Cj Hughes

Hygiene in the home: relating bugs and behaviour

Much infectious intestinal disease (IID) arises in the home environment. If programmes to prevent infection are to be effective it is essential to both identify the particular practices that risk disease transmission, and to understand the reasons for these practices. An in-depth, multidisciplinary study of carer and child hygiene in the domestic environment in the Wirral, UK, employed structured observation, surface swabbing for polio vaccine virus and enteric marker organisms, semi-structured interviews, projective interviews and focus group discussions. Observations revealed that child carers washed hands with soap after changing a dirty nappy on 42% of occasions, and that one in five toilet users did not wash hands with soap afterwards. Microbiological samples were taken from household surfaces at sites thought likely to be involved in the transfer of faecal material. 15% of bathroom samples showed contamination with polio vaccine virus. Nappy changing took place mainly in living rooms. Contact with living room surfaces and objects during nappy changing was frequent and evidence of faecal contamination was found in 12% of living room samples. Evidence of faecal contamination was also found in kitchens, again on surfaces thought likely to be involved in the transmission of faeces (taps and soap dispensers). Key factors motivating hygiene were the desire to give a good impression to others, protection of the child and aesthetics. In this setting, the particular risk practices to be addressed included washing hands with soap after stool and nappy contact and preventing the transfer of pathogenic organisms to the kitchen. The occasion of the birth of a child may be a privileged moment for the promotion of safer home hygiene practices. Using polio vaccine virus as an indicator of faecal contamination produces results that could be used in large-scale studies of household disease transmission. A better understanding of the household transmission of the agents of IID using multidisciplinary methods is needed if effective hygiene promotion programmes are to be designed.

The international development of the ‘Social Norms’ approach to drug education and prevention

The social norms approach to health promotion has become remarkably popular in the last 20 years, particularly in the American college system. It is an alternative to traditional fear-based approaches of health education, which a growing body of research demonstrates is often ineffective in reducing alcohol and drug misuse. The social norms approach differs by recognizing that individuals, particularly young adults, tend to overestimate how heavily and frequently their peers consume alcohol, and that these perceptions lead them to drink more heavily themselves than they would otherwise do. Similar misperceptions have been found in a range of other health and non-health behaviours. The social norms approach aims to reduce these misperceptions, and thus personal consumption, through the use of media campaigns and personal feedback. Although the numbers of completed social norms projects outside the USA is small, the evidence from them is that the approach can be equally effective in both European and Australian contexts. It is also acknowledged that as an emergent field, there are limitations to the current social norms literature. There is a lack of randomized control trial studies, a lack of clarity of the role of referent groups and a need to better understand the processes through which misperceptions are transmitted. However, despite these issues, the social norms approach represents a new avenue for reducing alcohol and drug-related harm and is an area which merits further research.

Alcohol Consumption and Parkinson’s Disease Risk: A Review of Recent Findings

Abstract Background: The association between Parkinson’s disease and lifestyle exposures such as smoking, coffee and alcohol consumption have been the focus of research for several decades, with varying and often conflicting results. Objective: This paper reviews the key features of observational studies investigating the relationship between alcohol drinking and PD risk, to determine potential sources of variability between the results. Methods: Relevant literature from 2000–2014 was systematically retrieved using three databases. Primary research articles were included if they reported a measure of association between quantity and frequency of alcohol intake and PD risk, and adjusted at least for the potential confounding factors of smoking and age. Results: Sixteen articles were identified. The seven case-control studies were more likely to report a weak protective association by level of alcohol consumption compared to the studies with prospective designs. Two studies reported the relationship between heavy (harmful to health) drinking and PD. There was weak evidence that associations varied by type of alcoholic beverage. Smoking may modify the association between alcohol intake and PD risk, however, the evidence does not support the theory that a confounder (such as an addiction-avoiding personality trait) produced the inverse associations between smoking, coffee and alcohol intake and PD risk. Methodological weaknesses of the studies, including selection and recall bias, residual confounding and lack of statistical power may in part account for their differences. Conclusion: The weak association between alcohol drinking and PD risk was found in studies at greater risk of selection and recall bias.

A Qualitative Study of Environmental Factors Important for Physical Activity in Rural Adults

Purpose Despite increasing evidence that the physical environment impacts on physical activity among urban-dwellers, little attention has been devoted to understanding this relationship in rural populations. Work in this area is further hindered by a lack of environmental measures specifically designed for rural settings. This qualitative study aimed to explore the salience of urban physical activity environment constructs among rural adults. Methods In 2011, 49 rural men and women from three distinct areas (coastal, animal-based farming, forestry/plant-based farming) of rural Tasmania, Australia, were purposively recruited to participate in semi-structured interviews. Interviews explored features of the built and social environment commonly examined in studies of urban adults, including functional characteristics (eg, lighting, footpaths, roads/verges), road and personal safety, availability and accessibility of places to be active, destinations, and aesthetics. Interviews were recorded, transcribed verbatim and analysed using a content-thematic approach using QSR NVivo software. Findings While some urban environmental constructs were salient to these rural adults, such as availability of and accessibility to places to be active, some constructs were operationalised differently, such as road safety (where large trucks and winding roads rather than traffic density was of concern), or were not considered relevant (eg, personal safety related to crime, availability of walkable destinations, aesthetics). Conclusions The measurement of the physical environment in rural populations may require reconsideration and/or modification to ensure salience and appropriate quantification of associations with physical activity in future studies.

Audience response devices ('clickers'): A discussion paper on their potential contribution to alcohol education in schools

Many schools endeavour to provide effective, relevant and appealing alcohol education to students, using up-to-date technologies and resources. However, choosing an appropriate, evidence-based programme or approach is rarely straightforward given the plethora of options and limited evidence base. The alcohol education literature and findings from a recent Australian study indicate four key features of effective alcohol education approaches: interactivity, peer education, exploration of students’ opinions/knowledge, and addressing alcohol-related misperceptions. These four features are acknowledged strengths of audience-response devices (‘clickers’). Clickers are increasingly popular, supported by growing evidence of suitability for a variety of educational applications and have untapped potential in the delivery of alcohol education. Clickers can engage and empower students and their ability to elucidate misperceptions regarding prevalence and acceptance of risky alcohol use among peers corresponds with normative education approaches. Clickers are effective, fun, create valuable ‘teachable moments’ and provide potential to enhance delivery of evidence-based alcohol education.

Exploring law enforcement and public health as a collective impact initiative: lessons learned from Tasmania as a case study

Purpose The purpose of this paper is to examine the potential benefits as well as some of the practical barriers to the implementation of a collective impact initiative in law enforcement and public health (LEPH) in Tasmania, Australia. Design/methodology/approach The paper is based on a review of programs, agencies and initiatives that are at the intersection of LEPH in Tasmania, through an analysis of the findings in evaluation reports, and the views of practitioners identified at a workshop on LEPH held at a national AOD conference and facilitated by the authors. Findings The strengths of collective impact initiatives, particularly in LEPH, are presented and some weaknesses identified. Some major obstacles to the consolidation of LEPH initiatives include siloed ways of working and budgets, lack of leadership and political will. Some progress has been made in addressing these weaknesses, although addressing complex social problems by moving beyond inter-agency collaboration toward an integrated model of service provision remains challenging. Practical implications The authors argue that there are practical benefits to the adoption of a collective impact model to address problems in Tasmania that lie at the nexus between LEPH. In reviewing existing collaborations, the authors demonstrate the value of a structural mapping process to identify ways forward for government and non-government agencies that are inclined to go further in merging the two disciplinary areas. The authors offer some suggestions with respect to identifying the preconditions for a collective impact model and how to build on these to initiate action. Originality/value A significant proportion of the literature on LEPH remains at a conceptual and theoretical level. This contribution highlights some practical issues while looking at existing examples of collaboration across LEPH at a state level in Australia, and starts mapping a way forward for constructing more integrative LEPH initiatives.

How do regional and rural general practitioners use the Internet to gather patient information

How do regional and rural general practitioners use the Internet to gather patient information? Jessica A. Marathe, BMedSc(Hons), MBBS, Jessica Woodroffe, BA(Hons), MA, PhD, Kathryn Ogden, MBBS(Hon), MPH, FRACGP, and Clarissa Hughes, BA(Hons), PhD Department of Medicine, Queen Elizabeth Hospital, South Australia, Centre for Rural Health, and Launceston Clinical School, University of Tasmania, Tasmania