Primary health care for Aboriginal and Torres Strait Islander children

This final report presents the findings from each of the phases of the Engaging Stakeholders in Identifying Priority Evidence-Practice Gaps and Strategies for Improvement in Primary Health Care (ESP) Project. This report is designed for people working in a range of roles including national and jurisdictional policy makers, managers, community-controlled organisations and government health authorities, peak bodies, clinical leaders, researchers, primary health care staff and continuous quality improvement (CQI) practitioners who may have an interest in the interpretation and use of aggregated CQI data to drive decision making. Stakeholders across services and systems that deliver Aboriginal and Torres Strait Islander primary health care (PHC) engaged in a process to analyse and interpret national continuous quality improvement (CQI) data from 132 health centres. We used a consensus process to identify priority evidence-practice gaps in child health care, based on these data. Stakeholders drew on their knowledge and experience working in Aboriginal and Torres Strait Islander PHC to identify barriers and enablers to addressing the priority evidence- practice gaps, and to suggest strategies to overcome barriers and strengthen enablers to addressing the priority evidence-practice gaps. Important messages emerge from these findings

Chronic illness care for Aboriginal and Torres Strait Islander people: final report

This project engage a range of stakeholders across different levels of the primary health care system, including service providers, management, policy-makers and researchers and capture their knowledge on the barriers and enablers to addressing the identified priority-evidence practice gaps and their suggestions on strategies for improvement. Overview The purpose of this project is to engage key stakeholders in the use of aggregate continuous quality improvement (CQI) data to identify and address system-wide evidence-practice gaps in Aboriginal and Torres Strait Islander chronic illness care. We aimed to engage a range of stakeholders across different levels of the primary health care (PHC) system, including service providers, management, policy-makers and researchers and capture their knowledge on the barriers and enablers to addressing the identified priority-evidence practice gaps and their suggestions on strategies for improvement. Our research has highlighted the wide variation in performance between different aspects of care and between health centres. While many aspects of care are being done well in many health centres, there are important gaps between evidence and practice in some aspects of PHC. System-wide gaps are likely to be due to deficiencies in the broader (PHC) system, indicating that system-level action is required to improve performance. Such system-level action should be developed with a deep understanding of the holistic nature of Aboriginal and Torres Strait islander wellbeing beyond just physical health (including healthy connections to culture, community and country), of the impact of Australian colonist history on Aboriginal and Torres Strait Islander people, and of how social systems – including the health system - should be shaped to meet the needs of Aboriginal and Torres Strait Islander people. This project aims to build on the collective strengths within PHC services in order to continue improving the quality of care for Aboriginal and Torres Strait Islander communities

Disproportionate epidemiology: differential impact of disease and flood on the socio-economically marginalised

This thesis presents four projects completed to fulfil the core competencies of the MAE. My field'placement was the University Centre for Rural Health (UCRH) in Lismore (Bundjalung Country). The UCRH builds rural health workforce capacity and conducts research relevant to the health needs of rural communities. Strategic research priorities of the UCRH focus on rural population health, health equity and health systems and service research. Data Analysis (A cross-sectional analysis of post-flood social capital in a diverse Australian rural community): In partnership with Community Advisory Groups in the Northern Rivers region of NSW, I conducted a cross-sectional analysis to examine the association between the components of social capital (community participation and personal social cohesion) and psychological distress six months after the 2017 major flood event and how this association may have varied for marginalised groups relative to other participants. While marginalised groups reported lower levels of social capital compared to other groups, the analysis showed that informal social connectedness and feelings of belonging were important factors for all, associated with reduced risk of psychological distress post-flood. Research Project (Longitudinal cohort study of mental health outcomes after flooding in a rural community): Following on from the data analysis project, I led the design and implementation of a two-year survey for participants who consented to follow-up with the primary aim of assessing long-term psychological outcomes following the 2017 major flood including the impact of secondary stressors (e.g., persistent damage, insurance disputes etc) and levels of social capital. We found that secondary stressors were more proximally associated with psychological morbidity after two years compared to the flood event itself. Informal social connectedness, belonging and optimism were again important predictors of reduced mental health harm over the 18-month study period. These findings are useful for mental health service planning needs for communities affected by flood over the longer-term. Outbreak investigation (Recurrent outbreaks of acute post-streptococcal glomerulonephritis (APSGN) in the Northern Peninsula Area (NPA), Qld in 2019): In partnership with Qld Health and local NPA health staff, I assisted with an outbreak investigation of APSGN in the NPA, Qld. APSGN results from the body's response to repeated Streptococcus pyogenes (a group A streptococci - GAS bacteria) infection usually via skin or upper respiratory tract. My role involved designing and maintaining spreadsheet information to monitor population screening and treatment of skin and throat sores for all children (aged 1 to <17 years) in the NPA. As this was the second outbreak to occur within six months, the investigation highlighted the need for sustained health promotion programs to minimise the occurrence of skin conditions and in the long term, improved socio-economic, community infrastructure and housing conditions to reduce inequities in GAS infections (and APSGN) between Aboriginal and Torres Strait Islander and non-Indigenous populations. Surveillance system evaluation (Tuberculosis surveillance in NSW - developing data systems for effective contact investigations): In partnership with NSW Health Protection, I facilitated the development of a generic contact investigation module for tuberculosis (TB) disease for the NSW Notifiable Conditions Information Management System (NCIMS). TB Coordinators across NSW were consulted to: evaluate the current contact investigation data system; assess gaps; and develop data specifications for a new NCIMS module that would meet their needs for effective contact tracing and reporting. While implementation of the new module did not occur within the MAE project timeframe, discussion initiated by this work contributed to development of a NCIMS contact tracing data system for COVID-19 in 2020

Conspicuous concealment : an investigation into the veiling of Roman women, with special reference to the time of Augustus.

Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2007.Although there is much evidence for the practice of female veiling in the Classical world it has for the most part been ignored. Evidence for the veiling of Roman women is found in many sources. Ancient lexicographers list many names for veils that these women wore. Each of these veils was particular to the context in which they were worn and by whom they were worn. The plenitude of veiling terminology as well as the specialized nature of these veils alerts the reader to the importance that the Romans attributed to the veil, suggesting that it formed an important part of their culture and this is described in visual and literary terms by ancient artists and writers. From discussions on modern veiling it is possible, through the application of a comparative methodology, to create models that can elucidate the Roman system. From anthropological studies undertaken on modern veiling cultures, it can be appreciated how notions of 'honour' and 'shame,' a belief in the evil-eye, the polluting force of the female body and the use of the veil as a means of sexual communication influenced Roman veiling. In this way it becomes possible to understand how the veil became a marker for the positive forces of femininity and for the containment of the negative influences. The veil became a signifier of sound gender relations. The fact that this vestimentary code is able to generate meaning in the minds of observers is because it works in conjunction with a rhetorical system of dress. The practice of veiling is therefore viewed by the Romans in a positive light, and its disruption is understood by them as a cause for concern. This concern was especially apparent during the late republic. The dissolution of the traditional forms of government was in some ways problematized in terms of gender, with women's abandonment of their traditional roles and their incursion into the public sphere being of specific importance. In order to remedy this, attempts were made by the new regime of Augustus to promote a return to what were seen to be traditional gender relations. This programme of moral reform made use of both formal, legalistic decree (the Julian marriage laws) and more propagandistic constructions (the public works of art). In this process traditional symbols assumed a high degree of salience. Because of its power to signify the beneficial and appropriate status of the female body, one of the most important of these symbols was the veil. In this dissertation the artistic and literary manifestations of veiling and its social and political significance are discussed with specific reference to the Augustan period

Veiled or unveiled? (Plut. Quaest. Rom. 267B–C).

No abstract available.Published online: 18 April 2008

Exploring systems that support good clinical care in Indigenous primary health-care services: a retrospective analysis of longitudinal systems assessment tool data from high-improving services

Background: Continuous quality improvement is a process for raising the quality of primary health care across Indigenous PHC services. In addition to clinical auditing using plan, do, study, act cycles, engaging staff in a process of reflecting on systems to support quality care is vital. The One21seventy Systems Assessment Tool (SAT) supports staff to assess systems performance in terms of five key components. This study examines quantitative and qualitative SAT data from five high-improving Indigenous primary health care services in northern Australia to understand the systems used to support quality care. Methods: High improving services selected for the study were determined by calculating quality of care indices for Indigenous health services participating in the ABCD National Research Partnership. Services that reported continuing high improvement in quality of care delivered across two or more audit tools in three or more audits were selected for the study. Pre-collected SAT data (from annual team SAT meetings) is presented longitudinally using radar plots for quantitative scores for each component and content analysis is used to describe strengths and weaknesses of performance in each systems component. Results: High improving services were able to demonstrate strong processes for assessing system performance and consistent improvement in systems to support quality care across components. Key strengths in the quality support systems included adequate and orientated workforce, appropriate health system supports and engagement with other organisations and community while the weaknesses included lack of service infrastructure, recruitment, retention and support for staff and additional costs. Qualitative data revealed clear voices from health service staff expressing concerns with performance and subsequent SAT data provided evidence of changes made to address concerns. Conclusion: Learning from the processes and strengths of high-improving services may be useful as we work with services striving to improve the quality of care provided in other areas

Understanding the structure and processes of primary health care for young indigenous children

INTRODUCTION: Primary health care organisations need to continuously reform to more effectively address current health challenges, particularly for vulnerable populations. There is growing evidence that optimal health service structures are essential for producing positive outcomes. AIM: To determine if there is an association between process of care indicators (PoCIs) for important young indigenous child health and social issues and: (i) primary health-care service and child characteristics; and (ii) organisational health service structures. METHODS: This was a cross-sectional study of 1554 clinical child health audits and associated system assessments from 74 primary care services from 2012 to 2014. Composite PoCIs were developed for social and emotional wellbeing, child neurodevelopment and anaemia. Crude and adjusted logistic regression models were fitted, clustering for health services. Odds ratios and 95% confidence intervals were derived. RESULTS: Overall, 32.0% (449) of records had a social and emotional wellbeing PoCI, 56.6% (791) had an anaemia PoCI and 49.3% (430) had a child neurodevelopment PoCI. Children aged 12–23 months were significantly more likely to receive all PoCIs compared to children aged 24–59 months. For every one point increase in assessment scores for team structure and function (aOR 1.14, 95% CI 1.01–1.27) and care planning (aOR 1.14, 95% CI 1.01–1.29) items, there was a 14% greater odds of a child having an anaemia PoCI. Social and emotional wellbeing and child neurodevelopment PoCIs were not associated with system assessment scores. DISCUSSION: Ensuring young indigenous children aged 24–59 months are receiving quality care for important social and health indicators is a priority. Processes of care and organisational systems in primary care services are important for the optimal management of anaemia in indigenous children

Building Community with a Farmers Market, Commercial Kitchen and Community Garden The Sprouts and Roots Program at Lincoln University

Presentation made at Latinos in the Heartland (12th : 2014 : St. Louis, Mo.) and published in the annual conference proceedingThe overall objective of the Lincoln University Cooperative Extension (LUCE) Sprouts and Roots Program (SRP) is to improve the well-being of minorities and other underserved communities through gardening and to promote intergenerational activities in Jefferson City and elsewhere in Missouri. To meet this objective, training is offered on nutrition, wellness, and gardening. The effects of gardening and healthy habits on the physical and psychological health of seniors and youth are being evaluated in an ongoing research study. Recruitment was done in schools, senior centers, Boys and Girls clubs, churches, and other locations with the assistance of the LUCE Paula Carter Center on Minority Health and Aging. Flyers, emails, calls, and personal visits were used to contact potential participants. Children and seniors attended indoor and outdoor classes in spring and fall, and pretests and posttests were provided to determine their change in knowledge of particular topics. Participants practiced their new knowledge to grow their own food at the community garden located on campus. Sixteen adult seniors and 16 children participated in 2012. The farmers market, also located on campus and adjacent to the garden, is offering the opportunity to SRP participants and area farmers to sell produce, baked goods, and other value-added products. An average of 14 vendors, and a total of 43, attended the market in 2012 where fresh or value-added products were sold on Thursdays and Saturdays during the growing season. Some vendors continued selling their products during the winter months. More than 4,000 people of different ethnicities, ages, and genders attended the market on Saturdays in 2012, compared to 1,305 in 2011. The SRP is providing communities the opportunity to develop their own value-added products by facilitating their access to a commercial kitchen recently opened to the public, located next to the market and community garden. www.cambio.missouri.edu/Library/ Keywords: urban agriculture, gardening, immigrant healt