Drinking contexts and their association with acute alcohol‐related harm : a systematic review of event‐level studies on adults' drinking occasions

Issues Event‐level alcohol research can inform prevention efforts by determining whether drinking contexts—such as people or places—are associated with harmful outcomes. This review synthesises evidence on associations between characteristics of adults' drinking occasions and acute alcohol‐related harm. Approach We systematically searched Ovid MEDLINE, Ovid PsycInfo and the Web of Science Social Sciences Citation Index. Eligible papers used quantitative designs and event‐level data collection methods. They linked one or more drinking contexts to acute alcohol‐related harm. Following extraction of study characteristics, methods and findings, we assessed study quality and narratively synthesised the findings. PROSPERO ID: CRD42018119701. Key Findings Searches identified 95 eligible papers, 65 (68%) of which study young adults and 62 (65%) of which are set in the United States, which limits generalisability to other populations. These papers studied a range of harms from assault to drink driving. Study quality is good overall although measures often lack validation. We found substantial evidence for direct effects of drinking context on harms. All of the contextual characteristics types studied (e.g. people, place, timing, psychological states, drink type) were consistently associated with harms. Certain contexts were frequently studied and associated with harms, in particular, weekend drinking, drinking in licensed premises and concurrent illicit drug use. Implications The findings of our review indicate target drinking contexts for prevention efforts that are consistently associated with increased acute alcohol‐related harm. Conclusion A large range of contextual characteristics of drinking occasions are directly associated with acute alcohol‐related harm, over and above levels of consumption

Liquor licences issued to Australian schools

BACKGROUND: Children's positive socialisation to alcohol is associated with early initiation of drinking and alcohol-related harm in adult life. Internationally, there have been reports of adults' alcohol consumption at school events in the presence of children. The aim of this research was to identify the conditions under which Australian schools are required to apply for a liquor licence and the associated prevalence of liquor licences for these events where children were likely to be present. METHODS: A document review was conducted to examine temporary liquor licensing legislation. Quantitative analysis was used to examine relevant licensing data. Coding criteria was developed to determine school type, student year levels and the likely presence of children. RESULTS: Four jurisdictions provided data on 1817 relevant licences. The average annual licences/100 schools was highest amongst Independent schools followed by Catholic and public (government) schools. The rates were highest in Queensland and Victoria where children were present at 61% and 32% of events respectively. CONCLUSIONS: While there are legislative differences across jurisdictions, the prevalence of adults' alcohol use at school events in the presence of children may reflect the various education department policies and principals' and school communities' beliefs and attitudes. Licences are not required for all events where liquor is consumed so the prevalence of adults' use of alcohol at school events is likely to be higher than our analyses imply. Such practices may undermine teaching about alcohol use in the school curriculum and health promotion efforts to develop alcohol-free events when children are present

A generic model for the assessment of disease epidemiology: the computational basis of DisMod II

Epidemiology as an empirical science has developed sophisticated methods to measure the causes and patterns of disease in populations. Nevertheless, for many diseases in many countries only partial data are available. When the partial data are insufficient, but data collection is not an option, it is possible to supplement the data by exploiting the causal relations between the various variables that describe a disease process. We present a simple generic disease model with incidence, one prevalent state, and case fatality and remission. We derive a set of equations that describes this disease process and allows calculation of the complete epidemiology of a disease given a minimum of three input variables. We give the example of asthma with age-specific prevalence, remission, and mortality as inputs. Outputs are incidence and case fatality, among others. The set of equations is embedded in a software package called 'DisMod II', which is made available to the public domain by the World Health Organization

I don't think general practice should be the front line: Experiences of general practitioners working with refugees in South Australia

Introduction Many refugees arrive in Australia with complex health needs. In South Australia (SA), providing initial health care to refugees is the responsibility of General Practitioners (GPs) in private practice. Their capacity to perform this work effectively for current newly arrived refugees is uncertain. The aim of this study was to document the challenges faced by GPs in private practice in SA when providing initial care to refugees and to discuss the implications of this for policy relating to optimising health care services for refugees. Methods Semi-structured interviews with twelve GPs in private practice and three Medical Directors of Divisions of General Practice. Using a template analysis approach the interviews were coded and analysed thematically. Results Multiple challenges providing care to refugees were found including those related to: (1) refugee health issues; (2) the GP-refugee interaction; and (3) the structure of general practice. The Divisions also reported challenges assisting GPs to provide effective care related to a lack of funding and awareness of which GPs required support. Although respondents suggested a number of ways that GPs could be assisted to provide better initial care to refugees, strong support was voiced for the initial care of refugees to be provided via a specialist refugee health service. Conclusion GPs in this study were under-resourced, at both an individual GP level as well as a structural level, to provide effective initial care for refugees. In SA, there are likely to be a number of challenges attempting to increase the capacity of GPs in private practice to provide initial care. An alternative model is for refugees with multiple and complex health care needs as well as those with significant resettlement challenges to receive initial health care via the existing specialist refugee health service in Adelaide.David R Johnson, Anna M Ziersch, Teresa Burges

Australia's insurance crisis and the inequitable treatment of self-employed midwives

Based upon a review of articles published in Australia's major newspapers over the period January 2001 to December 2005, a case study approach has been used to investigate why, when compared with other small business operators, including medical specialists, Australian governments have appeared reluctant to protect the economic viability of the businesses of self-employed midwives. Theories of agenda setting and structuralism have been used to explore that inequity. What has emerged is a picture of the complex of factors that may have operated, and may be continuing to operate, to shape the policy agenda and thus prevent solutions to the insurance problems of self-employed midwives being found

In the Margins: The Impact of Sexualised Images on the Mental Health of Ageing Women

This paper describes key findings of a study exploring how a cohort of 16 rural Australian women aged over 60 years think, feel and respond to the prevalence of sexualised imagery in the media. The qualitative research framework was informed by Feminist Standpoint Theory. Participants in three focus groups responded to semi-structured questions and prompts, interspersed with viewing examples of sexualised images. Five strong thematic categories emerged: concern for the harmful impacts of sexualised images on the vulnerable, the media’s portrayal of sexual content with a focus on physical appearance and youth, descriptions of the impact of viewing sexualised images, moderators of the impact of sexualised images on well-being, and marginalisation of women in the media. Findings from this research indicate that sexualised images in the media do have an impact on older women’s self image and mental health in numerous ways and in a range of situations. Emotional impacts included sadness, anger, concern, envy, desensitisation, marginalisation, and discomfort that their appearance was being judged by others. A strong sense of self apart from appearance, feeling valued by family and community, ignoring or overlooking media content, and being aware that media images are not real and attainable helped buffer the link between sexualised images and well-being. Another important finding is that the impact is variable: women may experience different responses to similar sexualised content depending on a range of social, health and lifestyle factors affecting them at any given time

Role Models or Gateways to Resources?: Contemporary Confusions in Mentoring Practice

Mentoring has become increasingly popular in recent years in the criminal justice system, presented across the UK and internationally as a service that can address the specific ‘needs’ of women involved with the criminal justice system. This article draws on original qualitative research with mentors and mentees to explore their experiences and to establish the aims and processes of mentoring. The rhetoric of mentoring offered by mentors and staff suggested that mentoring was based on an individualistic approach that contained responsibilising strategies. In practice, however, mentors were helping women to resolve issues related to the welfare system and other services outwith the criminal justice system. If positive outcomes of mentoring are viewed by policy makers to be the result of an individualistic approach aimed at fostering ‘pro-social’ interventions, rather than the result of attempts to mitigate wider structural failures outwith the criminal justice system, then this takes responsibility away from the state and distracts from the deeper effects of criminalising processes

The effectiveness of environment assessment tools to guide refurbishment of Australian residential aged care facilities: A systematic review

Objective: To determine applicability of environment assessment tools in guiding minor refurbishments of Australian residential aged care facilities. Method: Studies conducted in residential aged care settings using assessment tools which address the physical environment were eligible for inclusion in a systematic review. Given these studies are limited, tools which have not yet been utilised in research settings were also included. Tools were analysed using a critical appraisal screen. Results: Forty-three publications met the inclusion criteria. Ten environment assessment tools were identified, of which four addressed all seven minor refurbishment domains of lighting, colour and contrast, sound, flooring, furniture, signage and way finding. Only one had undergone reliability and validity testing. Conclusion: There are four tools which may be suitable to use for minor refurbishment of Australian residential aged care facilities. Data on their reliability, validity and quality are limited

Desired Chinese medicine practitioner capabilities and professional development needs: a survey of registered practitioners in Victoria, Australia

Background The State of Victoria in Australia introduced Chinese medicine practitioner registration in 2000 and issued its education guidelines in late 2002 for introduction in 2005. This study obtained practitioners' views on desired capabilities for competent Chinese medicine practice and to identify professional development needs. Methods A questionnaire, consisting of 28 predefined capabilities in four categories with a rating scale of importance from one to five, was developed and sent to all registered Chinese medicine practitioners in the State of Victoria, Australia in October, 2005. Results Two hundreds and twenty eight completed questionnaires were returned which represented a response rate of 32.5%. Of the four categories of capabilities, technical capabilities were considered to be the most important for clinical practice. Specifically, the ability to perform acupuncture treatment and/or dispense an herbal prescription was ranked the highest. In contrast, research and information management capabilities were considered the least important. The educational background of practitioners appeared to be an important factor influencing their rating of capabilities. Significantly, nearly double the number of practitioners with Australian qualifications than practitioners trained overseas valued communication as an important capability. For continuing professional education, clinical skills courses were considered as a priority while research degree studies were not. Conclusion Registered Chinese medicine practitioners viewed skills training as important but did not support the need for research and information management training. This represents a significant hurdle to developing Chinese medicine as a form of evidence-based healthcare