Janice Chesters

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.

SURGEONS’ ATTITUDES TOWARDS AND USAGE OF EVIDENCE‐BASED MEDICINE IN SURGICAL PRACTICE: A PILOT STUDY

Background:  Within surgery the debate about the place of evidence‐based medicine (EBM) has focused on the nature and compatibility of EBM with surgical practice with an inevitable polarization of opinion. However, EBM techniques are being embedded into undergraduate medical curricula and surgical training programs across Australia. The Monash University Department of Surgery at Monash Medical Centre implemented a pilot study to explore current knowledge, attitudes and behaviours of practising surgeons towards EBM techniques.

“You Still Need to Give Her a Token of Appreciation”: The Meaning of the Exchange of Money in the Sexual Relationships of Out-of-School Adolescents in Rural Southwest Uganda

This article challenges the pervasive assumption that exchanging gifts and money in adolescent sexual relationships is transactional. Data were derived from a multi-method, qualitative sexual health needs assessment of 31 out-of-school adolescents in rural southwest Uganda. Grounded theory analysis allows contextual meanings of exchange to emerge. Adolescents have developed gendered courting and exchange models that parallel marital relationships in this cultural context. Whereas exchange is considered transactional and immoral in some types of relationships, in adolescent relationships, it is not. Young women are not ashamed of, or stigmatized by, the exchange; they are proud of it. The exchange signifies several things: self-respect and a partners willingness to wait for the relationships to become sexual and, therefore, that they are valued and respected by their partners. This demonstrates commitment from a partner, whose role is as a provider. To expect no gift or to have sex for pleasure are the hallmarks of the worst kind of woman—a malaya. “Need” is the only acceptable rationale for extramartial sex for any woman in this sexual value system. Interventions promoting longer courting and sustained support for one partner would encourage a delay in debut for young women and encourage greater monogamy in young men.

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.

Interprofessional Education in Australasia

In April 2006 at the ‘‘All Together Better Health 3’’ conference in London a small group of health professionals from Australia and New Zealand took the opportunity to meet face-toface and share their experiences of IPL (interprofessional learning). The irony was that these people were meeting half the world away from their institutions. They had heard each other’s names before but few had talked face-to-face. It took an international meeting to launch the idea of AIPPEN – the Australasian Interprofessional Practice and Education Network. Since my own move to Australia almost four years ago I have been stimulated by the increasing interest in IPE ‘‘down under’’. In 2005 in an editorial for this journal I wondered where the teamwork approach to health care was hidden in my new home (Thistlethwaite, 2005). Similarly I had trouble finding IPE initiatives within local universities. I realize now that there were in fact many projects going on, particularly in rural and remote areas, but that there was a lack of promotion of these. RIPEN (the Rural Interprofessional Education Network) was and is going strong but there was less focus on initiatives in other areas – hence the decision to form AIPPEN. AIPPEN is a network of individuals, groups, institutions and organizations committed to researching, delivering, promoting and supporting IPE and IPP (interprofessional practice). Its primary objective is to promote better health care outcomes and enhance IPE and IPP in Australia and New Zealand by developing a network to promote communication and collaboration among members. We also aim to influence workforce policy and practice change and disseminate information on IPL throughout the region (Nisbet et al., 2007). The steering group members are involved in a range of activities and meet regularly by teleconference. In line with international trends, IPL activity within Australia and New Zealand is rapidly expanding. Results of a 2005 survey of Australian universities (Thistlethwaite and Nisbet, unpublished) indicated that 19 of the 38 Australian universities offered campus-based IPL opportunities, particularly in undergraduate programs run by Faculties of Health, rural clinical schools and Departments of Nursing. These, however, tended to focus on content rather than specific IPL objectives, e.g., Indigenous studies; research methodologies. There was minimal indication that IPL was an embedded component of curricula. However, close to 60% of respondents indicated they aimed to increase the amount of IPE offered in the future, with 40% suggesting no change. Although two thirds of the courses had been evaluated, only three evaluations had been published, highlighting the need for more formal evaluation of programs and dissemination of findings. There is also a dearth of sociological and critical papers or monographs about IPE and IPP. To meet this need for scholarship the production of a critical text in the field is high on the agenda of the Monash University Department of Rural and Indigenous Health. Journal of Interprofessional Care, August 2007; 21(4): 369 – 372

Treatment Content in Child and Adolescent Mental Health Services: Development of the Treatment Recording Sheet

This paper presents a clinician self-report measure developed to record the specific components of treatment used with adolescents attending a Child and Adolescent Mental Health Service (CAMHS). Using action research methodology, 18 clinicians attended up to five facilitated discussion groups during 2006 to discuss the planned implementation of a clinical trial. The clinicians helped adapt a checklist for recording treatment strategies applied in CAMHS with adolescents. The sessions were audio-taped and transcribed for thematic analysis. The final treatment recording checklist is presented. The clinicians reported the instrument was helpful for recording the content of their interventions and understanding their colleagues practice.

Mental illness recovery and place

Abstract This paper explores fifteen residents’ perspectives on a supported housing program for people recovering from low prevalence mental health disorders in rural Gippsland, Victoria, Australia. It moves beyond the often unproductive institutional versus community care dichotomy to present a more complex consideration of the residents’ perceptions of supported housing as a site for recovery. This paper contributes to the literature on consumers’ experiences of mental health care in particular places. The residents’ narratives highlight the importance of supported accommodation as an integral part of a recovery focused service system delivered predominantly, but not exclusively, in the community.

Sexual partner types and related sexual health risk among out-of-school adolescents in rural south-west Uganda

Abstract This paper defines the range of sexual partners chosen by out-of-school adolescents from Masaka District in rural south-west Uganda, and implications for sexual and reproductive health discussed. Data are drawn from a sexual health needs assessment using applied anthropological techniques with 31 adolescents, their parents, guardians and community leaders. Data were analysed using inductive thematic methods. Out-of-school adolescents are exposed to risk both stable and casual sexual relationships. Young men and women want a stable relationship with one reliable partner. Young men seek a “steady” relationship with younger schoolgirls; some also seek multiple “casual” relationships with young women easily convinced with gifts. Young women accept “permanent” partnerships with traders or transport workers one–three years older than themselves; some accept “casual” relationship with age mates, others have “casual” relationships with older men. All relationships involve the exchange of gifts and money. Older partners, or “sugar daddies”, are valued, despite the knowledge they are more likely to be HIV positive, because they offer greater financial rewards than age mates. Though far less common, some older women seek relationships with younger men, but are treated with suspicion by young men, who believe they are seeking to “infect” them “maliciously” with AIDS. The community sees these relationships as a source of AIDS in adolescents, and condemn older men, whom they believe to be “killing” the younger generation. Both young men and women are exposure to sexual health risk in their primary partnerships; young men in partnerships with schoolgirls who have concurrent partnerships with older men, unlikely to use condoms and young women with partners who work, and have casual relationships in urban trading centres. Health promotion encouraging partnership with age mates, discouraging sex with older partners and 100% condom use before marriage are most appropriate for out-of-school adolescents in this context.

Delaying sexual debut amongst out-of-school youth in rural southwest Uganda

This paper focuses on ‘sexual debut’ among out-of-school youth in Masaka District, Uganda, factors influencing its timing and assistance young people feel they need to delay sexual initiation. Data were drawn from a sexual health needs assessment using applied anthropological techniques with young people aged 13–19 years. Parents, guardians and community leaders were also consulted. All participants felt that young people begin their sexual lives too early. Young men feel under pressure from friends and older men to prove their masculinity. Most delay further activity after debut and want assistance to resist the pressure. Young womens debut after physical maturation prompts ‘pestering’ for sex from boys and men who offer gifts. After debut, young women remain sexually active but believe younger women need assistance to resist pressure. Programmes are needed to help young people achieve these goals. Structurally, the community needs to develop means of preventing men from pestering young women for sex and of redeveloping both the social role and pathway to marriage for young women who are marrying later than is traditional.