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PubMed1993

Aboriginal and Torres Strait Islander health: current status and recent initiatives. Health and Community Development Branch, Aboriginal and Torres Strait Islander Commission.

Against a background of the appalling health problems experienced by indigenous Australians, the following discussion details the current status of health services for Aboriginal and Torres Strait Islander peoples and recent government and non-government initiatives to address these problems. In many localities, health services are overwhelmed by the tasks confronting them. State and Territory governments, having primary responsibility for the health of all citizens, must act in close cooperation with local communities, the Aboriginal and Torres Strait Islander Commission (ATSIC), regional councils and Aboriginal health services to ensure inequalities are addressed in health service provision to Australia's indigenous people. The Federal government, through ATSIC and the Department of Human Services and Health, has implemented a range of initiatives in order to make a significant contribution to indigenous health and welfare. A primary task remains to implement broader scale changes relevant to Aboriginal and Torres Strait Islander people within the mainstream health services. Mainstream services have the primary responsibility, and are funded on behalf of the whole population, to address health problems in a working partnership with the communities they serve. The Australian Hospital Association and its membership can help to improve the health of indigenous peoples by actively and sensitively working with them in the localities where they live, and through advocacy in the policies and plans that shape the whole of our health system.

Acquired Immunodeficiency Syndrome↗

PubMed1996

Alternative and Complementary Cancer Treatments.

Alternative and complementary therapies differ importantly, and the distinction between the two is crucial for clinical oncologists. "Alternative" or unproven therapies are treatments used independent of surgery, radiation and chemotherapy. They can be dangerous directly and also by delaying patients' receipt of mainstream care. In contrast, complementary therapies typically are adjuncts to mainstream medicine. They can provide symptom control and noninvasive palliation with minimal side effects, improve patients' well-being and enhance cancer medicine. Complementary therapies represent a desired addition and balance to technologically sophisticated cancer care.

Journal Article↗

PubMed1999

Culturalizing health care for a culturally diverse population: the Amish.

Advanced practice nurses (APNs) are often the major source of primary care for culturally diverse groups. Working with patients who have values that differ from the mainstream culture can make delivery of health care complex and challenging. The purpose of this qualitative study was to use grounded theory methods to explore the process by which APNs develop and maintain therapeutic relationships with a culturally unique group, the Amish. Nine APNs who practiced primarily with Amish patients were interviewed about their strategies to promote therapeutic relationships. The process of culturalizing health care emerged as the strategy used by the APNs. Specific themes were learning the culture, developing a relationship, individualizing care, being comfortable with abilities, and working two systems. Rather than expecting patients to conform to the mainstream cultural beliefs and practices, APN informants used a variety of methods that allowed Amish patients to blend self-care practices with conventional (i.e., English care).

Attitude to Health↗

PubMed2000

Voice processing abilities in children with autism, children with specific language impairments, and young typically developing children.

It is well established that people with autism have impaired face processing, but much less is known about voice processing in autism. Four experiments were therefore carried out to assess (1) familiar voice-face and sound-object matching; (2) familiar voice recognition; (3) unfamiliar voice discrimination; and (4) vocal affect naming and vocal-facial affect matching. In Experiments 1 and 2 language-matched children with specific language impairment (SLI) were the controls. In Experiments 3 and 4 language-matched children with SLI and young mainstream children were the controls. The results were unexpected: the children with autism were not impaired relative to controls on Experiments 1, 2 and 3, and were superior to the children with SLI on both parts of Experiment 4, although impaired on affect matching relative to the mainstream children. These results are interpreted in terms of an unexpected impairment of voice processing in the children with SLI associated partly, but not wholly, with an impairment of cross-modal processing. Performance on the experimental tasks was not associated with verbal or nonverbal ability in either of the clinical groups. The implications of these findings for understanding autism and SLI are discussed.

Affect↗

PubMed2002

[Information about cancer treatment and the media].

A 'hopeful' development in cancer treatment (angiostatin) was reported in the Dutch press, which led to considerable disquiet amongst patients. There were no scientific articles that warranted this press publication. It has previously been stated that it is unethical for medical researchers to inform the press about treatments which have not been scrutinized by the medical community. The press on the other hand, should maintain a more responsible attitude toward medical claims and double-check medical information, even when it comes from renowned medical researchers. The main distinction between mainstream medicine and medical quackery is that the former is based on the results of controlled published research. When physicians propagate results in the popular press that have not been critically evaluated by the medical community, the distinction between quackery and mainstream medicine is undermined.

Angiostatins↗

PubMed2001

Eo na Mahu o Hawai'i: the extraordinary health needs of Hawai'i's Mahu.

An overview of health and social issues is presented here regarding Native Hawaiian transgenders. Perhaps due to relatively greater tolerance of gender diversity among Polynesian cultures, approximately 70% of all male-to-female transgenders in Hawai'i are Native Hawaiian. However, the overall climate is one of discrimination and harassment such that transgenders--who tend to be under-educated, under-employed, and medically underserved--may be the most severely impacted of all Native Hawaiians. Lei Anuenue, human immunodeficiency virus (HIV) prevention program for Native Hawaiians, has provided a variety of services for transgenders, including outreach, educational workshops, support groups, HIV testing, and case management. All services are provided by peer leaders who are employed by the program. Data for this article are based on case management, including client self-disclosures and reports of peer staff who knew details of clients' lives having shared with them both generic experiences and specific activities. Information from 100 transgender clients and their case managers indicated that the transgender health profile is far more serious than that of mainstream Native Hawaiians. For example, 74% smoke, 31% use illegal drugs (excluding marijuana), more than 50% have been involved in street or domestic violence, and few individuals over age 50 have been found during three years of outreach. To some extent, employment options limit transgenders to prostitution, drug dealing, and minimum-wage jobs. In addition, a lifestyle of multiple sex partners and lack of opportunities for stable relationships place transgenders at much greater risk for HIV, sexually transmitted diseases (STD), and other infectious and non-infectious diseases as compared to the mainstream Native Hawaiian community. Clients in this study were from O'ahu, primarily from downtown Honolulu, Chinatown, and Wai'anae. Future studies should compare the results of this sample to transgenders from the neighbor islands (especially in rural Hawaiian areas), as well as utilize a structured prospective longitudinal approach.

Adolescent↗

PubMed1994

National pride and multiculturalism.

The author traces trends in attitudes toward ethnic assimilation and multiculturalism in Australia. "'Hard multiculturalism' was promoted by the left-liberal intelligentsia. It valued separate ethnic cultures and denigrated mainstream Australia. It is now being supplanted by 'soft multiculturalism' which values tolerance, acceptance and inclusion, values that have long been central to mainstream Australia."

Acculturation↗

PubMed2003

Mapping the themes of Maori talk about health.

AIM: This paper reports the findings of a qualitative research project that investigated: how Maori talk about health; Maori health; and Maori experiences of interacting with both mainstream and Maori providers of healthcare. METHODS: Twenty eight self-identified Maori were recruited from urban, marae-based healthcare services. Rich descriptions of commonly occurring themes were used to examine participants' experiences, explanations and ideas. RESULTS: Twelve themes provide an overview of how Maori health is conceptualised, the importance of 'traditional' concepts, the experiences of Maori within mainstream healthcare, and Maori health promotion mechanisms. CONCLUSIONS: Providing holistic healthcare to Maori in a respectful and collaborative way will provide opportunities for health professionals to have a positive impact on the health of individuals, their whanau and, in turn, their communities, hapu and Iwi.

Attitude to Health↗

PubMed2002

Representing clinical guidelines in UMl: a comparative study.

Clinical guidelines can be represented using models, such as GLIF, specifically designed for healthcare guidelines. This paper demonstrates that they can also be modelled using a mainstream business modelling language such as UML. The paper presents a guideline in GLIF and as UML activity diagrams, and then presents a mapping of GLIF primitives to UML. The potential benefits of using a mainstream modelling language are outlined. These include availability of advanced modelling tools, transfer between modelling tools, and automation via business workflow technology.

Diabetes Mellitus↗

PubMed2005

Scope for regulation of cigarette smoke toxicity: the case for including charcoal filters.

AIM: To compare the emissions toxicity of two manufactured cigarette brands, one with and one without a charcoal filter, in the light of manufacturers' laboratory research findings on the properties of charcoal filters. METHOD: Emissions of Mild Seven charcoal filter brands, regular (labelled '12 mg tar') and Light (labelled '9 mg tar') purchased in 2004, were compared with those of Holiday Extra-mild brand (9 mg tar, acetate filter), purchased in 2002. All emissions were tested under intensive machine smoking conditions by Labstat International Inc., Kitchener, Ontario. RESULTS: The Mild Seven brands contained a small amount of charcoal, its black granules visible against the white acetate filter. The charcoal filter in the brands tested did not reduce toxicity to the extent expected, though they gave significantly lower emissions for the respiratory-toxicants acrolein (14%-17% lower, p 'less than and equal to' 0.01) and formaldehyde (26-37% lower, p 'less than and equal to' 0.01). Reductions were not significant for acetaldehyde, and actually higher for hydrogen cyanide. Overall, estimated cardiovascular-respiratory toxicity was not reduced, whether based on toxicant emissions or the toxicant to nicotine ratios. Of the packet labels, neither tar yield (mg) nor the descriptors 'mild', 'light', or 'extra-mild', or 'charcoal filter' for these three brands was associated with any reduction of the combined respiratory--and cardiovascular toxicity of mainstream smoke, as measured by leading toxicants tested by the intensive method. Previously secret documents from cigarette companies, including British American Tobacco, reported reductions of 75%-80% in hydrogen cyanide, acetaldehyde, acrolein, and formaldehyde in mainstream smoke from addition of charcoal to the filter. We estimated that an effective charcoal filter could reduce a brand's overall relative toxicity score for identifiable toxicant by over 40%. CONCLUSION: Since 1965, major cigarette firms have known from their chemists that many smoke toxicants, including hydrogen cyanide and acrolein, were removable by manufacturing the cigarette with a charcoal filter. To this day, few brands have charcoal filters. The best known, Mild Seven, contained a token charcoal filter only. In neither Japan nor New Zealand did this brand lower cardiovascular toxicant emissions in smoke. In the Smoke-free Environments Act, Government has the power to lower smoke emissions by regulation, but no regulations are in place. The Act does not give power to add filters to cigarettes, but does give power to lower smoke emissions to the level attainable by using a charcoal filter, which could reduce smoke emission toxicity to a large extent. Regulation to require effective charcoal filters is now long overdue.

Carcinogens↗

PubMed2000

New opportunities, new approaches: serving children with special health care needs under SCHIP.

OBJECTIVE: To identify models for caring for children with special health care needs (CSHCN) under the State Children's Health insurance Program (SCHIP) and to analyze the strengths and weaknesses of each. DATA SOURCE: Site visits in five study States conducted in late 1999. STUDY DESIGN: Approximately 12 to 15 interviews were conducted in each site with state and local-level policymakers, program administrators, providers, and families. DATA COLLECTION: Standard protocols were used across sites to explore a range of key policy variables including eligibility, enrollment , identification, and referral of CSHCN; benefits; service delivery systems; payment mechanisms; and quality assurance and monitoring strategies. PRINCIPAL FINDINGS. Each of the study States' approaches to serving CSHCN represents one of four models: a mainstream approach , a wrap-around model, a service carve out , or a specialized system of care. Special provisions designed to enhance the coverage and accessibility of services beyond those extended to children generally can help to ensure that CSHCN enrolled in SCHIP receive comprehensive, coordinated care. CONCLUSIONS: The mainstream approach , wh ile aimed at providing comprehensive care for all children , could not identify CSHCN or monitor their care. Wrap-around models, while offering rich benefits to CSHCN, rely on providers to identify eligible children , with few referrals reported to date. Service carve outs preserve long-standing specialty systems of care for CSH CN but create challenges for care coordination . Specialized systems of care present challenges for capitation but appear to offer the most promise for comprehensive, coordinated care to CSHCN.

Attitude of Health Personnel↗

PubMed2005

Instructional technology adoption of medical faculty in teaching.

Despite large investment by higher education institutions in technology for faculty and student use, instructional technology is not being integrated into instructions in the higher education institutions, including medical education institutions. While diffusion of instructional technologies has been reached a saturation point with early adopters of technology, it has remained limited among mainstream faculty. This study explored technology adoption patterns and perceptions of medical faculty about barriers and incentives to technology adoption in teaching.Complete data was obtained from 155 participants by using survey methodology and analyzed on the basis of theories of diffusion of innovation.Findings provided evidence for limited adoption of relatively new tools associated with instruction into mainstream faculty. Inadequate hardware for students and faculty, lack of reward structure, insufficient traing oppurtunites were identified as major barriers to faculty technology adoption.

Education, Medical↗

PubMed2006

Working with an Aboriginal community liaison worker.

FPA Health (Family Planning NSW) has conducted two integrated clinical and health promotion projects with Aboriginal communities in western NSW, Australia. The first was in Coonamble, a small rural community which had been selected as a pilot site for the Royal Australian College of General Practitioners Women's Aboriginal and Torres Strait Islander Project and was managed by FPA Health with support from the Dubbo/Plains Division of General Practice and Macquarie Area Health Service. The second was in Dubbo, a regional city where FPA Health had an existing centre and which had funding support from the Rio Tinto Aboriginal Foundation. The aim of this article was to share the learning and knowledge gained in managing these projects and to describe the experience of working with Aboriginal Community Liaison Workers who belong to and are supported by, the local Aboriginal community. The article aimed to illustrate the role and value of utilising these workers within a mainstream health service. The beneficial outcomes include improving service provision to Aboriginal women, adding to community knowledge about reproductive and sexual health issues and increasing the cultural knowledge and competency of a mainstream health service organisation.

Australia↗

PubMed2005

A study of clinically related open source software projects.

Open source software development has recently gained significant interest due to several successful mainstream open source projects. This methodology has been proposed as being similarly viable and beneficial in the clinical application domain as well. However, the clinical software development venue differs significantly from the mainstream software venue. Existing clinical open source projects have not been well characterized nor formally studied so the 'fit' of open source in this domain is largely unknown. In order to better understand the open source movement in the clinical application domain, we undertook a study of existing open source clinical projects. In this study we sought to characterize and classify existing clinical open source projects and to determine metrics for their viability. This study revealed several findings which we believe could guide the healthcare community in its quest for successful open source clinical software projects.

Clinical Medicine↗

PubMed2006

Fundamentals of fungal molecular population genetic analyses.

The last two decades have seen tremendous growth in the development and application of molecular methods in the analyses of fungal species and populations. In this paper, I provide an overview of the molecular techniques and the basic analytical tools used to address various fundamental population and evolutionary genetic questions in fungi. With increasing availability and decreasing cost, DNA sequencing is becoming a mainstream data acquisition method in fungal evolutionary genetic studies. However, other methods, especially those based on the polymerase chain reaction, remain powerful in addressing specific questions for certain groups of taxa. These developments are bringing fungal population and evolutionary genetics into mainstream ecology and evolutionary biology.

Evolution, Molecular↗

PubMed2006

CI therapy distribution: theory, evidence and practice.

Traditional rehabilitation for hemiplegia is not necessarily based on a supported theoretical foundation and some evidence questiones the efficacy of current practice. The uncertainty relating to underlying theories is a serious issue, henceforth there has been a move to base treatment strategies on scientific foundations which incorporate knowledge of human learning mechanisms and accompanying neurobiological processes. In this paper we argue that constraint induced movement therapy is a potentially very effective intervention that benefits from a strong theoretical grounding. It is demonstrated that the treatment mechanisms are supported by established behavioural learning theory and evidence of brain plasticity. As empirical support for the therapy is gradually mounting, the integration into mainstream practice lends itself as a natural course. In this paper, a series of issues surrounding the distribution of CIT such as constraint use, dose response relationships and accessibility to a wider group of patients are discussed. Further research in these areas is considered important for CIT integration into mainstream practice.

Behavior Therapy↗

PubMedDate not supplied

The multilingual videotape project: community involvement in a unique health education program.

The large number of Southeast Asian, Hispanic, and Portuguese immigrants in Rhode Island face formidable language and cultural barriers in gaining access to the health care that they need. As the funding for refugee-specific programs diminishes, the focus is on programs that encourage self-sufficiency, assist in gaining access to mainstream health care, and involve a collaboration among service agencies and the communities they serve. On behalf of a coalition of health care and community agencies, Women and Infants Hospital of Rhode Island received a private foundation grant to produce nine multilingual videotapes that would educate immigrants and refugees about health issues specific to them and help them access the health care system. The project was structured to maximize the involvement of the various communities and to "empower" community members in working with mainstream service agencies. Coalition and other community members provided input into topic selection, script content, and presentation methods for the videotapes that would be culturally appropriate. During the 2-year project, nine videotapes were produced with narration in seven languages. Copies of the videotapes were distributed free of charge to coalition members.

Asia, Southeastern↗

PubMedDate not supplied

[Smoking trials with mercury contaminated cigarettes. Studies of attempted poisoning].

In the context with an attempted poisoning it was investigated, to which extent an intoxication can be caused by smoking cigarettes, which contain elementary mercury. With a smoking apparatus the effect of the amount (9 mg to 1.4 g) and of the distribution of the Hg within the cigarette on its concentration in the mainstream and sidestream smoke as well as in the ash and the filter was analytically determined. It follows from these experiments, that at a good distribution almost independently of the amount involved only up to 2 mg Hg per cigarette are inhalated with the mainstream smoke, whereas up to 97% are found in the sidestream smoke. In the ash and the filter only small amounts are detected. By comparison with cases described in literature it is shown, that a poisoning by such cigarettes is possible only after frequent smoking or by passive smoking via the sidestream smoke in small and badly aerated rooms.

Humans↗