Judith Crockett

Improving the mental health of drought-affected communities: an Australian model.

Abstract In recent years there has been increasing recognition of the social impact of drought on rural communities. This paper provides an overview of a major mental health program developed in response to persistent severe drought and longer-term social and economic restructuring in New SouthWales agriculture. Led by government and incorporating close collaboration with rural community agencies and services, the program’s design and implementation was informed by existing evidence regarding mental health promotion, illness prevention, early intervention models, disaster management and a series of core project principles and goals based on community development practice. Improvements in mental health literacy and service collaboration and coordination suggest lessons learnt from the program will have applicability to future projects that aim to address mental health needs and promote the capacity of rural communities to adapt to the continuing impacts of future droughts and longer-term climate change.

Patient responses to an integrated service, initiated by community pharmacists, for the prevention of osteoporosis

Objective This study aimed to develop, implement and evaluate an integrated service provided by pharmacists to consumers based on the results of a risk‐assessment survey carried out by the pharmacist and testing of bone mineral density (BMD) by a radiographer. It also investigated whether measurement of BMD in the pharmacy increased the effectiveness of the service and pharmacist referral in terms of adherence to advice and uptake of referral compared with the same service offered without BMD testing.

Outpatient cardiac rehabilitation: Effects on patient improvement outcomes

OBJECTIVE To determine if the Cardiac rehabilitation (CR) program had positive effects on the patient medically as well as effects on pathological risk factors, functional capacity, and mental health; and the extent to which targets for blood pressure (BP) control in patients with hypertension (HT) and diabetes mellitus (DM) are achieved. METHODOLOGY CR participant data was collected from 1st June 2014 until 31st December 2015 (19 months), which included: demographics, medical history, social history, medications, lipid profiles and anthropometric measurements. Additional data was collected on The Patient Health Questionnaire (PHQ-9) factors, and on the participants 6min walk test (6MWT). Study participants were eligible to participate in the study if they attended 10 or more CR program sessions out of 12 at the Calvary Public Hospital Canberra. RESULTS Seventy nine (79) participants participated in the study. Significant reductions in BP (n=79) (p=<0.05), blood LDL cholesterol levels (n=26) (p=<0.05), and improvements in participants PHQ-9 scores (n=79) (p=<0.001), and their 6MWT (n=78) (p=<0.001) were noted. Participants were also able to better manage their medication (p=<0.05). Importantly, results indicated that significant improvements (p=<0.05) were made in DM patients (n=18) diastolic BP, physical ability and depression and anxiety. CONCLUSION A CR program can reduce risk factors associated with CVD, and improves mental health and physical fitness of participants. RESULTS Indicated that the CR program reduces DM patient risk factors through improved physical fitness and reductions in depression and anxiety, leading to reduced risk of future cardiovascular and renal disease.

Equity for government school students: Reclaiming social work services in New South Wales

In Australia, school education is largely a state government responsibility, hence there are varying responses across Australia to the welfare needs of school students. The present study explores the basis for the provision of social work services within schools, particularly the special needs of rural schools, and suggests that NSW school students are disadvantaged by not having access to social work services that might help them overcome some of the educational barriers that they face. The nature of educational barriers is examined and literature on the role of school social workers is reviewed. The authors find that the social justice rhetoric of State and Commonwealth educational agencies is incongruent with NSW school practice.

Maternal health care initiatives: Causes of morbidities and mortalities in two rural districts of Upper West Region, Ghana

Background Maternal and neonatal morbidities and mortalities have received much attention over the years in sub-Saharan Africa; yet addressing them remains a profound challenge, no more so than in the nation of Ghana. This study focuses on finding explanations to the conditions which lead to maternal and neonatal morbidities and mortalities in rural Ghana, particularly the Upper West Region. Method Mixed methods approach was adopted to investigate the medical and non-medical causes of maternal and neonatal morbidities and mortalities in two rural districts of the Upper West Region of Ghana. Survey questionnaires, in-depth interviews and focus group discussions were employed to collect data from: a) 80 expectant mothers (who were in their second and third trimesters, excluding those in their ninth month), b) 240 community residents and c) 13 healthcare providers (2 district directors of health services, 8 heads of health facilities and 3 nurses). Result Morbidity and mortality during pregnancy is attributed to direct causes such urinary tract infection (48%), hypertensive disorders (4%), mental health conditions (7%), nausea (4%) and indirect related sicknesses such as anaemia (11%), malaria, HIV/AIDS, oedema and hepatitis B (26%). Socioeconomic and cultural factors are identified as significant underlying causes of these complications and to morbidity and mortality during labour and the postnatal period. Birth asphyxia and traditional beliefs and practices were major causes of neonatal deaths. Conclusion These findings provide focused targets and open a window of opportunity for the community-based health services run by Ghana Health Service to intensify health education and promotion programmes directed at reducing risky economic activities and other cultural beliefs and practices affecting maternal and neonatal morbidity and mortality.

The use of antenatal care in two rural districts of Upper West Region, Ghana

Background Despite decades of implementation of maternity healthcare programmes, including a focus on increasing the use of antenatal care (ANC) and concomitant birth preparedness and complication readiness (BPCR), the uptake of ANC continues to be below expectations in many developing countries. This has attendant implications for maternal and infant morbidity and mortality rates. Known barriers to ANC use include cost, distance to health care services and forces of various socio-cultural beliefs and practices. As part of a larger study on BPCR in rural Ghana, this paper reflects on the use of ANC in the study areas from rights-based and maternal engagement theoretical perspectives, with a focus on the barriers to ANC use. Methods Mixed methods approach was adopted to collect data from 8 study communities from individual in-depth interviews with 80 expectant mothers and 13 health care professionals, and 24 focus groups comprising 240 community members. The qualitative data followed a thematic analytical method, while the quantitative data was analysed using descriptive statistics. Results The average number of ANC visits were 3.34±1.292, and the majority of expectant mothers (71.3%) enrolled for ANC at the 8th week or later, with the longest delay recorded at the 6th month of gestation. Traditional norms significantly influenced this delay. Likewise, overall use of ANC during pregnancy was shaped by cultural factors related to perceptions of pregnancy, gender-based roles and responsibilities and concerns that ANC would result in an overweighed baby and culturally inappropriate delivery at a health care facility. Conclusion Greater understanding of the sociocultural barriers to ANC is essential if proposed changes in community-specific health education programs are to facilitate early commencement and increased use of ANC.

Services aimed at achieving desirable clinical outcomes in patients with chronic kidney disease and diabetes mellitus: A narrative review

There is a large number of patients with chronic kidney disease (CKD), diabetes mellitus (DM), and hypertension (HT) but whether the targets on blood pressure (BP) control in patients with DM and/or CKD are met is not clear. This narrative review therefore investigated evidence on services aimed at achieving desirable clinical results in patients with CKD and DM, and HT in Australia. Literature pertaining to pathology diagnosis and management of these patients as well as the complexities in management were considered. This involved evidence from PubMed-listed articles published between 1993 and 2016 including original research studies, focusing on randomised controlled trials and prospective studies where possible, systematic and other review articles, meta- analyses, expert consensus documents and specialist society guidelines, such as those from the National Heart Foundation of Australia, American Diabetes Association, the Department of Health, The Royal College of Pathologists of Australasia, and The Australasian College of Emergency Medicine. Based on the literature reviewed, it is yet unknown as to how effective programs, such as diabetes inpatient services, endocrine out-patient services, and cardiac rehabilitation services, are at achieving guideline recommendations. It is also not clear how or whether clinicians are encumbered by complexities in their efforts of adhering to DM, HT, and glucose control recommendations, and the potential reasons for clinical inertia. Future studies are needed to ascertain the extent to which required BP and glucose control in patients is achieved, and whether clinical inertia is a barrier.

Assessment of the efficacy and performance of the New South Wales Rural Mental Health Support line

The Rural Mental Health Support line is a 24-hour 7-day-a-week support service funded by the New South Wales Health Office of Mental Health and Drug and Alcohol, and run by McKesson Asia Pacific in their Sydney call centre. The line was established in 2005 to help cater for the needs of rural people experiencing prolonged drought and locust plagues. It has been overseen by the New South Wales Centre for Rural and Remote Mental Health and forms a component of a statewide Drought Mental Health Assistance Program. It aims to provide farmers and other members of rural communities with quick assistance with mental health problems through the provision of basic triage, referral, self-care advice and brief supportive counselling to callers. While the line performs a different function from the Area Health Service mental health intake lines, it is designed to allow ‘warm transfer’ to these lines if the situation warrants a response from Mental Health Services. Call centre staff responding to calls are mental health professionals who have been trained by people experienced in working with farmers and the impact of the drought, including Department of Primary Industry Drought Support Workers, Rural Financial Counsellors and staff of the New South Wales Centre for Rural and Remote Mental Health. A pilot study into the line’s efficacy and performance between June 2005 and June 2007 was undertaken by Hart in November 2007.