Muslim active citizenship in Australia: Socioeconomic challenges and the emergence of a Muslim elite

The most recent national Census demonstrated that Australian Muslims continue to occupy a socioeconomically disadvantaged position. On key indicators of unemployment rate, income, type of occupation and home ownership, Muslims consistently under-perform the national average. This pattern is evident in the last three Census data (2001, 2006 and 2011). Limited access to resources and a sense of marginalisation challenge full engagement with society and the natural growth of emotional affiliation with Australia. Muslim active citizenship is hampered by socioeconomic barriers. At the same time, an increasingly proactive class of educated Muslim elite has emerged to claim a voice for Muslims in Australia and promote citizenship rights and responsibilities. <br /

Assessing smoking status in disadvantaged populations: is computer administered self report an accurate and acceptable measure?

Background: Self report of smoking status is potentially unreliable in certain situations and in high-risk populations. This study aimed to determine the accuracy and acceptability of computer administered self-report of smoking status among a low socioeconomic (SES) population. Methods: Clients attending a community service organisation for welfare support were invited to complete a cross-sectional touch screen computer health survey. Following survey completion, participants were invited to provide a breath sample to measure exposure to tobacco smoke in expired air. Sensitivity, specificity, positive predictive value and negative predictive value were calculated. Results: Three hundred and eighty three participants completed the health survey, and 330 (86%) provided a breath sample. Of participants included in the validation analysis, 59% reported being a daily or occasional smoker. Sensitivity was 94.4% and specificity 92.8%. The positive and negative predictive values were 94.9% and 92.0% respectively. The majority of participants reported that the touch screen survey was both enjoyable (79%) and easy (88%) to complete. Conclusions: Computer administered self report is both acceptable and accurate as a method of assessing smoking status among low SES smokers in a community setting. Routine collection of health information using touch-screen computer has the potential to identify smokers and increase provision of support and referral in the community setting

A population-based investigation into inequalities amongst Indigenous mothers and newborns by place of residence in the Northern Territory, Australia

BACKGROUND: Comparisons of birth outcomes between Australian Indigenous and non-Indigenous populations show marked inequalities. These comparisons obscure Indigenous disparities. There is much variation in terms of culture, language, residence, and access to services amongst Australian Indigenous peoples. We examined outcomes by region and remoteness for Indigenous subgroups and explored data for communities to inform health service delivery and interventions. METHODS: Our population-based study examined maternal and neonatal outcomes for 7,560 mothers with singleton pregnancies from Australia’s Northern Territory Midwives’ Data Collection (2003–2005) using uni- and multivariate analyses. Groupings were by Indigenous status; region (Top End (TE)/Central Australia (CA)); Remote/ Urban residence; and across two large TE communities. RESULTS: Of the sample, 34.1% were Indigenous women, of whom 65.6% were remote-dwelling versus 6.7% of non- Indigenous women. In comparison to CA Urban mothers: TE Remote (adjusted odds ratio [aOR] 1.47, 95%CI: 1.13, 1.90) and TE Urban mothers (aOR 1.36 (95% CI: 1.02, 1.80) were more likely, but CA Remote mothers (aOR 0.43; 95% CI: 0.31, 0.58) less likely to smoke during pregnancy; CA Remote mothers giving birth at >32 weeks gestation were less likely to have attended ≥ five antenatal visits (aOR 0.55; 95%CI: 0.36, 0.86); TE Remote (aOR 0.71; 95%CI: 0.53, 0.95) and CA Remote women (aOR 0.68; 95%CI: 0.49, 0.95) who experienced labour had lower odds of epidural/ spinal/narcotic pain relief; and TE Remote (aOR 0.47; 95%CI: 0.34, 0.66), TE Urban (aOR 0.67; 95%CI: 0.46, 0.96) and CA Remote mothers (aOR 0.52; 95%CI: 0.35, 0.76) all had lower odds of having a ‘normal’ birth. The aOR for preterm birth for TE Remote newborns was 2.09 (95%CI: 1.20, 3.64) and they weighed 137 g (95%CI: -216 g, -59 g) less than CA Urban babies. There were few significant differences for communities, except for smoking prevalence. CONCLUSIONS: This paper is one of few quantifying inequalities between groups of Australian Indigenous women and newborns at a regional level. Indigenous mothers and newborns do worse on some outcomes if they live remotely, especially if they live in the TE. Smoking prevention and high-quality antenatal care is fundamental to addressing many of the adverse outcomes identified in this paper.Malinda Steenkamp, Alice Rumbold, Lesley Barclay and Sue Kilde

Evidence for models of diagnostic service provision in the community: literature mapping exercise and focused rapid reviews

Background Current NHS policy favours the expansion of diagnostic testing services in community and primary care settings. Objectives Our objectives were to identify current models of community diagnostic services in the UK and internationally and to assess the evidence for quality, safety and clinical effectiveness of such services. We were also interested in whether or not there is any evidence to support a broader range of diagnostic tests being provided in the community. Review methods We performed an initial broad literature mapping exercise to assess the quantity and nature of the published research evidence. The results were used to inform selection of three areas for investigation in more detail. We chose to perform focused reviews on logistics of diagnostic modalities in primary care (because the relevant issues differ widely between different types of test); diagnostic ultrasound (a key diagnostic technology affected by developments in equipment); and a diagnostic pathway (assessment of breathlessness) typically delivered wholly or partly in primary care/community settings. Databases and other sources searched, and search dates, were decided individually for each review. Quantitative and qualitative systematic reviews and primary studies of any design were eligible for inclusion. Results We identified seven main models of service that are delivered in primary care/community settings and in most cases with the possible involvement of community/primary care staff. Not all of these models are relevant to all types of diagnostic test. Overall, the evidence base for community- and primary care-based diagnostic services was limited, with very few controlled studies comparing different models of service. We found evidence from different settings that these services can reduce referrals to secondary care and allow more patients to be managed in primary care, but the quality of the research was generally poor. Evidence on the quality (including diagnostic accuracy and appropriateness of test ordering) and safety of such services was mixed. Conclusions In the absence of clear evidence of superior clinical effectiveness and cost-effectiveness, the expansion of community-based services appears to be driven by other factors. These include policies to encourage moving services out of hospitals; the promise of reduced waiting times for diagnosis; the availability of a wider range of suitable tests and/or cheaper, more user-friendly equipment; and the ability of commercial providers to bid for NHS contracts. However, service development also faces a number of barriers, including issues related to staffing, training, governance and quality control. Limitations We have not attempted to cover all types of diagnostic technology in equal depth. Time and staff resources constrained our ability to carry out review processes in duplicate. Research in this field is limited by the difficulty of obtaining, from publicly available sources, up-to-date information about what models of service are commissioned, where and from which providers. Future work There is a need for research to compare the outcomes of different service models using robust study designs. Comparisons of ‘true’ community-based services with secondary care-based open-access services and rapid access clinics would be particularly valuable. There are specific needs for economic evaluations and for studies that incorporate effects on the wider health system. There appears to be no easy way of identifying what services are being commissioned from whom and keeping up with local evaluations of new services, suggesting a need to improve the availability of information in this area. Funding The National Institute for Health Research Health Services and Delivery Research programme

2014 Australian community sector survey

This survey of almost 1,000 community service workers from around the country shows that 43% of services are simply unable to meet the needs of people coming to them for help. Overview The Australian Community Sector Survey (ACSS) was conducted at a time when changes to social policy were expected to significantly impact the lives of&nbsp; people experiencing poverty in Australia. The release of the Federal Budget 2014-15 included a range of proposed changes to social security payments and social welfare and health services and supports. Prior to the Budget, the Government initiated a National Commission of Audit to recommend ways to&nbsp; improve the efficiency and effectiveness of government expenditure in the face of ongoing fiscal challenges; and had instigated a review of the welfare system. This year the ACSS has been redesigned to focus on the perspectives of sector staff about the experience of the people who use their services. Sector staff involved in the day to day delivery of services have a unique and valuable contribution to make to the community’s knowledge and understanding of people’s experience of poverty and what services and policy measures are needed to alleviate it. This survey captures the perspectives of almost 1,000 sector&nbsp;&nbsp; participation of 2 million volunteers. The ACSS is the only annual, national survey of the community sector, by the community sector. For over 15 years, it has functioned as a gauge of how the sector and the people it serves are faring. This year the ACSS has been redesigned to focus on the perspectives of sector staff about the experience of the people who use their services. Sector staff involved in the day to day delivery of services have a unique and valuable contribution to make to the community’s knowledge and understanding of people’s experience of poverty and what services and policy measures are needed to alleviate it. This survey captures the perspectives of almost 1,000 sector staff to show what life is like for people most at risk of poverty and disadvantage in our communities. In the wake of recent proposed and enacted changes to a range of social policies in Australia, and in line with ACOSS’ strategic focus on income support and employment policy and housing and homelessness, three groups of service users were chosen as the focus of the survey: young unemployed people, sole parents and older unemployed people. Their particular experiences are drawn out in this report. ACOSS recognises that these groups are only a few of the many sections of the community that have been and will be affected by proposed social policy changes