become an HPH, we conducted a literature review. Eight studies met the criteria of research on HPH or evaluation of HP programs within an HPH framework. Seven key themes were identified in these studies. Enablers and barriers to HPH development were analyzed and discussed within these themes. This review found a dearth of high-level research on HPH. In particular, there were few Australian studies. There is limited evidence, therefore, of the efficacy of HPH. Much more high-level research and dissemination of the findings are needed in order to encourage policy-makers and health service administrators to invest resources in HPH and to support the work of HP practitioners interested in developing their health service into an HPH.

Rural Diversity in CAM Usage: The Relationship between Rural Diversity and the Use of Complementary and Alternative Medicine Modalities

Abstract Australian and American studies have found higher annual rural complementary and alternative medicine (CAM) use than predominantly metropolitan studies. Little has been written about variations in CAM use between rural places. The Perspectives on the Use in Communities of Complementary and Alternative Medicine (PUC-CAM) study explored CAM use in rural places through a survey of five rural and two metropolitan localities in Victoria, Australia. The survey was posted to 1308 people with a response rate of 40% (n=459). Metropolitan respondents’ current CAM use was 47% (n=46) and the rural respondents’ 54% (n=195), while lifetime use was 81%, (n=80) for the metropolitan respondents and 86%, (n=310) for the rural respondents. The respondents in agriculturally based rural places stayed with ‘established’ modalities such as chiropractic and massage therapy while in the sea change and peri-metropolitan places a wider range of modalities were used.

Student identification of the need for complementary medicine education in Australian medical curricula: A constructivist grounded theory approach

OBJECTIVE Across the Western world, including Australia, growing popularity of complementary medicines (CMs) mandates their implementation into medical education (ME). Medical students in international contexts have expressed a need to learn about CMs. In Australia, little is known about the student-specific need for CM education. The objective of this paper was to assess the self-reported need for CM education among Australian medical students. DESIGN Thirty second-year to final-year medical students participated in semi-structured interviews. A constructivist grounded theory methodological approach was used to generate, construct and analyse data. SETTING Medical school education faculties in Australian universities. RESULTS Medical students generally held favourable attitudes toward CMs but had knowledge deficits and did not feel adept at counselling patients about CMs. All students were supportive of CM education in ME, noting its importance in relation to the doctor-patient encounter, specifically with regard to interactions with medical management. As future practitioners, students recognised the need to be able to effectively communicate about CMs and advise patients regarding safe and effective CM use. CONCLUSIONS Australian medical students expressed interest in, and the need for, CM education in ME regardless of their opinion of it, and were supportive of evidence-based CMs being part of their armamentarium. However, current levels of CM education in medical schools do not adequately enable this. This level of receptivity suggests the need for CM education with firm recommendations and competencies to assist CM education development required. Identifying this need may help medical educators to respond more effectively.

Beyond a Generic Complementary and Alternative Medicine: The Holistic Health Care- Conventional Medicine Continuum

This article explores whether complementary and alternative medicine (CAM) users view CAM as a unified concept or individualize the modalities. A survey about the beliefs and concerns surrounding the use of 22 CAM modalities was posted to a random sample of 1,308 people in five rural and two metropolitan localities in Victoria, Australia. The response rate was 40% (n = 459). Overall, 91% of respondents were found to either have used one CAM modality (85%, n = 386) or be open to future use (6%, n = 33). Respondents did not view CAM as a unified concept. Each modality was used by people with different characteristics and beliefs about health care. However, it was practical to divide the 22 CAM modalities into four categories that we have named natural remedy, wellness, accepted, and established modalities. The four categories lie along a set of continua extending from natural remedy modalities and ‘‘holistic health care’’ beliefs at one end to established modalities and a belief in the tenets of conventional medicine at the other. We were able to develop a model to show this diagrammatically.

Footprints Forwards Blocked by a Failure Discourse: Issues in Providing Advice about Medicine and Other Health Science Careers to Indigenous Secondary School Students

A dominant discourse constructs Indigenous secondary school students as likely to leave school early and unlikely to take up a health career. We believe that this failure discourse shapes the school and tertiary transition experience for the majority of Indigenous students, regardless of their capabilities and aspirations. Career development practitioners have the potential to change the experiences of Indigenous school students and play a part in closing the gap between Indigenous and non-Indigenous health outcomes. However, only 18% or 26 out of 144 Victorian secondary school career advisers or guidance counsellors who responded to our survey demonstrated the knowledge, skills and understanding to effectively advise and support an Indigenous student who expressed an interest in a health career.

It's Not about Me, It's about the Community: Culturally Relevant Health Career Promotion for Indigenous Students in Australia.

The numbers of Indigenous students studying in health career courses at the tertiary level is low. This paper describes a forum conducted as part of a project of national significance which examines the solutions and barriers for Indigenous student entry to medical and other health science education. Small group discussions and observations were used to determine how a group of Indigenous students, school age and mature, became interested in a health career, what influenced them, their expectations and where they sourced information. The initial design of the forum, based on other successful non-Indigenous health career events, was deemed inappropriate. When an Indigenous educator intervened, and used a more culturally appropriate approach, the engagement of the Indigenous students increased. The importance of culturally relevant health career promotion is a vital part of a complex series of actions needed to increase the recruitment and retention of Indigenous students into health science careers.

Grassroots Community Engagement: The Key to Success in a Community Building Program

Abstract Governments in Australia are allocating resources to rural communities to increase their sustainable social, economic and environmental development. One of the projects funded for this purpose was ‘The Gippsland Community Building Program’, undertaken in three rural communities in Victoria in two stages from 2001–2004. A facilitator was appointed for each community project, and local government developed a model of governance in response to the characteristics and needs of the community. External evaluation of the program was undertaken in two stages over two years and consisted of a document audit, interviews and focus groups. Indicators used in the final evaluation to analyse the impact of each project on its community were ‘citizen participation’, ‘community structure’ and ‘development instruments’. The governance structures were found to be particularly important, although results from each community project were also affected by the community’s characteristics, the project design, and the role of the facilitator. Better project outcomes resulted from transparent governance structures, and consultation with and encouragement of the grassroots community to become actively involved and take responsibility for outcomes with assistance from the facilitator. Governance structures that encouraged inclusive local grassroots ownership of projects were associated with successful community building programs.

A cross-sectional analysis of local government health and wellbeing plans and priorities in Victoria, Australia

The aim of this study is to explore local health and wellbeing plans and priorities by Victorian local governments (LGs), specifically to: (1) analyse how LG priority areas are described in comparison to the State-level plan; (2) identify differences between regional and metropolitan health priorities; and (3) identify differences between LGs with high and low socioeconomic status. Content analysis of 79 LG health and wellbeing plans was undertaken. Differences in health and wellbeing priorities between LGs were examined using the t-test for two proportions. In total, 20% of the plans did not specify actions to address health priorities. One in three (34%) did not specify how evaluation will be done. Alcohol and other drugs, gambling and housing were prioritised more by metropolitan LGs, whereas disease prevention was prioritised more in regional LGs. There was no significant difference in health and wellbeing priorities of LGs with high and low socioeconomic status except for gambling. State-level health and wellbeing plans should be sensitive to differences in priorities of LGs. There is a need for local plans to commit to specific actions and evaluation. This analysis provides basis for more community-reflective, State-level planning and calls for more emphasis on identifying actions and evaluation in local level planning.