Working at the interface in Aboriginal and Torres Strait Islander health: focussing on the individual health professional and their organisation as a means to address health equity

Background: Aboriginal and Torres Strait Islander people experience inequity in health outcomes in Australia. Health care interactions are an important starting place to seek to address this inequity. The majority of health professionals in Australia do not identify as Aboriginal and/or Torres Strait Islander people and the health care interaction therefore becomes an example of working in an intercultural space (or interface). It is therefore critical to consider how health professionals may maximise the positive impact within the health care interaction by skilfully working at the interface. Methods: Thirty-five health professionals working in South Australia were interviewed about their experiences working with Aboriginal people. Recruitment was through purposive sampling. The research was guided by the National Health and Medical Research Council Values and Ethics for undertaking research with Aboriginal communities. Critical social research was used to analyse data. Results: Interviews revealed two main types of factors influencing the experience of non-Aboriginal health professionals working with Aboriginal people at the interface: the organisation and the individual. Within these two factors, a number of sub-factors were found to be important including organisational culture, organisational support, accessibility of health services and responding to expectations of the wider health system (organisation) and personal ideology and awareness of colonisation (individual). Conclusions: A health professional’s practice at the interface cannot be considered in isolation from individual and organisational contexts. It is critical to consider how the organisational and individual factors identified in this research will be addressed in health professional training and practice, in order to maximise the ability of health professionals to work with Aboriginal and Torres Strait Islander people and therefore contribute to addressing health equity.Annabelle M. Wilson, Janet Kelly, Anthea Magarey, Michelle Jones and Tamara Mackea

Relationships between the home environment and physical activity and dietary patterns of preschool children: a cross-sectional study

Objective: To assess relationships between characteristics of the home environment and preschool children's physical activity and dietary patterns. Methods: Homes of 280 preschool children were visited and information obtained by direct observation and parent interview regarding physical and nutritional characteristics of the home environment. Children's physical activity, sedentary behaviour and dietary patterns were measured using standardised parent-report questionnaires. Associations were analysed using analysis of variance and correlation. Results: Parental physical activity (p = 0.03–0.008), size of backyard (p = 0.001) and amount of outdoor play equipment (p = 0.003) were associated with more outdoor play. Fewer rules about television viewing (p < 0.001) and presence of playstation (p = 0.02) were associated with more indoor sedentary time. Higher fruit and vegetable intake was associated with restricting children's access to fruit juice (p = 0.02) and restricting high fat/sugar snacks (p = 0.009). Lower intake of noncore foods was associated with restricting children's access to fruit juice (p = 0.007), cordial/ carbonated drinks (p < 0.001) and high fat/sugar snacks (p = 0.003). Lower fruit and vegetable intake was associated with reminding child to 'eat up' (p = 0.007) and offering food rewards to eat main meal (p = 0.04). Higher intake of non-core foods was associated with giving food 'treats' (p = 0.03) and offering food rewards to eat main meal (p = 0.04). The availability of food groups in the home was associated with children's intake of these foods (fruit and vegetables, p < 0.001; fat in dairy, p = <0.001; sweetened beverages, p = 0.004–<0.001; non-core foods, p = 0.01–<0.001). Conclusion: Physical attributes of the home environment and parental behaviours are associated with preschool children's physical activity, sedentary behaviour and dietary patterns. Many of these variables are modifiable and could be targeted in childhood obesity prevention and management.Nicola J Spurrier, Anthea A Magarey, Rebecca Golley, Fiona Curnow and Michael G Sawye

The professional journey of Saudi nurse graduates: A lived experience

Objective: To illuminate the lived experience of Saudi Nurse graduates during their early years in the workplace as professional nurses encompassing their experiences from being nurse students, preparations to become registered nurses, their struggles from being a student to a professional nurse, their cultural competence towards colleagues and patients in their new workplace, their impression of Nursing as a profession and other challenges they faced in especially on language and communication with their patients and colleagues. Methods: An interpretive phenomenological inquiry was utilized to inquire and discover the lived experiences of Saudi Nurse graduates to their job as nurses in different hospitals in Riyadh, Saudi Arabia. A total of 12 nurses were interviewed for this study in the course of 5 months. The interviews conducted with the 12 nurses were audiotaped recorded and subsequently transcribed in verbatim form and the Collaizi Method was used for the extraction of meanings from the interviews. Results: Five major themes were identified in the transcribed form of the interview and 11 subthemes emerged as well. The five major themes were educational preparation, transition into practice, cultural competence, image of nursing and language and communication. Conclusions: The study described the different challenges faced by Saudi nurse graduates from being students to professionals based from their experiences as newly employed staff nurses in different hospitals in Saudi Arabia. Their stories captured the story of novice nurses not only as a Saudi but may be true for other nationalities. These stories are shared by all nurses across the world who struggle to meet the demands of the nursing profession.Mohammad Alboliteeh, Judy Magarey, Richard Wiechul

Cardiac conditions in pregnancy and the role of midwives: A discussion paper

Aim This paper provides an overview of the two broad categories of cardiac conditions observed in pregnancy (congenital and acquired). It also identifies the midwives' role in the childbirth continuum and includes assessment, track and trigger systems and management during labour and delivery. Design Discussion paper. Methods Data were collected by reviewing international evidence and by searching computerized databases. Results Research has identified that women with associated risk factors of a cardiac condition who delay pregnancy have an increased risk of experiencing cardiovascular complications in pregnancy with poorer outcomes. The Three Ps in a Pod clinical initiative in the United Kingdom highlights working as a team in multidisciplinary programmes to improve mothers' care and save lives. Midwives play a key role during pregnancy and need to be appraised in relation to cardiovascular disease observed in pregnancy, its potential risks and anticipated problems and within the continuum of care.Sandra Millington, Judith Magarey, Gustaaf A. Dekker, Robyn A. Clar

Phosphonic (phosphorous) acid controls Plasmopara viticola the cause of downy mildew of grapevines

Abstract Phosphonic (phosphorous) acid (Fol

Histamine, mast cells and tumour cell proliferation in breast cancer: does preoperative cimetidine administration have an effect?

Endogenous histamine has been shown to effect growth mechanisms in experimental mammary carcinomas via H2 membrane receptors (Cricco et al, 1994). Both H1 and H2 binding sites are present in human mammary glands but only 75% malignant carcinomas express H2 receptors (Lemos et al, 1995). The presence of mast cells around tumour tissue raises questions concerning the source of histamine in breast tumour tissue. While cimetidine, an H2 antagonist, has been shown to influence the presence of tumour infiltrating lymphocytes (TIL) in colorectal cancer (Adams and Morris, 1994, 1997) that was not found to be the case in breast cancer (Ng et al, 1995). In recent studies tumour cell proliferation, as measured by Ki-67 antibody labelling, has been seen as an additional prognostic indicator in breast cancer (Railo et al, 1993, 1997; Ferno, 1998; Schauer et al, 1998). We investigated the possibility that cimetidine may influence tumour proliferation by blocking the growth-promoting effects of histamine. No relationship between preoperative cimetidine administration and tumour cell proliferation was seen overall. A weak correlation was seen between tissue histamine content and mast cell count which was not influenced by cimetidine. Tumour cell proliferation correlated well with other prognostic indicators such as grade and differentiation. © 2000 Cancer Research Campaig

Adherence to clinical practice guidelines for South Australian pregnant women with cardiac conditions between 2003 and 2013

Background For pregnant women with a known cardiac condition or those who develop cardiac disease during pregnancy, there is an increased risk of complications during pregnancy, to both mother and foetus. To reduce this risk, best practice guidelines have been developed and available in South Australia for several years. Measuring clinical practice against the guideline recommendations verifies real-life practice and an essential part of any clinical practice quality improvement project by identifying gaps. This study is the first report on adherence to statewide perinatal guidelines for these women in South Australia. Objectives To evaluate adherence to evidence-based clinical practice perinatal guidelines To identify predictors of adherence. Make comparisons across three practice settings examined. Design A retrospective cross-sectional observational design that analysed data from medical records. Setting Three SA Health public metropolitan, university-affiliated teaching hospitals with an obstetric service within a ten-year timeframe (2003–2013). Participants 271 admissions of women who were categorised as ‘pre-existent’ or ‘newly acquired’ cardiac condition during their pregnancy. Outcome measures Adherence to guidelines was measured using a purposefully designed scoring system across the three sites. The researcher chose a minimum acceptable score of 17 applicable to the ‘newly acquired’ group and 35 for the ‘pre-existent’ group. Results Overall adherence to the perinatal guidelines for the combined groups (n = 271) reported a mean score of 16.3, SD ± 6.7, with a median score of 17. Women in the ‘newly acquired’ group scored less compared to women in the ‘pre-existent’ group (Estimate -2.3, CI -3.9,-0.7). Variance in adherence was observed across the three hospitals (P value <0.0001). The most significant predictor of adherence to guidelines was pre-pregnancy cardiac consultation which increased the likelihood of preconception care by Odds ratio 18.5 (95%, CI 2, 168). Similarly, compliance with mental health screening was associated with improved adherence to antenatal assessments (OR: 11.3(95% CI 4.7, 27.3). Conclusion There was overall suboptimal adherence to the statewide guidelines for women with cardiac conditions in pregnancy. The variance in the level of adherence across the three hospitals correlated with the exposure to higher acuity cases, and that appropriate up- referral to a higher acuity hospital was intrinsically linked to better adherence. Recommendations include preconception counselling, and to ensure that all health practitioners have the skills, sufficient training and time to complete a comprehensive initial antenatal assessment Trial registration ACTRN12617000417381Sandra Millington, Margaret Arstall, Gustaaf Dekker, Judith Magarey, Robyn Clar

PEACH™ Queensland program improved child eating behaviours and reduced BMI z-score for overweight children (pilot study)

Background/Aims: Parenting, Eating and Activity for Child Health (PEACH™) Queensland is a 6-month family-focussed child weight management program currently targeting 1400 Queensland children. This study aims to investigate changes in child BMI and eating behaviours during the pilot phase. Methods: From 2013 – 2014, 251 overweight children (US-CDC BMI percentile ≥ 85th) were enrolled in the pilot phase of PEACH™ Queensland, using pre-defined inclusion criteria which included having a child above a healthy weight for their age (5 – 11 years). Baseline and follow-up data were collected from parents by questionnaire and included child eating behaviours, measured by core food intake and Children’s Dietary Questionnaire (CDQ). Children attending sessions were weighed and measured by a trained facilitator. Results: Children attending sessions were 80% obese (IOTF cut-points), 60% female, with average age of 9.0 ± 1.9 years. For the subset of children with complete anthropometry (n = 69), we observed significant decreases in US-CDC z-scores for weight and BMI, 2.3 ± 0.7 to 2.2 ± 0.7 (p < 0.001) and 2.2 ± 0.5 to 2.1 ± 0.7 (p < 0.0001), respectively. This reduction in BMI z-score was accompanied by increases in the proportion meeting recommendations for serves of fruit and vegetables, and significantly lower scores for sweetened beverages and discretionary food intake as measured by CDQ. Conclusions: The PEACH™ Queensland pilot reduced child weight and BMI z-scores, and improved eating behaviours (increased fruit and vegetable intake, decreased intake of discretionary foods and sweetened beverages) although there is need for further improvement