Rick McLean

Aboriginal health worker screening for sexually transmissible infections and blood-borne viruses in a rural Australian juvenile correctional facility.

INTRODUCTION In Australia, Aboriginal youth are disproportionately represented in juvenile detention centres. We assessed the prevalence of sexually transmissible infections (STIs) and blood-borne viruses (BBVs) identified by an Aboriginal Health Worker (AHW)-led screening program delivered to male detainees of a rural juvenile detention centre. METHODS A retrospective review of first screening visit data was performed. Demographic and behavioural data were collected and the prevalence of STI/BBV was assessed. RESULTS Over a 4-year period to November 2004, 101 screens on new medium-to-long-term detainees were performed. The median age of participants was 17 years (range 14-20) and 87% were Aboriginal. Most reported multiple lifetime sexual partners (mean 14, range 0-60) and a minority had used a condom for the last episode of vaginal intercourse. Injecting drug use and non-professional tattoos or piercings were both reported by over one-third of participants, with over 80% reporting previous incarceration. One-quarter of those screened were newly diagnosed with one or more STI/BBV. The most common infection identified was urethral chlamydia (prevalence 16.3%, 95% confidence interval 10.0-25.5%), although the prevalence of newly diagnosed syphilis, hepatitis B and hepatitis C were each over 5%. Many participants remained susceptible to hepatitis B. CONCLUSION An AHW-led STI/BBV screening program identified a large number of asymptomatic and previously undiagnosed infections in this group of young male detainees. Such an education and screening program using skilled Aboriginal staff not affiliated with the correctional system could have a substantial impact on the prevalence of STI/BBV among juvenile detainees.

Students' perceptions of clinical attachments across rural and metropolitan settings

For many years, medical students at the University of Sydney undertook their clinical clerkships in traditional metropolitan teaching hospitals, which were regarded as the ‘gold standard’ for clinical training. In 2001 the university established a rural clinical school at which increasing numbers of students now complete a significant proportion of their medical education. The aim of the study reported here is to examine students’ perceptions of what facilitates their learning in clinical settings and to compare their perceptions across rural and metropolitan settings. Focus groups were conducted to collect students’ views on their experiences of learning in clinical settings. The findings were used to generate a questionnaire with items designed directly from focus‐group data ensuring content validity. The questionnaire was sent to all students in the 2004 cohort. Exploratory factor analysis was used to provide evidence of construct validity. The internal consistency reliability of the questionnaire was assessed using Cronbach’s alpha. Factor scores were computed to compare students’ perceptions across the two settings. Four factors were extracted: (1) clinical teachers’ orientation to teaching; (2) opportunities to develop clinical skills; (3) supportiveness of the clinical setting; and (4) student confidence and sense of self‐efficacy. Students rated the rural experience more highly and positively than the metropolitan hospital experience with regard to all four factors. This study highlights the positive role that rural attachments can play in providing an educationally sound learning experience. The findings are important in the context of both the drive, among medical programs worldwide, to seek out additional and alternative settings for clinical education and the national agenda to foster student interest in rural careers through positive rural training experiences.

Tracking Australian health and medical research expenditure with a PubMed bibliometric method

Objective: To assess Australian health and medical research (HMR) investment returns by measuring the trends in HMR expenditure and PubMed publications by Australian authors.