Linda Slack-Smith

Indigenous women and smoking during pregnancy: Knowledge, cultural contexts and barriers to cessation

Despite active tobacco control efforts in Australia, smoking prevalence remains disproportionately high in pregnant Indigenous women. This study investigated the place of smoking in pregnancy and attitudes towards smoking within the broader context of Indigenous lives. Focus groups and in-depth interviews were used to collect data from 40 women, and ten Aboriginal Health Workers (AHWs) in Perth, Western Australia. The research process and interpretation was assisted by working with an Indigenous community reference group. Results demonstrated the impact of contextual factors in smoking maintenance, and showed that smoking cessation even in pregnancy was not a priority for most women, given the considerable social and economic pressures that they face in their lives. Overwhelmingly, smoking was believed to reduce stress and to provide opportunities for relaxation. Pregnancy did not necessarily influence attitudes to cessation, though womens understanding of the consequences of smoking during pregnancy was low. Reduction of cigarette intake during pregnancy was seen as an acceptable and positive behaviour change. The AHWs saw their role to be primarily one of support and were conscious of the importance of maintaining positive relationships. As a result, they were often uncomfortable with raising the issue of smoking cessation with pregnant women. The stories of Indigenous women and AHWs provided important insight into smoking during pregnancy and the context in which it occurs.

Breast cancer and the uptake of mammography screening services by women with intellectual disabilities

BACKGROUND It is estimated that approximately 50% of women in Australia with intellectual disability will live to 70 years of age and as a result many will fall within the age group at highest risk for breast cancer (50-69 years). METHODS Subjects were identified through the Western Australia Disability Services database. To determine the number of women diagnosed with breast cancer during the period 1982-2000, individual records (n = 2,370) were linked to the Western Australia Cancer Registry and the Mammography Screening Registry. RESULTS The incidence of breast cancer among women with intellectual disability was 64.0 per 100,000 person-years, by comparison with 146.7 per 100,000 person-years in the general population. The uptake of breast cancer screening was examined in a subgroup of 380 women, 34.7% of whom had used mammographic screening, as opposed to 54.6% screening uptake in the general population. Failure to use screening services was highest in women who were unmarried, and was positively associated with severity of intellectual disability, presence of physical disabilities, and urban residence. CONCLUSIONS The lower incidence of breast cancer in women with intellectual disability may in part be attributable to decreased life expectancy, but it also appears to reflect significant under utilization of the readily available screening services.

Dispensing patterns and pregnancy outcomes for women dispensed selective serotonin reuptake inhibitors in pregnancy

BACKGROUND The safety of selective serotonin reuptake inhibitors (SSRIs) during pregnancy remains uncertain. The purpose of this study was to investigate dispensing patterns and pregnancy outcomes for women dispensed an SSRI in pregnancy. METHODS Using data linkage of population-based health datasets from Western Australia and a national pharmaceutical claims dataset, our study included 123,405 pregnancies from 2002 to 2005. There were 3764 children born to 3703 women who were dispensed an SSRI during their pregnancy. RESULTS A total of 42.3% of the women were dispensed an SSRI in each trimester, and 97.6% of the women used the same SSRI throughout the first trimester without switching. The women who were dispensed an SSRI were more likely to give birth prematurely (adjusted odds ratio [aOR], 1.4; 95% confidence interval [CI], 1.2-1.7), to have smoked during the pregnancy (OR, 1.9; 95% CI, 1.8-2.1), and parity>1 (OR, 1.7; 95% CI, 1.5-1.8). The singletons were found to have a lower birth weight than expected when other factors were taken into account (OR, 1.2; 95% CI, 1.1-1.3). There was an increased risk of major cardiovascular defects (OR, 1.6; 95% CI, 1.1-2.3). The children of women dispensed citalopram during the first trimester had an increased risk of vesicoureteric reflux (OR, 3.1; 95% CI, 1.3-7.6). Children born to women dispensed sertraline had a higher mean birth weight than those born to women dispensed citalopram, paroxetine, or fluoxetine. This pattern was also seen in birth length. CONCLUSIONS Most women were dispensed the same SSRI throughout their pregnancy. We have confirmed previous findings with an increased risk of cardiovascular defects and preterm birth. New findings requiring confirmation include an increased risk of vesicoureteric reflux with the use of citalopram.

Pharmacovigilance in pregnancy using population-based linked datasets

National dispensing data for subsidised prescription medicines have recently been approved for linkage to the population‐based health datasets in Western Australia (WA), creating the capacity to study how these medicines are used and their impact on pregnancy outcomes.

Hospitalisations from birth to 5 years in a population cohort of Western Australian children with intellectual disability

Aims: To describe the hospitalisation history in the first five years of life for all children born in Western Australia (WA) between 1983 and 1992 and diagnosed with intellectual disability (ID). Methods: Unit record linkage of the WA Midwives Collection, WA Intellectual Disability Database, and the WA Hospital Morbidity Dataset provided the population database of WA born children with and without ID. Affected children were divided into those co-affected with autism spectrum disorders (ASD), and those whose ID had or had no known biomedical cause. Those without a biomedical cause were further subdivided into mild–moderate and severe categories. Results: On average, ID affected children were more likely than non-affected children to be admitted to hospital (RR: 1.64; 95% CI 1.6 to 1.7), on more occasions (5.3 versus 2.2 admissions), for longer (29.6 versus 8.3 days), and for a larger range of clinical diagnoses. The only exception was the group of children co-diagnosed with ASD whose hospitalisation profile resembled more that of non-affected children. Conclusions: This total population study is unique because of the availability of the system of linkable population registers and administrative health databases in WA. The results indicated that this vulnerable population of children with ID has substantial medical needs. This paper points to the need for authorities to develop supportive programmes for this population especially in the current climate of de-medicalisation of ID. More research is not only needed on the welfare of the affected children but also on the impact of the substantial medical and other needs of affected children on the rest of their immediate and extended families.

Linking a pharmaceutical claims database with a birth defects registry to investigate birth defect rates of suspected teratogens

Data linkage of population administrative data is being investigated as a tool for pharmacovigilance in pregnancy in Australia. Records of prescriptions of known or suspected teratogens dispensed to pregnant women have been linked to a birth defects registry to determine if defects associated with medicine exposure can be detected.

Understanding the use of breast cancer screening services by women with intellectual disabilities.

Summary.Objectives: The uptake of mammography for breast cancer screening is considerably lower among women with intellectual disability than for women in the general population. The purpose of the present study was to investigate carer perceptions of barriers and enablers to mammography use by these women.Methods: To determine the reasons why women with intellectual disability are not utilising screening services, a series of focus groups were held with social trainers working in accommodation provided for people with intellectual disability.Results: The major themes identified included the need for a medical referral or invitation from the mammography service to motivate people to attend; the belief that many women with intellectual disability would not understand the procedure or why it needs to be done and therefore would experience fear and anxiety to a greater extent than women in the general population; and that physical disabilities comorbid in many of the women would limit their ability to be adequately accommodated by the machines used to take a mammogram.Conclusions: The social trainers agreed that many of the barriers to screening would be difficult to overcome and supported alternative strategies to mammography, such as clinical breast examination.Zusammenfassung.Die Nutzung von Brustkrebsvorsorgeuntersuchungen von Frauen mit geistiger BehinderungFragestellung: Frauen mit geistiger Behinderung nehmen eine Mammographie als eine Vorsorgeuntersuchung von Brustkrebs erheblich weniger in Anspruch als der generelle Durchschnitt von Frauen in der Gesamtbevölkerung. Die Absicht dieser Studie bestand darin, die von Sozialbetreuern wahrgenommenen Hinderungs- und Erleichterungsgründe im Zusammenhang von Frauen mit geistiger Behinderung und deren Nutzung von Mammographien zu untersuchen.Methode: Um die Gründe genauer zu bestimmen, warum Frauen mit geistiger Behinderung die Vorsorgeuntersuchungen nicht in Anspruch nehmen, wurde dieses Thema in einer Reihe von Arbeitsgruppen mit Sozialbetreuern, die in betreuten Wohneinrichtungen für geistig Behinderte arbeiten, diskutiert.Ergebnisse: Wesentliche Gründe, die herausgearbeitet wurden umfassen: Die Notwendigkeit von ärztlichen Überweisungen oder Einladungen von Mammographie-Einrichtungen, um die Frauen zu motivieren, sich untersuchen zu lassen; die Annahme, dass viele Frauen mit geistiger Behinderung das Verfahren selbst und die Gründe für eine Mammographie nicht verstehen können und daher wesentlich grössere Unsicherheit und Ängste durchleben als Frauen ohne geistige Behinderung; und dass körperliche Behinderungen, die bei vielen Frauen mit einer geistigen Behinderung einhergehen, weitere einschränkende Folgen haben, da Apparate, die für eine Mammographie benutzt werden, körperlich behinderten Frauen nicht immer adäquat Platz bieten können.Schlussfolgerung: Die Sozialbetreuer stimmten zu, dass viele der Hürden für eine generelle Mammographie bei geistig behinderten Frauen schwierig zu überwinden wären und unterstützten Alternativprogramme, wie z.B. klinische Brustuntersuchungen.Résumé.Dépistage du cancer du sein chez les femmes souffrant d’un handicap mentalObjectif: L’usage de la mammographie pour dépister le cancer du sein est beaucoup moins fréquent chez les femmes souffrant d’un handicap mental que dans la population féminine en général. Le but de l’étude actuelle était d’examiner les perceptions d’aide familiale de barriéres et enablers à l’utilisation de mammographie par ces femmes.Méthode: Une série de dicussions de groupe ont été organisées afin de déterminer les raisons pour lequelles les femmes souffrant d’un handicap mental n’utilisent pas les services de dépistage. Ces discussions ont été dirigées par des formatrices attachées aux logements pour personnes handicappées.Résultats: Les discussions de groupe ont révélé l’importance pour ces femmes d’être conseillées par leur médecin ou d’être sollicitées par le service de mammographie, un élément important étant la difficulté pour les femmes handicappées de comprendre la procédure et son importance et donc une tendance à éprouver plus d’anxiété que la population féminine en général. Il est aussi apparu que des handicaps physiques dont souffrent aussi beaucoup de ces femmes rendent difficile l’utilisation des appareils de dépistage.Conclusions: Les formatrices confirment que beaucoup d’obstacles au dépistage du cancer par la mammographie sont virtuellement insurmontables et favorise d’autres stratégies telles qu’un examen médical des seins.

How Can the Internet Help Parents of Children With Rare Neurologic Disorders

The objective of this study was to determine the value of an e-mail listserv for parents of children with Rett syndrome, a rare neurologic disorder. This Web-based survey was completed by parents and carers. The setting was an e-mail listserv established by the International Rett Syndrome Association for parents of children with Rett syndrome and other interested persons. The participants included members of the e-mail listserv Rettnet. The main outcome measures were the perceived advantages and disadvantages of the listserv, overall rating of usefulness, and reasons for satisfaction or dissatisfaction. Most (81.5%) of the participants felt that Rettnet provided helpful advice concerning their childs management. They also indicated that Rettnet was useful in dealing with their childs education and as a source of carer support. They rated it highly (mean 8.1 on a scale of 1 to 10), and the most common reason given for recommending the service to other parents was the emotional support provided. E-mail listservs can play an important role in disseminating information and providing networking and support to parents of children with rare disorders. Their impact and influence warrant attention from health professionals, including neurologists. ( J Child Neurol 2004; 19:902-907).

Oral health care issues in aged care facilities in Western Australia: resident and family caregiver views

OBJECTIVE To investigate resident and family perceptions and attitudes towards oral health care and access to dental services for aged care facility residents. METHOD Focus groups and individual interviews with residents and family caregivers were conducted at aged care facilities in the Perth Metropolitan Area, Western Australia. RESULTS There were 30 participants from twelve aged care facilities (21 residents and nine family caregivers). Five focus groups comprising both residents and family caregivers were conducted in addition to three face-to-face interviews with residents. Both groups considered oral health very important to overall health and quality of life. Family caregivers noted a lack of dental check-ups and specialised professional oral care, particularly in high-care facilities. Low care residents were more likely to have regular dental check-ups or dental treatment and off-site dental visits were straightforward due to their mobility and family member assistance. Family caregivers noted time limitations and lack of expertise in oral health care amongst staff in high-care facilities, and the challenges of maintaining oral care for residents with poor mobility or cognitive impairment. It was considered important that staff and management liaise with family caregivers and family members in provision of oral care. CONCLUSION Regular oral care, assessment and treatment were considered limited, particularly for residents in high care. There is a need for comprehensive, ongoing oral health programmes involving appropriately trained and empathetic dental health professionals and staff to improve oral health care in Perths aged care facilities.

The relationship between demographic and health-related factors on dental service attendance by older Australians

Objective To determine factors associated with dental attendance by those of 60 years or older in a population-based sample.Design Cross-sectional national health survey.Setting The study used data from the Australian 1995 National Health Survey, which consisted of people interviewed by households.Subjects and Methods A total of 7,544 eligible respondents randomly selected by households from defined statistical areas.Main outcome measures The main outcome investigated in this study was having had a dental visit in the previous 12 months.Main results Age, income, level of social disadvantage, level of education, uptake of private health insurance, smoking, exercise, self assessment of health and having a health concession card all independently influenced the attendance ratios. In combination, after adjusting for all other factors, factors associated with having visited a dentist for males were age, years of schooling, level of social disadvantage, exercise level index, possession of a health concession card and smoking status. Factors associated with having visited for females were age, education, exercise, smoking status and some levels of the interaction between possession of a health concession card and level of social disadvantage.Conclusions The strong influence of age, education, exercise and smoking status indicated a need to target dental services towards those elderly persons in low attendance groups, which mostly represented disadvantaged groups.