Marisa Gilles

Prison health and public health responses at a regional prison in Western Australia

Objective: To describe the health of inmates in a Western Australian regional prison and evaluate the coverage of public health interventions.

Reintegrating Coastal Development and Public Health in Western Australia

This article presents three case studies that take a socio-ecological perspective to highlight an interconnectedness between the environment, human participation and organization, and public health, in Western Australian marine, coastal, and near-coastal places. We examine the degree to which coastal zone planning and management interact with public health practitioner, and the consequences of this interaction for biophysical surroundings and human health. The case studies demonstrate the limited roles the public health sector has played, and the indispensable expanded role it might play, in what is traditionally seen as the domain of natural resource management. A socio-ecological analysis highlighted the value of decision-making processes for coastal developments that emphasize dialogue, place, public health issues, resource distribution, as well as ecology. These adaptive capabilities offer scope for understanding the consequences of coastal planning and management actions on both the biophysical condition of the environment and human health, break the cycles of reaction, and provide an alternative framework for regulating the developmental expansion of the Western Australian coastline.

Perinatal HIV transmission and pregnancy outcomes in indigenous women in Western Australia

Background:  Implementation of obstetric and neonatal interventions has reduced mother to child transmission of HIV. Health outcomes for Aboriginal people are often worse than for non‐Aboriginal people; was this the case for HIV infection in pregnancy?

“Slowed right down”: Insights into the use of alcohol from research with Aboriginal Australians living with HIV

OBJECTIVE To describe the role that alcohol plays in the lives of Aboriginal people living with HIV in Western Australia. METHODS Semi-structured interviews were conducted between February and September 2003 with 20 Aboriginal people who were HIV-positive; almost half the total number of Aboriginal people known to be living with HIV in Western Australia at that time. The main purpose of the study was to document their experiences of living with HIV and aspects of health service delivery. RESULTS Drinking emerged as a key theme in the majority of interviews. Alcohol had a major role in disinhibition and risk-taking behaviour of both the participants and those they socialized with. It was perceived as a commodity, a way of altering reality, and a pathway through which social connection was maintained and was central to the common narratives of loss, chaos and transformation. Post-diagnosis, alcohol helped with disclosure and temporary blunting of distress as a result of the HIV diagnosis. It also contributed to a lack of capacity to comply with anti-retroviral therapy although narratives also included personal growth and restoration of physical health. CONCLUSIONS Effective strategies to reduce risk of STIs and HIV and prevent other health problems need to address substance use issues but this also requires amelioration of the structural inequalities that make minority groups vulnerable.

Text 2 treat - using SMS to recall clients for treatment.

Prompt treatment of patients with genital Chlamydia shortens the period of infectivity with benefits to the individual and wider community. With large numbers of genital Chlamydia notifications, predominantly occurring in younger age groups, short message service (SMS) is a potentially useful technology for recalling this patient group quickly and efficiently. In the sexual health unit of Population Health-Midwest, Western Australia, genital Chlamydia cases were recalled for treatment with an SMS. Ninety-four per cent (n1⁄4 60) of clients responded to the SMS, with 84% (n1⁄4 54) responding on the same day they were contacted. All clients (n1⁄4 64) were treated for their infection, with 72% (n1⁄4 46) having directly-observed treatment within one day of being informed of their results via SMS. Our results suggest that SMS is a highly effective, youth-friendly communication tool.Prompt treatment of patients with genital Chlamydia shortens the period of infectivity with benefits to the individual and wider community. With large numbers of genital Chlamydia notifications, predominantly occurring in younger age groups, short message service (SMS) is a potentially useful technology for recalling this patient group quickly and efficiently. In the sexual health unit of Population Health-Midwest, Western Australia, genital Chlamydia cases were recalled for treatment with an SMS. Ninety-four per cent (n = 60) of clients responded to the SMS, with 84% (n = 54) responding on the same day they were contacted. All clients (n = 64) were treated for their infection, with 72% (n = 46) having directly-observed treatment within one day of being informed of their results via SMS. Our results suggest that SMS is a highly effective, youth-friendly communication tool.

Audit of opportunistic immunisation of paediatric inpatients in rural Western Australia.

Figure 1 illustrates the number and complexity of tasks, many of which occurred in parallel across jurisdictions. The greatest delays were in developing agreements between data providers and gaining approvals for national linkage. Overall, the approvals stage(s) took more than two years; each linkage phase took six months; while the extraction and supply of data to the researcher took a further three months. Although data analysis and reporting of results extended over a 24-month period, this was not continuous.

Violence in the lives of incarcerated aboriginal mothers in Western Australia

Drawing on in-depth interviews with incarcerated Aboriginal and Torres Strait Islander mothers in Western Australia, we report on the women’s use of violence in their relationships with others. Results reinforce that Aboriginal women are overwhelmingly victims of violence; however, many women report also using violence, primarily as a strategy to deal with their own high levels of victimization. The “normalization” of violence in their lives and communities places them at high risk of arrest and incarceration. This is compounded by a widespread distrust of the criminal justice system and associated agencies, and a lack of options for community support.

Findings from a clinical audit in regional general practice of management of patients following acute coronary syndrome

Patients with acute coronary syndrome (ACS) require ongoing treatment and support from their primary care provider to modify cardiovascular risk factors (including diet, exercise and mood), to receive evidence-based pharmacotherapies and be properly monitored and to ensure their take-up and completion of cardiac rehabilitation (CR). This study assesses adherence to National Heart Foundation guidelines for ACS in primary care in a regional centre in Western Australia. Patients discharged from hospital after a coronary event (unstable angina or myocardial infarction) or a coronary procedure (stent or coronary artery bypass graft) were identified through general practice electronic medical records. Patient data was extracted using a data form based on National Heart Foundation guidelines. Summary statistics were calculated and reported. Our study included 22 GPs and 44 patients in a regional centre. In total, 90% (n=39) of discharge summaries recorded medications. Assessment of pharmacological management showed that 53% (n=23) of patients received four or more classes of pharmacotherapy and that GPs often augmented medication beyond that prescribed at discharge. Of 15 smokers, 13 (87%) had advice to quit documented. Minimal advice for other risk-factor modification was documented in care plans. Patients with type 2 diabetes (n=20) were 70% more likely to receive allied health referral (P=0.02) and 60% more likely to receive advice regarding diet and exercise (P=0.007). However, overall, only 30% (n=13) of those eligible were referred to a dietician, and only 25% were referred to CR (n=10) with six completing CR. Although most GPs did not use standardised tools for mood assessment, 18 (41%) patients were diagnosed as depressed, of which 88% (n=16) were started on antidepressants and 28% (n=6) were referred to a psychologist. Although pharmacotherapy, mood management and smoking cessation management generally followed recommended guidelines, risk factor management relating to diet and exercise by GPs require improvement. Detailed care plans and referral to CR and allied health staff for patient support is recommended.

Improving the management of acute coronary syndrome for Aboriginal and non‐Aboriginal patients in a regional hospital

Objectives: To determine inequities in clinical adherence to national diagnostic and management guidelines for acute coronary syndrome (ACS) for Aboriginal and non‐Aboriginal ACS patients at a regional hospital.