Too busy: why time is a health and environmental problem

Time pressure is emerging as a modern malaise. It is linked to changes in working life, with longer work hours and faster work pace, and it is compounded in families; nowadays both parents must combine working with caring. Time pressure also challenges urban, health and environmental policy because many interventions have an unacknowledged time dimension. People need time to keep healthy, to exercise and to maintain strong social and family bonds. If urban designs or environmental solutions can reduce time demands they may directly improve health and social outcomes. However, where they increase time demands they may have unanticipated health costs, create disincentives for the uptake of interventions and disadvantage those who are most time poor.     

General practice nursing education in Australia

The quality of care delivered by nurses working in Australian general practices rests on a strong foundation of nursing educatlon and training. A national study of nurses working in general practice was conducted using qualitative and quantitative research techniques to explore their role and educational needs. Results from this research suggest that education for general practice nurses is seen by nurses and General Practitioners to be largely non-formal in nature and is seen by GPs and nurses to be tailored towards general practice nursing needs. Such education is often available locally through general practice support organisations; is strongly focused on National Health Priority Areas and clinical care; and is more appropriate for registered rather than enrolled nurses. The educational opportunities currently available to support nursing in general practice are largely ad hoc and vary in relation to quality, appropriateness and accessibility. Nurses working in general practices in Australia need a system of ongoing training and education to support their responsibilities and foster the development of the position as a viable career option for nurses.     

Survey of the knowledge, attitudes and experiences of Western Australian women in relation to prenatal screening and diagnostic procedures

OBJECTIVE: To determine the knowledge, attitudes and experiences of women in Western Australia (WA) regarding prenatal procedures. DESIGN: A self-administered mail survey. SAMPLE: The survey was sent to all women who gave birth during July 2001 (n = 1801). The participants were 633 women aged 15-45. RESULTS: The mean total knowledge score was 16 out of a possible 26 (62%). The average score for all three attitude factors was four, 'agree', on a Likert scale of five. Women who reported they had private health insurance and women in the metropolitan area had significantly higher knowledge levels and had significantly more positive attitudes towards the adequacy of information. Those who did not have a screening test had less positive attitudes towards the value of the tests and had less confidence in results. Those with higher educational attainments had higher knowledge and less positive attitudes towards the value of the tests. CONCLUSIONS: Women felt positive towards the value of the tests, were confident in their results and felt positive towards the adequacy of information; however, their understanding of this information seems to be poor. It seems that the choice to undergo testing is not well informed. It was clear women need more support, information, explanations, and more time to absorb the information.     

Microinvasive squamous cell carcinoma of the cervix: immunohistochemically detected prognostic factors in a case with poor clinical outcome

BACKGROUND: Established prognostic factors for cervical cancer are tumor stage, vascular space invasion, tumor size/volume, depth of invasion, and lymph node status. Although patients with superficially invasive lesions have a very good prognosis, cases are still reported which have a poor clinical outcome. CASE: We report a case of a 41-year-old woman with very early stromal invasion (0.6 mm deep and <1 mm wide) who presented with a pelvic recurrence at 3 years and then developed an anterior abdominal wall and disseminated peritoneal recurrence 4 years after extrafascial hysterectomy. Archival tissue of the cone biopsy was stained immunohistochemically for CD44v6, Her2-neu, p53, bcl-2, MMP-1, and VEGF and showed positive staining for CD44v6 and MMP-1. CONCLUSION: The identification of new prognostic factors may enhance our understanding of the biologic behavior of early invasive cancer of the cervix. Our findings suggest that CD44v6 and MMP-1 may be markers worth further investigation in patients with microinvasive cervical cancer.     

Social work practice in the donation of human tissue for transplantation: utilising social work values and competencies to achieve effective outcomes for transplant patients and donor families

In Queensland, Australia, senior social workers have pioneered the coordination of tissue donation at coronial autopsies, seeking consent for the donation of heart valve, bone and eye tissue after sudden deaths which have been reported to the coroner. The urgent need for tissue for transplantation is balanced with the counselling, information and practical needs of potential donor families in their shock and grief. Social work assessment, advocacy, liaison, counselling, crisis intervention and particularly communication skills have been utilised, both as an integral component of obtaining informed consent and in working with families' experience of grief and loss in sudden, traumatic bereavement. This tissue donation program, over a period of eight years, has maximised the availability of tissue with its high donation rates, while upholding the rights and needs of potential donor families through provision of an effective social work service. The paper will reflect upon key social work knowledge and processes which have respected the subjective experience of client and worker while working within a medical model.     

A prospective study of the effect of nursing home residency on mortality following hip fracture

Background: The strength of nursing home residence as a prognostic indicator of outcome following hip fracture has not previously been examined in Australia. The aim of the study was to examine the influence of nursing home residency on mortality after sustaining an acute hip fracture. Methods: A prospective study of all adults aged 65 years and over presenting to a single tertiary referral hospital for management of a proximal femoral fracture between July 2003 and September 2006. Residential status was obtained at admission. Patients were followed up to September 2007 (minimum 12 months). Relative risk values for mortality were calculated comparing nursing home residents with non‐nursing home residents. Survival analysis was performed. Results: Relative risk of death was higher in nursing home patients compared with non‐nursing home patients. The difference was greater in the immediate period (30 days) post‐injury (relative risk 1.9, 95% confidence interval 1.0–3.6, P= 0.04) than after 12 months (relative risk 1.5, 95% confidence interval 1.2–1.8, P= 0.001). Survival analysis showed that 25% of patients in the nursing home group died by 96 days post‐injury, compared with 435 days in the non‐nursing home group. Conclusions: Nursing home residence confers an increased risk of death following hip fracture; this difference is greater in the immediate post‐injury period. The relative risk of death decreases over time to equal previously reported comparative mortality rates between nursing home residents and community dwellers without hip fracture.