"Look Mum, no hands!" : the effects of increasing opportunities for choice-making and independence for children with disabilities when using a Riding for the Disabled programme : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University

Many non-disabled people take for granted their ability to choose when they receive help from others. Those with disabilities are often denied this choice, having minimal control over their lives. Increasing literature and research advocate that children with disabilities should be allowed choice-opportunities, as this is an essential component of becoming self-determined. Increasing access to choice has many benefits, including increasing enjoyment, confidence, assertiveness, motivation, and performance. Furthermore, it has been shown to decrease challenging and undesirable behaviour. The current project investigated the effects of providing choice to children with disabilities while participating in riding sessions at the Riding for the Disabled. Furthermore, it investigated whether the children could become more independent when completing riding related tasks. The mastery of two routines (mounting and dismounting) was analysed. All participants improved in their mastery of routines, and thus their independence increased. The hypothesis that with the provision of choice and increase in independence, the children would express higher levels of enjoyment was supported. Those who see providing choice as a deleterious concept fear that children with disabilities will make poor decisions. The project investigated the effect of choice opportunities on the level of risk that the children engaged in when performing riding activities. It was found that the children did not expose themselves to any unnecessary risk despite the increase in control they experienced while riding. An alternating treatment design was used for eight single-case studies. Dependent variables measured were expressions of enjoyment, inattention, undesirable behaviour, level of risk, mastery of routines, number of prompts needed, and incidents of crying

Chlamydia prevalence in young attenders of rural and regional primary care services in Australia: a cross-sectional survey.

OBJECTIVE To estimate chlamydia prevalence among 16-29-year-olds attending general practice clinics in Australia. DESIGN, PARTICIPANTS AND SETTING A cross-sectional survey was conducted from May 2010 to December 2012. Sexually experienced 16-29-year-olds were recruited from 134 general practice clinics in 54 rural and regional towns in four states and in nine metropolitan clinics (consecutive patients were invited to participate). Participants completed a questionnaire and were tested for chlamydia. MAIN OUTCOME MEASURE Chlamydia prevalence. RESULTS Of 4284 participants, 197 tested positive for chlamydia (4.6%; 95% CI, 3.9%-5.3%). Prevalence was similar in men (5.2% [65/1257]; 95% CI, 3.9%-6.4%) and women (4.4% [132/3027]; 95% CI, 3.5%-5.2%) (P = 0.25) and high in those reporting genital symptoms or a partner with a sexually transmissible infection (STI) - 17.0% in men (8/47; 95% CI, 2.8%-31.2%); 9.5% in women (16/169; 95% CI, 5.1%-13.8%). Nearly three-quarters of cases (73.4% [130/177]) were diagnosed in asymptomatic patients attending for non-sexual health reasons, and 83.8% of all participants (3258/3890) had attended for non-sexual health reasons. Prevalence was slightly higher in participants from rural and regional areas (4.8% [179/3724]; 95% CI, 4.0%-5.6%) than those from metropolitan areas (3.1% [17/548]; 95% CI, 1.5%-4.7%) (P = 0.08). In multivariable analysis, increasing partner numbers in previous 12 months (adjusted odds ratio [AOR] for three or more partners, 5.11 [95% CI, 2.35-11.08]), chlamydia diagnosis in previous 12 months (AOR, 4.35 [95% CI, 1.52-12.41]) and inconsistent condom use with most recent partner (AOR, 2.90 [95% CI, 1.31-6.40]) were significantly associated with chlamydia in men. In women, increasing partner numbers in previous 12 months (AOR for two partners, 2.59 [95% CI, 1.59-4.23]; AOR for three or more partners, 3.58 [95% CI, 2.26-5.68]), chlamydia diagnosis in previous 12 months (AOR, 3.13 [95% CI, 1.62-6.06]) and age (AOR for 25-29-year-olds, 0.23 [95% CI, 0.12-0.44]) were associated with chlamydia. CONCLUSIONS Chlamydia prevalence is similar in young men and women attending general practice. Testing only those with genital symptoms or a partner with an STI would have missed three-quarters of cases. Most men and women are amenable to being tested in general practice, even in rural and regional areas

"One country, two systems": Sociopolitical implications for female migrant sex workers in Hong Kong

<p>Abstract</p> <p>Background</p> <p>Under the "two countries, one system" policy implemented by China to manage the return of Hong Kong's sovereignty, Hong Kong has maintained a comparatively prosperous economy within the Asian region. This has resulted in an environment which fosters migration from the mainland to Hong Kong, due largely to proximity, higher earning potential, common language, and a relaxing of border control measures. However not all mainland China citizens are equally able to access these new migration schemes and indeed a number of women such as sex workers are either migrating and/or working illegally and without occupational, legal and health protection within Hong Kong.</p> <p>Discussion</p> <p>Female migrant sex workers are exposed to a number of significant threats to their health, however their illegal status contributes to even greater vulnerability. The prevailing discourses which view these women as either "trafficked women" or as "illegal immigrants" do not adequately account for the complex situations which result in such women's employment in Hong Kong's sex industry. Rather, their position can best be understood within the broader frameworks provided by migration literature and the concept of "structural violence". This allows for a greater understanding of the socio-political issues which are systematically denying migrant sex workers adequate access to health care and other opportunities for social advancement. When these issues are taken into account, it becomes clear that the current relevant legislation regarding both immigration and sex work is perpetuating the marginalised and vulnerable status of migrant sex workers. Unless changes are made, structural barriers will remain in place which impede the ability of migrant sex workers to manage their own health needs and status.</p> <p>Conclusion</p> <p>Female migrant sex workers in Hong Kong are extremely vulnerable to a number of occupational health and safety hazards which have significantly detrimental effects on their health. These risks can best be understood within a broad framework of socio-political factors contributing to their vulnerability. Ensuring that migrant sex workers have adequate support for their health and legal rights requires require structural interventions such as decriminalisation and providing open and inclusive access to health service to counteract such factors.</p

"Place" and sexual and reproductive health in Australia

© 2020 Amie Lee BinghamSexual and reproductive health are significant public health concerns, and come with considerable costs to be individuals and the public, whether physical, emotional, mental or financial. There have been calls, particularly internationally, for responses to sexual and reproductive health issues to take an ecological perspective, addressing the multiple levels of influence on people’s health outcomes, such that interventions may potentially be more effective and enduring. ‘Place based’ approaches to health engage with ecological understandings of health, and a small body of literature has applied this framework to sexual and reproductive health. Few have done so within the Australian context, however. The aim of this thesis was to improve understanding of whether and how geographic location may be impacting on the sexual and sexual and reproductive health of Australians. In order to do so, three objectives were addressed: 1 - to explore associations between geographic location and sexual and reproductive health outcomes in Australia; 2 - to explore associations between geographic location and sexual and reproductive health risk behaviours in Australia; and 3 - explore the mechanisms by which geographic location may be affecting sexual and reproductive health behaviours and outcomes. Chapters 1 to 3 are introductory chapters, including a review of relevant literature pertaining to both sexual and reproductive health, and to conceptual frameworks which may inform place-based approaches to understanding health. Chapters 4, 5 and 6 present analyses of associations between ‘place’ and sexual and reproductive health outcomes and behaviours. Chapter 4 comprises a publication in analysing associations between country-level income inequality and notifications of Neisseria gonorrhoea in females. It finds that higher levels of income inequality were significantly associated with higher rates of notification for gonorrhoea. Chapters 5 and 6 report on analyses of a national dataset of prescribing data for the subdermal contraceptive implant and the levonorgestrel intra-uterine device, respectively, finding associations between living outside major cities and higher rates of prescription of long-acting contraceptives. The analyses also tested associations between proximity to specialist health services, such as Aboriginal Medical Services and Family Planning Clinics, but found little evidence of significant association. Chapter 7 presents the finding of a qualitative analysis of interviews with key informants in rural and regional areas of Australia, exploring mechanisms though which characteristics of their local communities may be affecting the sexual and reproductive health of young people. Participants were able to articulate a broad range of factors related to their location that were affecting these – and other – outcomes, including: the social context, broader social and political structures, local structural elements, and geographic location. Informed by findings from the qualitative analysis, Chapter 8 explores associations between alcohol availability and prevalent chlamydia at the level of postcode, multilevel analyses, finding no evidence of significant associations. Together, these analyses have contributed to a small body of Australian literature which takes a place-based approach to sexual and reproductive health outcomes. Showing associations at various levels, it emphasises the potential utility of taking an ecological approach to interventions designed to improve sexual and reproductive health – from the national level to the level of individuals

Factors affecting utilization of cervical cancer prevention services in low-resource settings

Strategies for introducing or strengthening cervical cancer prevention programs must focus on ensuring that appropriate, cost-effective services are available and that women who most need the services will, in fact, use them. This article summarizes the experiences of research projects in Bolivia, Peru, Kenya, South Africa, and Mexico. Factors that affect participation rates in cervical cancer prevention programs are categorized in three sections. The first section describes factors that arise from prevailing sociocultural norms that influence women's views on reproductive health, well being, and notions of illness. The second section discusses factors related to the clinical requirements and the type of service delivery system in which a woman is being asked to participate. The third section discusses factors related to quality of care. Examples of strategies that programs are using to encourage women's participation in cervical cancer prevention services are provided

Factores determinantes de utilización de programas de detección oportuna de cáncer cervical en población de bajos recursos

Las estrategias para introducir o fortalecer programas de prevención de cáncer cervical deben enfocarse hacia garantizar servicios costo-efectivos, que se encuentren disponibles para que las mujeres que los necesiten puedan utilizarlos. Este artículo resume la experiencia de proyectos de investigación realizados en Bolivia, Perú, Kenya, Sudáfrica y México. Los factores que afectan la tasa de participación en programas de prevención son categorizados en tres secciones. La primera describe los factores que surgen predominantemente por normas socioculturales que influyen en la visión que las mujeres tienen sobre la salud reproductiva. La segunda discute los factores relacionados con los requerimientos clínicos y el tipo de servicio ofrecido, así como el sistema mediante el cual las mujeres están siendo invitadas a participar. La tercera sección discute factores relacionados con la calidad de la atención. Finalmente, se proveen ejemplos de las estrategias sobre los programas que son utilizados para alentar la participación de las mujeres en los servicios de prevención del cáncer cervical. Este artículo también está disponible en: http://www.insp.mx/ salud/index.htm