Biomedical subjects
Publications and source records attributed to Jon Adams.
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INTRODUCTION: While it is well recognized that rural background medical students are more likely to enter rural practice than urban background, students' research shows that 34% to 67% of rural doctors have urban backgrounds. This article explores the factors influencing urban background medical students' interest in rural practice. METHOD: The study used a qualitative design employing focus groups and semi-structured interviews. Data were collected at three Australian universities and a national student rural health conference, and the participants were 82 first and final year medical students who participated in focus groups, and 49 who were interviewed individually. Data were analysed using the N6 computer package to manage the data. Forty-three urban background students indicated an interest in rural practice and the data presented in this article relate to this group of students. RESULTS: This article presents an analysis of data from one part of a larger project conducted from 2002 to 2004 investigating medical student career choice. The students' level of interest in rural practice depends on an interaction between student and location factors and other external influences with students seeking to match their needs and interests with locations. Some are 'predisposed' to develop interest in rural practice via their familiarity with rural areas, level of altruism, interest in generalist work, and interest in certain leisure activities. Exposure to rural locations provides knowledge about different places. Students recognize differences between rural locations in relation to the size of town and the remoteness of the town, and they seek specific rural locations which will match their values and interests. Existing social relationships can be enabling or limiting factors in the student's ability to follow through their interest in rural practice and to enter rural practice, and are important in the students finding a match between themselves and an appropriate location. CONCLUSIONS: Exposure of urban background students to rural practice and a range of rural locations generates an interest in rural practice among many urban background students. This exposure may increase the number of students who become interested in rural practice and decide to enter rural practice. Further quantitative research is required to test the findings from this exploratory qualitative study.
PURPOSE: The aim of this study is to examine the prevalence of chiropractic and osteopathy use and the profile of chiropractor/osteopath users among middle-aged Australian women. METHODS: This article reports on research conducted as part of the Australian Longitudinal Study on Women's Health. The focus of this article is the middle-aged women who responded to Survey 3 in 2001 when they were between the ages of 50 and 55 years. The demographic characteristics, health status, and health service use of chiropractic/osteopathy users and nonusers were compared using chi2 tests for categorical variables and t tests for continuous variables. RESULTS: We estimate that 16% of middle-aged women consult with a chiropractor or osteopath (after adjustment for the oversampling of rural women). Area of residence, education, and employment status were all statistically significantly associated with chiropractic and osteopath use. Specifically, women who live in nonurban areas were more likely to consult a chiropractor or osteopath, compared with women who live in urban areas. Women are significantly more likely to consult with a chiropractor/osteopath if they have had a major personal injury in the previous year, and women who use chiropractic/osteopathy are also high users of 'conventional' health services. CONCLUSIONS: Chiropractic/osteopathy use among women in Australia is substantial and cannot be ignored by those providing or managing primary health care services for women. It is essential that the interface and communication between chiropractors/osteopaths and other health care providers be highlighted and maximized to establish and maintain effective overall patient coordination and management.
OBJECTIVES: The aim of this study was to explore the use of complementary and alternative medicine (CAM) therapies in patients with acne, psoriasis, or atopic eczema and the attitudes about CAM of these patients. DESIGN: This was a qualitative study, utilizing semistructured interviews and thematic analysis. SETTING: Patients were recruited from the practices of dermatologists and general practitioners in a noncapital Australian city. RESULTS: Twenty-six (26) interviews were conducted with patients with acne, 29 with psoriasis, and 7 with atopic eczema. Use of CAM therapies was common. Participants tended to value CAM over orthodox therapies because of their preference for natural approaches to their skin diseases and the perceived lesser potential for adverse effects of CAM therapies. Respondents with acne were more confident about the efficacy of CAM than were those with psoriasis or eczema. The resulting sense of control attenuated psychologic sequelae of acne. This was not apparent in psoriasis or eczema. CONCLUSIONS: Practitioners should be cognizant of the likely use of CAM and its implications (including the potential for attenuation of psychologic morbidity) in their patients who have skin diseases.
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Complementary and alternative medicine (CAM) is increasingly popular amongst midwives in Australia. A growing number of hospital midwives are personally integrating one or a range of CAM within their midwifery practice. Despite this trend we still know little about CAM in midwifery, particularly at a grass-roots level. This paper reports findings from one section of a larger exploratory study examining grass-root practitioners' understandings and experiences of complementary therapies in nursing and midwifery. Thirteen in-depth interviews were conducted with midwives working in New South Wales public hospitals and currently integrating CAM within their general midwifery practice. Analysis illustrates how midwives' explanations of, and affinity claims regarding, CAM feed into wider ongoing issues relating to professional autonomy and the relationship between midwifery and obstetrics.
OBJECTIVE: To establish the prevalence and characteristics of occupational violence in Australian urban general practice, and examine practitioner correlates of violence. DESIGN, SETTING AND PARTICIPANTS: Cross-sectional questionnaire survey mailed to all members (n = 1085) of three urban divisions of general practice in New South Wales in August and September 2004. The three divisions were chosen to provide a range of socioeconomic status (SES) demographics. MAIN OUTCOME MEASURES: Occupational violence towards general practitioners during the previous 12 months. RESULTS: 528 GPs returned questionnaires (49% response rate). Of these, 63.7% had experienced violence in the previous year. The most common forms of violence were "low level" violence - verbal abuse (42.1%), property damage/theft (28.6%) and threats (23.1%). A smaller proportion of GPs had experienced "high level" violence, such as sexual harassment (9.3%) and physical abuse (2.7%). On univariate analysis, violence was significantly more likely towards female GPs (P < 0.001), less experienced GPs (P = 0.003) and GPs working in a lower SES status area (P < 0.001), and among practice populations encompassing greater social disadvantage (P = 0.006), mental health problems (P < 0.001), and drug- and alcohol-related problems (P < 0.001). Experience of violence was greater for younger GPs (P = 0.005) and those providing after-hours care (P = 0.033 for after-hours home visits). On multivariate analysis, a significant association persisted between high level violence and lower SES area (odds ratio [OR], 2.86), being female (OR, 5.87), having practice populations with more drug-related problems (OR, 5.77), and providing home visits during business hours (OR, 4.76). More experienced GPs encountered less violence (OR, 0.77) for every additional 5 years of practice. CONCLUSION: Occupational violence is a considerable problem in Australian urban general practice. Formal education programs in preventing and managing violence would be appropriate for GPs and doctors-in-training.
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The aim of this research was to assess the prevalence and predictors of complementary and alternative therapy (CAT) use among cancer patients in Australia. A total of 1492 cancer patients attending nine major public cancer treatment centers in New South Wales, Australia, were asked to complete the Supportive Care Needs Survey. Of the 1354 consenting patients, 888 (65%) returned a completed survey. This article reports the secondary analyses of the survey data, specifically focusing on CAT use. For all cancers, 17.1% of patients were using at least one CAT. The two main demographic characteristics of CAT users were gender and age, where females were more likely to use CAT than males and that CAT use declined as age increased. Time since diagnosis was identified as the only significant clinical predictor of CAT use, where CAT use increased with time until 5 years since diagnosis. Our research shows that herbal treatments and naturopathy are the most popular CAT used by cancer patients (constituting over 30% of all CAT use recorded). The use of CAT among cancer patients is a significant issue in cancer care, especially considering the potential interactions between CAT and conventional medicines. Given that many cancer patients may not be aware of potential risks associated with these interactions it is important that oncologists and others involved in cancer patient care are informed about CAT and its use amongst their patients.
BACKGROUND: Isotretinoin is an effective acne medication. The evidence for it causing depression and suicide, although widely publicised, remains uncertain. METHODS: Twenty-six semi-structured interviews with patients with acne were coded and subjected to thematic analysis. RESULTS: Isotretinoin was perceived to be effective but dangerous. The most well known adverse effects were depression and suicide. DISCUSSION: The overemphasis of serious psychological adverse events in patients might discourage the use of isotretinoin by those who might benefit from it.
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Complementary and Alternative Medicine (CAM) has become increasingly popular amongst healthcare consumers world-wide. As such, CAM is now an important public health issue with taking non-prescription medications. This paper constitutes an exploratory investigation into CAM use over time. As such, there is need for further research to provide in-depth examination of the adoption and relinquishment of CAM use over a longer time period. serious implications for healthcare organization and delivery. While previous studies have provided a profile of CAM users, there remains very limited analysis of CAM consumption over time. The purpose of this paper is to describe the changing use of CAM practitioners over time by 11,454 mid-age women in the Australian Longitudinal Study on Women's Health. Over the study period (1996-1998), 10% of women adopted the use of CAM and 9% relinquished CAM. The predominant factor found to be predictive of CAM adoption was changes in health status. Specifically, those women experiencing more illness over time are more likely to adopt CAM than those experiencing no change or better health. CAM relinquishment was associated with use of non-prescription medications, where women were more likely to relinquish CAM if they never used non-prescription medications or if they stopped.
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OBJECTIVES: To compare the characteristics of complementary and alternative medicine (CAM) users and non-users among Australian women. DESIGN: Cross-sectional postal questionnaire conducted during 1996, forming the baseline survey of the Australian Longitudinal Study on Women's Health. PARTICIPANTS: Women aged 18-23 years (n = 14 779), 45-50 years (n = 14 099) and 70-75 years (n = 12 939), randomly selected from the Health Insurance Commission database, with over-sampling of women from rural and remote areas of Australia. MAIN OUTCOME MEASURES: Consultation with an alternative health practitioner in the 12 months before the survey. RESULTS: Women in the mid-age cohort were more likely to have consulted an alternative health practitioner in the previous year (28%) than women in the younger cohort (19%) or older cohort (15%). In all age groups, CAM users were more likely than CAM non-users to reside in non-urban areas, to report poorer health, have more symptoms and illness, and be higher users of conventional health services. CONCLUSIONS: Women in non-urban Australia are more likely to use CAM but do so in in parallel with conventional health services.
The use of complementary and alternative medicine (CAM) in the general population has grown considerably in recent years. However, little is known about the prevalence of CAM use amongst women with cancer. Our research provides the first step in addressing this gap in knowledge by reporting on a survey of 9375 Australian women aged 73-78. We found that, for all cancers combined, 14.5% of women with cancer consulted an alternative practitioner. This percentage varied depending on the type of cancer: skin (15.0%), breast (11.5), bowel (8.8%), and other (16.5%). Our findings suggest that CAM is now a significant practice issue for those delivering cancer-patient care and management.