Meegan Kilcullen

Fetal autopsy and closing the gap

Over the past 30 years, the perinatal mortality rate (PMR) in Australia has been reduced to almost a quarter of that observed in the 1970s. To a large extent, this decline in the PMR has been driven by a reduction in neonatal mortality. Stillbirth rates have, however, remained relatively unchanged, and stillbirth rates for Aboriginal or Torres Strait Islander mothers have remained approximately twice that for non‐Indigenous women over the last 10 years. The causes for this difference remain to be fully established. Fetal autopsy is the single most important investigative tool to determine the cause of fetal demise. While facilitators and barriers to gaining consent for autopsy have been identified in a non‐Indigenous context, these are yet to be established for Indigenous families. In order to address the gap in stillbirths between Indigenous and non‐Indigenous mothers, it is essential to identify culturally appropriate ways when approaching Aboriginal and Torres Strait Islander families for consent after fetal death. Culturally safe and appropriate counselling at this time provides the basis for respectful care to families while offering an opportunity to gain knowledge to reduce the PMR. Identifying the cause of preventable stillbirth is an important step in narrowing the disparity in stillbirth rates between Indigenous and non‐Indigenous mothers.

Cultural identity and mental health: Australian Aboriginal and Torres Strait Islander health and wellbeing

Background: Theorised pathways in an ‘extended’ common-sense model of illness representations (CSM) in those affected by Irritable Bowel Syndrome (IBS) were examined. Analysis contrasted between those using complementary medicines (CAM-users) and those not using CAM (non-users). Methods: A web-based cross-sectional survey. Participants (n=653) were recruited from an IBS self-help network and other online illness discussion forums and assessed on the IPQ-R, the BMQ-General, the Brief-COPE and IBS-QOL. Findings: CAM-users reported poorer quality of life compared to non-users. Stronger perceptions of illness consequences and emotional representations were strongly correlated with reduced quality of life and poorer emotional outcomes in both groups. Self-blame and behavioural disengagement partially mediated the pathway from perception to outcome. Discussion: Findings suggest consistency with CSM theory. The detected influence of representations on quality of life (via coping strategies) suggests health psychologists could address components of illness perceptions to improve quality of life in those affected by IBS.Background: Psychological preparation has been demonstrated to improve post-operative outcomes including pain and health care resource use. This systematic review (registered with the Cochrane Anaesthesia Review Group) will investigate which methods of preparation are effective and for which outcomes. Economic data will be reviewed where available. Methods: Randomised controlled trials (RCTs) of adults undergoing elective surgery under general anaesthesia are included. Papers are identified using electronic searches, reference lists and contact with authors of studies to identify unpublished research. Expected results: In a meta-analysis including 38 RCTs, Johnston and Vogele (1993) found psychological preparation to be effective in improving various postoperative outcomes. It is expected that this up-dated review will provide further evidence about which techniques are effective because more studies are now available. Current stage of work: Papers are being screened for inclusion. Discussion: Identifying effective pre-surgical interventions may result in improved patient outcomes and healthcare resource use.[Extract] Background: Qualities of resilience have been strongly identified within farming populations. This resilience is being challenged, with high suicide rates raising concerns about the mental health of the farming population. This research explored those factors which impacted the resilience of farming families of Australia. Methods: Interviews were conducted (N=53 participants) and analysed using Grounded Theory and Content Analysis. Based on qualitative findings, a subsequent sample (N=278) of farming families from across Australia completed the survey. Measures of stressors, work-life balance, coping, buffering characteristics and well-being were distributed. Findings: Outcomes suggested themes of commitment and identification with farming helped build resilience. Path analysis indicated that buffering characteristics mediated and moderated the impact of stressors and role interference on indicators of well-being, χ² (18)=23.98, p=0.156. Discussion: Recommendations were made for raising awareness to the farming community of the risk factors for poor health and suggestions for increasing the resilience of groups at-risk of poor well-being.Resiliance and Health - 26th Conference of the European Health Psychology Society, Prague, Czech Republic, 21st - 25th August 2012Using two behavioral risk tasks (Balloon Analogue Risk Task BART; Lejuez et al. 2002 and Columbia Card Task, CCT; Figner et al. 2009) that mimic important features of real-world risk taking behaviors, we investigated the effects of different types of negative affect on risk taking. Methods: Participants (N¼50) were first administered the Hospital Anxiety and Depression Scale (HADS; Zigmond et al. 1983). One month later, they completed the BART and the cold CCT, in counterbalanced order. State mood was assessed before participants played the CCT and BART. Findings: Higher levels of anxiety were associated with less risk taking in both tasks; depression was unrelated to risk taking. Hierarchical regression analysis showed that these findings were robust to mood effects. Discussion: Findings from the current study indicated that healthy subjects’ risk taking tendencies vary between anxiety and depression. Implications for prevention of health risks are discussed. 194 EHPS 2012 abstracts Downloaded byBackground: Physical exercise contributes to healthy ageing, and strength training has beenshown to improve independence in older people.Method: Six hundred older people wererandomly selected from ...Background: Conceptual clarification of salutogenesis (Antonovsky 1987) and resilience – what is common and different? Methods: A systematic research synthesis 1992–2010 based on about 1300 papers ...Resiliance and Health - 26th Conference of the European Health Psychology Society, Prague, Czech Republic, 21st - 25th August 2012This conference abstract looks provides an analysis of the behaviour change techniques used in Scottish Government supported behaviour change interventionsBackground: The aim of this research was to examine variables that influence attention to health information in order to develop a predictive model. Methods: Community participants(N=330) were randomly assigned to one of two conditions presenting information about coronary heart disease (CHD) or road accidents. Information was either risk or neutral in valency. Attention to information was measured using a surprise recall task. Other variables measured included perceived risk, optimism, control and coping strategies. Findings: Overall, participants in the CHD condition remembered significantly more risk information than participants in the road condition. Participants in the road condition endorsed significantly lower beliefs in personal control perceptions while also endorsing greater beliefs in other’s control over their own road outcomes. Discussion: While perceived control is usually emphasised as integral in adopting protective behaviours these findings suggest that they are also central in communicating health information.

Mental health and connectedness: exploring Aboriginal and Torres Strait Islander perspectives

Background: Ureaplasmas are the most prevalent bacteria isolated from preterm deliveries and the prognosis for neonates varies depending on the gestation at delivery. Ureaplasmas vary their surface-exposed antigen (MBA, a virulence mechanism) during chronic intra-amniotic infections, but it is not known when changes first occur during gestation. Method: U. parvum serovar 3 (2x10e7CFU) was injected intra-amniotically (IA) into six experimental cohorts of pregnant ewes (of n=7), 3 days (d) or 7d before delivery at either: 100d, 124d or 140d gestation (term=145d). Control ewes received IA 10B broth. Fetuses were delivered surgically and ureaplasmas cultured from amniotic fluid (AF), chorioamnion, fetal lung (FL) and umbilical cord. Ureaplasmas were tested by western blot to demonstrate MBA variation. Results: The highest number of ureaplasmas were recovered from FL at 100d gestation after 3 days of infection (p<0.03). Six of 7(86%) 100d–3d FL demonstrated an ureaplasma MBA variant, but only 17% and 15% of FL showed an MBA variant after 3d infection at 124d and 140d gestation respectively. Greatest variation of the MBA occurred in AF and FL at 124d gestation after 7d infection. The least MBA variation was observed at 140d; however, at this time the most severe histological chorioamnionitis was observed. Conclusions: After intra-amniotic ureaplasma injections, higher numbers of ureaplasmas gained access to the FL at 100d gestation than observed at later gestations. This may exacerbate the adverse outcomes for neonates delivered early in gestation. In late gestation, ureaplasma MBA variation was minimal, but chorioamnionitis was the most severe. Adverse pregnancy outcomes associated with IA ureaplasma infection may vary depending on the duration of gestation, the number of ureaplasmas isolated from the fetal tissues and the degree of MBA variation.