Gabriele Bammer

The long-term impact of childhood sexual abuse in Australian women.

OBJECTIVE The aim of this study was to examine the association between childhood sexual abuse (CSA) and a range of adverse adult outcomes in a community sample of women using multivariate analysis which accounted for a number of potential confounding effects. METHOD Retrospective study of cross-sectional data on the long-term impact of CSA, collected as part of a larger two-stage case-control study of the possible relationship between CSA and alcohol abuse. Data were appropriately weighted to adjust for the different selection probabilities of cases and controls. RESULTS Significant associations were found between reporting CSA and experiencing domestic violence, rape, sexual problems, mental health problems, low self-esteem, and problems with intimate relationships even after taking into account a range of family background factors. Women who had experienced abuse involving intercourse were the most vulnerable to these negative outcomes. CONCLUSIONS The findings indicate that the influence of CSA on adverse long-term effects is mediated and influenced both by the severity of the abuse experiences and by a range of family and social background factors.

Integration and Implementation Sciences: Building a New Specialization

Developing a new specialization—Integration and Implementation Sciences—may be an effective way to draw together and significantly strengthen the theory and methods necessary to tackle complex societal issues and problems. This paper presents an argument for such a specialization, beginning with a brief review of calls for new research approaches that combine disciplines and interact more closely with policy and practice. It posits that the core elements of Integration and Implementation Sciences already exist, but that the field is currently characterized by fragmentation and marginalization. The paper then outlines three sets of characteristics that will delineate Integration and Implementation Sciences. First is that the specialization will aim to find better ways to deal with the defining elements of many current societal issues and problems: namely complexity, uncertainty, change, and imperfection. Second is that there will be three theoretical and methodological pillars for doing this: 1) systems thinking and complexity science, 2) participatory methods, and 3) knowledge management, exchange, and implementation. Third, operationally, Integration and Implementation Sciences will be grounded in practical application, and generally involve large-scale collaboration. The paper concludes by examining where Integration and Implementation Sciences would sit in universities, and outlines a program for further development of the field. An appendix provides examples of Integration and Implementation Sciences in action.

Women, work and musculoskeletal health.

Why are employed women at increased risk for upper limb musculoskeletal disorders and what can this tell us about the way work and family life shape health? Despite increases in womens labour force participation, gender differences in work-related health conditions have received little research attention. This appears be the first study to examine why employed women are much more likely than men to experience upper body musculoskeletal disorders. A mailed self-report survey gathered data from 737 Australian Public Service employees (73% women). The majority of respondents were clerical workers (73%). Eighty one per cent reported some upper body symptoms; of these, 20% reported severe and continuous upper body pain. Upper body musculoskeletal symptoms were more prevalent and more severe among women. The gender difference in symptom severity was explained by risk factors at work (repetitive work, poor ergonomic equipment), and at home (having less opportunity to relax and exercise outside of work). Parenthood exacerbated this gender difference, with mothers reporting the least time to relax or exercise. There was no suggestion that women were more vulnerable than men to pain, nor was there evidence of systematic confounding between perceptions of work conditions and reported health status. Changes in the nature of work mean that more and more employees, especially women, use computers for significant parts of their workday. The sex-segregation of women into sedentary, repetitive and routine work, and the persisting gender imbalance in domestic work are interlinking factors that explain gender differences in musculoskeletal disorders.

A Study of Potential Risk Factors for Sexual Abuse in Childhood.

Research aimed at identifying risk factors for childhood sexual abuse (CSA) is crucial for the development of preventative strategies. This study examined the relationship between a number of possible risk factors and CSA in a community sample of women using multivariate analysis and carefully operationalized variables. The variables significantly associated with CSA were physical abuse, having a mother who was mentally ill, not having someone to confide in, and being socially isolated. With the exception of physical abuse, different predictors emerged for abuse before and after age 12. Social isolation and experiencing the death of a mother were significant predictors for abuse before age 12, while the predictors of CSA after age 12 were physical abuse and a mentally ill mother. For abuse perpetrated by a family member, the significant predictors of CSA were physical abuse, having no one to confide in, having no caring female adult, and having an alcoholic father. For girls abused by someone outside of the family, the significant predictors were physical abuse, social isolation, mothers death, and having an alcoholic mother. While CSA can happen to any child, this study highlights circumstances that may increase the chances of abuse and should form the basis of prevention and intervention strategies.

Australian women's experiences of living with hepatitis C virus: Results from a cross‐sectional survey

Background: Of the estimated 160 000 Australians currently infected with the hepatitis C virus (HCV), over one‐third are women and very few have received clinical treatment, with most managing their illness in non‐specialist settings. Little is known about the experiences of women living with HCV in the general community. The present study provides the results from the first comprehensive social survey of Australian womens experiences of living with HCV.

Research Integration Using Dialogue Methods

Research on real-world problems—like restoration of wetlands, the needs of the elderly, effective disaster response and the future of the airline industry—requires expert knowledge from a range of disciplines, as well as from stakeholders affected by the problem and those in a position to do something about it. This book charts new territory in taking a systematic approach to research integration using dialogue methods to bring together multiple perspectives. It links specific dialogue methods to particular research integration tasks.

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.

Implementing Buprenorphine Treatment in Community Settings in Australia: Experiences from the Buprenorphine Implementation Trial

Buprenorphine was registered in Australia as a maintenance and detoxification agent for the management of opioid dependence in November, 2000, and became widely available in August, 2001. This paper provides an overview of key developments in the introduction of buprenorphine treatment in Australia, with an emphasis upon the delivery of services in community-based (primary care) settings. A central study in this work was the Buprenorphine Implementation Trial (BIT), a randomized, controlled trial comparing buprenorphine and methadone maintenance treatment delivered under naturalistic conditions by specialist and community-based service providers (general practitioners and community pharmacists) in 139 subjects across nineteen treatment sites. In addition to conventional patient outcome measures (treatment retention, drug use, psychosocial functioning, and cost effectiveness), the BIT study also involved the development and evaluation of clinical guidelines, training programs for clinicians, and client literature, which are described here. Integration of treatment systems (methadone with buprenorphine, specialist and primary-care programs) and factors thought to be important in the uptake of buprenorphine treatment in Australia since registration are discussed.

Framing practice-research engagement for democratizing knowledge

Practice research engagement (PRE) is increasingly important for producing knowledge and innovations in practice for complex social problem-solving. We pose several questions: Why do PRE? What is required to organize effective PRE? And what is needed for PRE to contribute to democratizing knowledge? We present a framework to encourage researchers to think systematically about organizing PRE that focuses on: 1) frameworks, goals and interests, 2) relationships and organization, 3) strategies and methods, and 4) contextual forces and institutions. We describe challenges to effective engagement posed by these elements and identify a few approaches to dealing with them. We illustrate the concept and the challenges with four case studies - Gender Relations in India; Heroin Prescriptions in Australia; Inter-sectoral Cooperation in Africa and Asia; and Building Grassroots Movements in the US. We argue that PRE that contributes to the democratization of knowledge must pay special attention to social change theories, power relations, long-term domain development strategies and building friendly institutional bases.

Comparative assessment of transport risks: how it can contribute to health impact assessment of transport policies

Health impact assessment (HIA) and comparative risk assessment (CRA) are important tools with which governments and communities can compare and integrate different sources of information about various health impacts into a single framework for policy-makers and planners. Both tools have strengths that may be combined usefully when conducting comprehensive assessments of decisions that affect complex health issues, such as the health risks and impacts of transport policy and planning activities. As yet, however, HIA and CRA have not been applied widely to the area of transport. We draw on the limited experience of the application of these tools in the context of road transport to explore how comparative assessment of transport risks can contribute to HIA of transport policies.