Georgina Sutherland

Health Issues for Adults with Developmental Disability.

The aim of this paper is to review recent literature on health issues for adults with developmental disability and reflect on how this research informs service provision, future research work, and social and health policy. Studies based on mortality data are most likely to aim at identifying individuals most at risk of premature death, and some researchers argue that health-oriented service systems appear ill-equipped to address the needs of the at risk groups. Morbidity studies highlight specific health concerns found in this population and commonly report high rates of untreated, yet treatable, conditions. The emerging literature on the behavioral determinants of health suggests risk of preventable morbidity and mortality because of the lack of health-promoting behaviors, particularly in relation to diet and physical activity. Of particular interest in this literature is the affect of living arrangements on health promoting activities. This paper concludes that future directions in health research for adults with developmental disability will be concerned with the complexity of the interactions between biology, pathology, and behavioral and environmental determinants. More use of self-reported health studies is suggested, as well as further exploration of effective strategies of health promotion and health promoting decision-making and self-determination among this population.

Assessing the unmet supportive care needs of newly diagnosed patients with cancer.

Adequate monitoring in cancer control needs to include measures of psychosocial outcomes so as to take account of the totality of the felt cancer experience. There is a need to know whether the experience of cancer is changing, as well as a need for tools to identify where supportive care interventions or services could be targeted to good effect. The aim of this study was to investigate the utility of using a telephone-administered survey to identify the unmet needs of cancer patients. Participants were identified from a statewide population-based cancer registry following an episode of hospitalized care in Victoria (Australia). Of the 506 eligible patients, 236 completed a telephone adaptation of the Supportive Care Needs Survey-Short Form (SCNS-SF31). Sampling from the cancer registry was shown to provide timely contact with patients. Results from the survey indicated that perceived needs for this newly diagnosed group of cancer patients were mostly in the area of information provision. Results also showed that some socio-demographic and disease-specific variables affected the level of perceived unmet needs. Overall, this study indicated that registry-based sampling was practical and the telephone adaptation of the SCNS-SF31 provided a reliable method to explore the unmet needs of newly diagnosed patients with cancer.

Relaxation and Health-Related Quality of Life in Multiple Sclerosis: The Example of Autogenic Training

This study was a pilot project to explore the effect of an autogenic training program (AT; a relaxation intervention) on the health-related quality of life (HRQOL) and well-being for people with multiple sclerosis. Participants either met weekly for sessions in AT for 10 weeks (n = 11) or were assigned to the control group (n = 11). The AT group was also asked to practice the technique daily at home. Scales designed to measure HRQOL and aspects of well-being (mood and depressed affect) were taken preintervention and at week 8 of the 10-week program. ANCOVAs using a measure of social support and pretest scores as covariates revealed that at the posttest the AT group reported more energy and vigor than the control group and were less limited in their roles due to physical and emotional problems. Future research should involve studies conducted over an extended period, together with sufficiently sized samples to explore the effect of frequency of practice of relaxation training on HRQOL and well-being for people with multiple sclerosis.

In-Hospital Formula Supplementation of Breastfed Babies: A Population-Based Survey

BACKGROUND   In-hospital formula supplementation of breastfed newborns is commonplace despite its negative association with breastfeeding duration. Although several studies have described the use of formula supplementation, few have explored the factors that may be associated with its use. The aim of this study was to explore factors associated with in-hospital formula supplementation using data from a large Australian population-based survey. METHODS   All women who gave birth in September and October 2007 in two Australian states were mailed questionnaires 6 months after the birth. Women were asked how they fed their baby while in hospital after the birth. Multivariable logistic regression was used to explore specified a priori factors associated with in-hospital formula supplementation. RESULTS   Of 4,085 women who initiated breastfeeding, 23 percent reported their babies receiving formula supplementation. Breastfed babies had greater odds of receiving formula supplementation if their mother was primiparous (adj. OR=2.16; 95% CI: 1.76-2.66); born overseas and of non-English-speaking background (adj. OR=2.03; 95% CI: 1.56-2.64); had a body mass index more than 30 (adj. OR=2.27; 95% CI: 1.76-2.95); had an emergency cesarean section (adj. OR=1.72; 95% CI: 1.3-2.28); or the baby was admitted to a special care nursery (adj. OR=2.72; 95% CI: 2.19-3.4); had a birthweight less than 2,500 g (adj. OR=2.02; 95% CI: 1.3-3.15) or was born in a hospital not accredited with Baby-Friendly Hospital Initiative (BFHI) (adj. OR=1.53; 95% CI: 1.2-1.94). CONCLUSIONS   The number of factors associated with in-hospital formula supplementation suggests that this practice is complex. Some results, however, point to an opportunity for intervention, with the BFHI appearing to be an effective strategy for supporting exclusive breastfeeding.

Women's Experience of Discrimination in Australian Perinatal Care: The Double Disadvantage of Social Adversity and Unequal Care

BACKGROUND Discrimination in womens health care, particularly perinatal care, has received minimal attention. The aim of this study is to describe womens experience of discrimination in different models of maternity care and to examine the relationship between maternal social characteristics and perceived discrimination in perinatal care. METHODS A population-based postal survey was mailed 6 months postpartum to all women who gave birth in two Australian states in September and October 2007. Perceived discrimination was assessed using a five-item measure designed to elicit information about experiences of unequal treatment by health professionals. RESULTS A total of 4,366 eligible women completed the survey. Women attending public models of maternity care were significantly more likely to report perceived discrimination compared with women attending a private obstetrician (30.7% vs 19.7%, OR 1.79, 95% CI 1.5-2.1). Compared with women reporting no stressful life events or social health issues in pregnancy, those reporting three or more stressful life events or social health issues had a twofold increase in adjusted odds of perceived discrimination (41.1% vs 20.4%, adj OR 2.27, 95% CI 1.8-2.8). Young women (< 25 yr) and women who were smoking in pregnancy were also at increased risk of experiencing perceived discrimination. CONCLUSIONS Discrimination is an unexplored factor in how women experience perinatal care. Developing approaches to perinatal care that incorporate the capacity to respond to the needs of vulnerable women and families requires far-reaching changes to the organization and provision of care.

Applying a social disparities lens to obesity in pregnancy to inform efforts to intervene

OBJECTIVE to examine the social correlates of pre-pregnancy overweight and obesity in an Australian population-based sample and consider implications for intervention effectiveness during pregnancy. DESIGN population-based survey distributed by hospitals to women 6 months after birth. SETTING two states of Australia. PARTICIPANTS women who gave birth in Victoria and South Australia in September/October 2007. MEASUREMENTS AND FINDINGS surveys were completed by 4,366 women. Pre-pregnancy body mass index (BMI) was calculated from womens self-reported weight in kilograms/(height in metres)(2). Results showed high rates of overweight (22%) and obesity (14%) among Australian women entering pregnancy. After adjusting for other factors in the model, pre-pregnancy obesity was significantly associated with lower household income levels, less education, the experience of financial stress in pregnancy and increasing parity. KEY CONCLUSIONS to date, there is little evidence to support the efficacy of interventions to manage problematic weight in pregnancy. Applying a social disparities lens to obesity in pregnancy challenges us to consider social factors that may seem distal to obesity but are highly relevant to efficacious intervention. IMPLICATIONS FOR PRACTICE pregnancy care offers an opportunity to address social issues on the pathway to obesity. Current clinical care guidelines on maternal overweight and obesity in pregnancy rarely consider social contexts that place some women at risk and are a likely impediment to efficacious intervention.

How does a cancer education program impact on people with cancer and their family and friends

Background. In this article, we report on the effects of patient education for people with cancer in comparison to family and friends. Methods. Data are from 666 participants with cancer and 324 family and friends who completed preprogram and postprogram questionnaires. Results. Results show high levels of participant satisfaction and positive changes in measures such as illness perceptions and emotional functioning. In many cases, the pattern of change was different for people with cancer compared to family and friends. Conclusions. This education program may be useful for helping people with cancer cope with the disease, with some distinct benefits for family and friends.

Self-harm following release from prison: A prospective data linkage study:

Objective: Prisoners are at increased risk of both self-harm and suicide compared with the general population, and the risk of suicide after release from prison is three times greater than for those still incarcerated. However, surprisingly little is known about the incidence of self-harm following release from prison. We aimed to determine the incidence of, identify risk factors for and characterise emergency department presentations resulting from self-harm in adults after release from prison. Method: Cohort study of 1325 adults interviewed prior to release from prison, linked prospectively with State correctional and emergency department records. Data from all emergency department presentations resulting from self-harm were secondarily coded to characterise these presentations. We used negative binomial regression to identify independent predictors of such presentations. Results: During 3192 person-years of follow-up (median 2.6 years per participant), there were 3755 emergency department presentations. In all, 83 (6.4%) participants presented due to self-harm, accounting for 165 (4.4%) presentations. The crude incidence rates of self-harm for males and females were 49.2 (95% confidence interval: [41.2, 58.7]) and 60.5 (95% confidence interval: [44.9, 81.6]) per 1000 person-years, respectively. Presenting due to self-harm was associated with being Indigenous (incidence rate ratio: 2.01; 95% confidence interval: [1.11, 3.62]), having a lifetime history of a mental disorder (incidence rate ratio: 2.13; 95% confidence interval: [1.19, 3.82]), having previously been hospitalised for psychiatric treatment (incidence rate ratio: 2.68; 95% confidence interval: [1.40, 5.14]) and having previously presented due to self-harm (incidence rate ratio: 3.91; 95% confidence interval: [1.85, 8.30]). Conclusion: Following release from prison, one in 15 ex-prisoners presented to an emergency department due to self-harm, within an average of 2.6 years of release. Demographic and mental health variables help to identify at-risk groups, and such presentations could provide opportunities for suicide prevention in this population. Transition from prison to the community is challenging, particularly for those with a history of mental disorder; mental health support during and after release may reduce the risk of adverse outcomes, including self-harm.

Role of general practitioners in primary maternity care in South Australia and Victoria

Background:  Recent policy debates about the challenges facing maternity services in Australia provide an opportunity to reflect on current care practices.

Discussing sexuality in the clinical setting: The impact of a brief training program for oncology health professionals to enhance communication about sexuality

Aim:  Cancer and its treatments can profoundly affect a persons sexuality and self‐image. However, oncology health professionals (OHP) are often reluctant to discuss these issues with patients. Cancer Council Victoria developed a short workshop to increase OHPs discussion of sexuality issues with cancer patients. We examined the immediate and longer term effect of workshop participation on perceived barriers to these discussions, their confidence in initiating the discussions, and changes in the frequency of their discussing sexuality issues with patients.