Beverly Sibthorpe

Drug use, binge drinking and attempted suicide among homeless and potentially homeless youth

In order to assess the need for drug-related services for at-risk youth, a survey was conducted among young people aged 12–17 years who, owing to severe family discord, were currently living away from home (homeless) or had experienced periods away from home in the past 12 months (potentially homeless). Prevalence of use and of potentially harmful levels of use of alcohol and other licit and illicit drugs were higher than in a comparative population. Of the 155 people interviewed, 54% reported past physical abuse, 28% reported past sexual abuse, and 73% had a family alcohol or other drug history. Of the total, 62% had been in a youth refuge at some time in the past 12 months. Twenty four per cent had been to hospital as a result of alcohol or other drug use and 45% had attempted suicide. Female sex and an interaction between sexual abuse and binge drinking predicted suicide attempts. This study points to the need for a comprehensive approach to interventions for troubled youth which gives greater recognition to mental health issues related to family circumstances, including abuse.

Self-Assessed Health Among Indigenous Australians: How Valid Is a Global Question?

OBJECTIVES This study assessed the validity of a global measure of self-assessed health among Indigenous Australians. METHODS Logistic regression was used to identify factors associated with self-assessed health in a nationally representative sample. RESULTS Among 8782 adult respondents, poorer self-assessed health was strongly associated with several factors, including age, number of health conditions, and recent health actions. The association with health conditions was attenuated when the respondents primary language was not English. CONCLUSIONS Self-assessed health may be a valid measure among indigenous Australians whose primary language is English. However, although the measure draws on common experiences of health and illness, it may obscure differences in how people incorporate these experiences into social actions.

Improving vaccine storage in general practice refrigerators.

Vaccines are biological products and are susceptible to fluctuations in temperature. In many general practices vaccines are exposed to adverse temperatures.1 2 The aim of this study was to determine whether educating one staff member in each practice about correct vaccine storage conditions and nominating that staff member to monitor the refrigerators temperature would improve vaccine storage in general practices. A random sample of general practices in a metropolitan division of Western Australia and all general practices in a rural division were invited to participate in the study. Those that already monitored their refrigerators with a maximum-minimum thermometer or did not store vaccines were excluded. Practices were randomised into control and intervention groups, and their vaccine refrigerators were monitored for 30 days with a computerised …

A cost effectiveness study of integrated care in health services delivery: a diabetes program in Australia

BackgroundType 2 diabetes is rapidly growing as a proportion of the disease burden in Australia as elsewhere. This study addresses the cost effectiveness of an integrated approach to assisting general practitioners (GPs) with diabetes management. This approach uses a centralized database of clinical data of an Australian Division of General Practice (a network of GPs) to co-ordinate care according to national guidelines.MethodsLong term outcomes for patients in the program were derived using clinical parameters after 5 years of program participation, and the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model, to project outcomes for 40 years from the time of diagnosis and from 5 years post-diagnosis. Cost information was obtained from a range of sources. While program costs are directly available, and costs of complications can be estimated from the UKPDS model, other costs are estimated by comparing costs in the Division with average costs across the state or the nation. The outcome and cost measures are used derive incremental cost-effectiveness ratios.ResultsThe clinical data show that the program is effective in the short term, with improvement or no statistical difference in most clinical measures over 5 years. Average HbA1c levels increased by less than expected over the 5 year period. While the program is estimated to generate treatment cost savings, overall net costs are positive. However, the program led to projected improvements in expected life years and Quality Adjusted Life Expectancy (QALE), with incremental cost effectiveness ratios of

Needle Use and Sexual Practices: Differences in Perception of Personal Risk of HIV among Intravenous Drug Users

A8,106 per life-year saved and

Circumstances Surrounding Needle Use Transitions among Injection Drug Users: Implications for HIV Intervention

A9,730 per year of QALE gained.ConclusionsThe combination of an established model of diabetes progression and generally available data has provided an opportunity to establish robust methods of testing the cost effectiveness of a program for which a formal control group was not available. Based on this methodology, integrated health care delivery provided by a network of GPs improved health outcomes of type 2 diabetics with acceptable cost effectiveness, which suggests that similar outcomes may be obtained elsewhere.

Data for diagnosis, monitoring and treatment in Indigenous health: the case of cervical cancer

Of 161 out-of-treatment intravenous drug users interviewed in Portland, Oregon, where syringes and needles can be purchased without prescription, 52% reported sharing needles with others in the preceding year and 55% reported practicing unsafe sex. There was a high level of knowledge of the HIV transmission risk associated with both needle sharing and sexual practices. However, while those with unsafe needle use perceived their risk of contracting HIV as greater than those with safer needle use, those practicing unsafe sex did not see their risk as greater than those practicing safer sex. Unsafe needle use and unsafe sex require different approaches to intervention and sexual risk reduction education needs to be specifically targeted at helping IVDUs better understand their sexual relationships in terms of their risk of contracting HIV.

Positions and training of the Indigenous health workforce

Injection drug users (IDUs) are at increased risk of infection with the human immunodeficiency virus (HIV). Intervention programs aimed at reducing the spread of HIV in this population typically incorporate a range of risk reduction strategies, including encouragement to move from injection to noninjection. However, very little is known about the factors associated with needle use transitions, either spontaneous or in response to intervention. We report a study in which a cohort of IDUs were asked about the reasons they stopped and restarted injection. Of 855 IDUs, 179 (21%) had had a least one 12-month period of noninjection since they first injected. Almost one-half of the reasons given for stopping injecting related to personal crises, characterized by major shifts in attitude to drugs and/or life more generally, and often generated by pressures in significant relationships. Concerns about HIV were cited by only one respondent. Many of the factors associated with transition out of needle use in the study population are not readily amenable to intervention. The implications of this for HIV risk reduction programs are discussed.

The Response of Injection Drug Users to Free Treatment on Demand: Implications for HIV Control

Deficiencies in the availability and quality of data on the health status of Indigenous Australians have long been recognised. For cervical cancer, data demonstrate a 2–5 fold greater incidence rate and an 8–10 fold greater mortality rate for Indigenous women compared to non‐Indigenous Australians. However, incidence and mortality data are only available for some states and there is little or no information available on the geographic or social distribution of risk, or the reasons for risk differentials. There are also little or no data on the utilisation of, or preferences for, screening services. Thus, while there is clearly a need for a cervical cancer control program specifically to target Indigenous women, current data are inadequate to inform planning and implementation, and current systems are inadequate to monitor effectiveness. This situation is the result of insufficient research and inadequate attention to recording of Indigenous status in routine data systems and applies to a greater or lesser extent across the spectrum of health of Indigenous Australians. Health workers across the spectrum in mainstream and Indigenous medical services have a shared responsibility for improving the availability and quality of data and ensuring the appropriate use of information necessary to achieve and monitor improvements in service delivery and health status of Indigenous people.

Impediments to change in an Australian trial of coordinated care

A survey of community‐controlled and state health services was conducted in 1995 as part of a needs assessment for a tertiary training initiative in applied epidemiology. Information for 792 Indigenous people in health‐related occupations was obtained. Mean time in the current position was 4.8 years, 75% were in designated Aboriginal positions and 44% were health workers. Of the total, 49% had a diploma or certificate, but only 3% had a bachelors degree. The latter compares with 75% of the public health workforce generally which has a bachelors degree or higher. The high proportions of health worker and designated Aboriginal positions, short tenure and low level of degree training suggest that there are a range of employment and training issues which need to be addressed if an appropriate level of Indigenous workforce participation is to be achieved and Indigenous health professionals are to have access to the same vertical and lateral employment mobility as non‐Indigenous workers. In particular, there is a huge need to enhance Indigenous participation in health workforce training, and to develop strategies for certification and recognition of the wide range of non‐course‐based training being undertaken.