http://nova.newcastle.edu.au/vital/access/services/Feed ${session.getAttribute("locale")} 5 http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:12326 Objective: People with advanced cancer who may benefit from specialised palliative care (SPC) do not necessarily access such services. Methods: To obtain a deeper understanding of issues affecting access to SPC, five focus groups were undertaken with nurses (35), physicians (three), allied health professionals (seven) and an academic involved in providing care. Results: Thematic analysis revealed that palliative care providers consistently view palliative care as a broad holistic approach to care benchmarked on good symptom management. Whilst participants themselves perceived SPC as aiming to maximise the quality of life of the patient and family across all domains of care, they perceived that some health professionals and community members viewed palliative care largely as symptom control and terminal care for access after all disease-modifying treatment has been exhausted. Concern was expressed that such misconceptions were an important barrier to timely SPC. Participants did not nominate a time or particular milestone in the disease process which should prompt referral and suggested that SPC be available at any time where needs are complex and/or are not being met. Conclusion: Failure to properly recognise and understand the breadth of care provided within the palliative care framework may result in people with advanced cancer and their caregivers not accessing SPC services or accessing them too late to receive maximum benefit. Education may be required to promote the holistic nature of SPC services amongst health professionals and the community and to help realise the potential benefits to patients, families and health professionals resulting from timely access to SPC services. 2012-12-19T03:40:12.775Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:12249 Dementia is a chronic illness involving increasing levels of care, often provided by family members, particularly in culturally and linguistically diverse (CALD) communities. Multicultural community link workers are often the primary service providers assisting families to access health and welfare services and as such have extensive experience of, and possess in-depth knowledge about, CALD family care-giving for dementia. While research has been undertaken on dementia in CALD communities, this research has not focused on the experiences and perceptions of these multicultural workers with regards to CALD family care-giving. In response to this gap in the research, this paper presents the results of an empirical investigation of multicultural workers’ perspectives with regard to the cultural traditions informing CALD family care-giving, CALD families’ understandings of the term ‘carer’ and family arrangements regarding care. Due to their close relationship and knowledge of families, multicultural workers can offer an important perspective that is invaluable in informing the provision of carer education and support within CALD communities. 2012-12-17T02:00:04.648Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:12240 Background: The use of complementary and alternative medicine is increasingly prevalent in contemporary Western societies. The objective of this study was to explore trends and patterns in complementary and alternative medicine practitioner consultations and the use of complementary and alternative medicine consumption before, during, and after pregnancy and between pregnancies. Methods: Analysis focused on data from 13,961 women from the younger cohort of the Australian Longitudinal Study on Women’s Health collected between 1996 and 2006. Chi-square tests were employed for the cross-sectional analysis of categorical variables and t tests for continuous variables. Generalized estimating equations were used to conduct multivariate longitudinal analysis. Results: Complementary and alternative medicine use among pregnant and nonpregnant women continued to increase over the 10-year period. Although pregnancy status was not predictive of the use of alternative treatments, pregnant women employed these therapies or modalities for the relief of pregnancy-related complaints and symptoms. Analysis also revealed that women used complementary and alternative treatments selectively during pregnancy. Conclusions: This study highlights the need for further research that is sensitive to the consumption of specific complementary and alternative therapies or modalities and to the wider contexts within which women perceive risk associated with their use of complementary and alternative treatments. 2012-12-17T00:00:04.085Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:11497 Background: Occupational violence is well documented among general practice receptionists, who are singularly vulnerable because they are placed in the general practice ‘frontline’. One response to this threat has been to physically isolate reception staff from waiting room patients by having a perspex shield at the reception desk and a locked door between waiting room and staff areas. Method: A qualitative study employing semistructured interviews, an inductive approach and a thematic analysis. The study explored the experiences and perceptions of three receptionists who work in a practice with a perspex and lockdown system, and 16 who work in practices without these. Results: Receptionists were universally positive about the safety measures for reducing risk. But there was also a view that these safety measures potentially compromise the feeling of a practice being patient centred by alienating patients from staff and, paradoxically, increasing levels of patient violence and staff fearfulness. Discussion: These safety measures, while viewed positively by receptionists, may have adverse effects on patient-staff relationships and exacerbate violence and increase staff fearfulness. 2012-09-10T05:00:05.648Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:10734 Quantitative questionnaire-based research has suggested a considerable effect of skin disease on the sexual life of sufferers. In this study, we explored the effects of acne, psoriasis and atopic eczema upon sexual functioning and sexual relationships in the context of a wider exploration of the psychological sequelae of these diseases. We employed a qualitative methodology employing in-depth semistructured interviews and involving thematic analysis and constant comparison. Participants were patients with currently active acne, psoriasis or atopic eczema. Purposive sampling aimed to obtain a sample reflecting a wide range of participant characteristics including skin disease severity, age, sex, and care by general practitioner or dermatologist. Sixty-two semi-structured interviews were conducted. Acne had adverse effects on participants’ self-perceived sexual attractiveness and self-confidence, as did psoriasis and eczema. But psoriasis and eczema also had marked effects on sexual well-being and on capacity for intimacy. These were related to issues of self-esteem and sexual self-image and were often pervasive, resulting in marked behavioural avoidance of intimate situations and continuing effects on sexual well-being even in long-established sexual relationships. Effects of psoriasis and eczema on sexual well-being and sexual relationships were mediated more by appearance and texture of nongenital skin than by involvement of genital skin. We conclude that, while recognising the distressing effects of acne on self-perceived sexual attractiveness, clinicians should be especially aware of the capacity of psoriasis and eczema to profoundly affect patients’ psychological and sexual well-being. 2012-05-03T04:36:47.693Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:10612 An exploratory qualitative study was undertaken with the aim of examining oral discomfort from the perspective of terminally ill patients. Interviews focusing on the experiences and perceptions of oral discomfort and effects on day-to-day functioning among 14 palliative care patients from a mid-size hospital in a regional city in Australia were conducted. The findings reveal that a range of oral problems significantly impact on the physical, social and psychological wellbeing of terminally ill patients to varying degrees, sometimes over extended periods of time. In particular, dry mouth (xerostomia) was experienced as a significantly troubling and ongoing symptom, and bouts of ulceration and infection were also commonly discussed. Furthermore, participants reported a lack of oral assessment and virtually no input from dental experts to assist with palliating oral problems. A better understanding of the impact of oral discomfort among terminally ill patients is a significant care issue for hospice and palliative care teams, especially nursing staff, and further research of this significant issue is required. The results of the current study provide preliminary evidence to support raising the clinical focus and priority of oral care for terminally ill patients in all settings. 2012-04-12T01:44:17.543Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:381 Objective: To establish the prevalence and characteristics of occupational violence in Australian urban general practice, and examine practitioner correlates of violence. Design, setting and participants: Cross-sectional questionnaire survey mailed to all members (n = 1085) of three urban divisions of general practice in New South Wales in August and September 2004. The three divisions were chosen to provide a range of socioeconomic status (SES) demographics. Main outcome measures: Occupational violence towards general practitioners during the previous 12 months. Results: 528 GPs returned questionnaires (49% response rate). Of these, 63.7% had experienced violence in the previous year. The most common forms of violence were "low level" violence - verbal abuse (42.1%), property damage/theft (28.6%) and threats (23.1%). A smaller proportion of GPs had experienced "high level" violence, such as sexual harassment (9.3%) and physical abuse (2.7%). On univariate analysis, violence was significantly more likely towards female GPs (P < 0.001), less experienced GPs (P = 0.003) and GPs working in a lower SES status area (P < 0.001), and among practice populations encompassing greater social disadvantage (P = 0.006), mental health problems (P < 0.001), and drug-and alcohol-related problems (P < 0.001). Experience of violence was greater for younger GPs (P = 0.005) and those providing after-hours care (P = 0.033 for after-hours home visits). On multivariate analysis, a significant association persisted between high level violence and lower SES area (odds ratio [OR], 2.86), being female (OR, 5.87), having practice populations with more drug-related problems (OR, 5.77), and providing home visits during business hours (OR, 4.76). More experienced GPs encountered less violence (OR, 0.77) for every additional 5 years of practice. Conclusion: Occupational violence is a considerable problem in Australian urban general practice. Formal education programs in preventing and managing violence would be appropriate for GPs and doctors-in-training. 2012-03-01T01:33:26.214Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:6982 Objective: To explore the experiences of patients with acne, psoriasis or atopic eczema in their relationships with their treating doctors. Design: Qualitative study, using semi-structured interviews conducted between January 2004 and April 2005, thematic analysis and modified grounded theory methodology. Setting and participants: Participants were patients with acne, psoriasis or atopic eczema recruited from urban general practices and urban dermatology practices. Results: 62 semi-structured interviews were conducted. Reports of negative experiences with doctors treating participants’ skin conditions were common. Both general practitioners and dermatologists were reported as having poor comprehension of the psychological implications of skin diseases, being insensitive to their patients’ emotional suffering, and trivialising participants’ disease. Participants acknowledged that time considerations and other pressures may explain these apparent deficiencies. Some participants perceived their doctors as medical technicians and sought treatment for their physical skin disease, not for its emotional or social aspects. Conclusion: We recommend education for GPs about the psychological effects of skin diseases, and education for dermatologists and GPs on how to elicit and manage, or appropriately refer, these problems. 2012-01-30T05:04:23.062Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:6983 Post-traumatic stress disorder (PTSD) in veterans is well documented, less so the long-term impact on the health of their partners and families. The perceived health and wellbeing of women partners of Australian Vietnam veterans who were members of partners of veterans support groups is reported. This qualitative study used data from 76 participants in 10 focus groups in metropolitan, regional, and rural and remote areas of New South Wales (NSW). The data were tape-recorded, transcribed and thematically analysed using constant comparison methods. The impact of living with a partner with war-related PTSD appears to be significant and ongoing with women drawing parallels to living in a war zone. The biggest negative impact was on their mental health. They felt burdened as carers and struggled to find explanations for their husbands' problems. Support groups were very helpful. There are implications for partners of veterans who have returned from active military duty and from peacekeeping in current conflicts. 2012-01-30T05:03:57.089Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:9658 Back problems and back pain are amongst the most prevalent conditions afflicting Australians and carry high direct and indirect costs for the health care systems of all developed countries. A major gap in the research literature on this topic is the longitudinal analysis of health seeking behaviour for people with back pain. All studies to date have been cross-sectional and it is important that the use of different providers (both conventional and complementary and alternative medicine, CAM) is examined over time. This study analysed data from a longitudinal study conducted over a 3-year period on 8,910 young Australian women. Information on health service use, self-prescribed treatments, and health status was obtained from two questionnaires mailed to study participants in 2003 and 2006. We found that there is little difference in the consultation practises or use of self-prescribed CAM between women who recently sought help for back pain and women who had longer-term back pain; the only difference being that women with longer-term back pain consulted more with chiropractors. We conclude that women who seek help for their back pain are frequent visitors to a range of conventional and CAM practitioners and are also high users of self-prescribed CAM treatments. The frequent use of a range of conventional providers and practitioner-based and self-prescribed CAM amongst women with back pain warrants further investigation. 2011-12-08T00:50:03.991Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:8289 Background: The significance of occupational violence in general practice is well established, but research has focused almost exclusively on the experiences of GPs. Only limited research has examined the role of general practice receptionists despite their acknowledged vulnerability to violent patient behaviour. No qualitative research has explored this problem. Aim: To explore the experiences of general practice receptionists regarding occupational violence and the effects of violence on their psychological and emotional wellbeing and on their work satisfaction and performance. Design of study: Qualitative study. Setting: Constituent practices of an Australian network of research general practices. Practices were located in a range of socioeconomic settings. Method: Semi-structured interviews were conducted with practice receptionists. The interviews were audiotaped, transcribed, and subjected to thematic analysis employing a process of constant comparison in which data collection and analysis were cumulative and concurrent. Qualitative written responses from a cross-sectional questionnaire-based study performed concurrently with the qualitative study were similarly analysed. Results: Nineteen interviews were conducted and 12 written responses were received. Violence was found to be a common, sometimes pervasive, experience of many receptionists. Verbal abuse, both `across the counter' and telephone abuse, was the most prominent form of violence, although other violence, including assault and threats with guns, was reported. Experiences of violence could have marked emotional and psychological effects and could adversely affect job satisfaction, performance, and commitment. Conclusion: It is apparent that occupational violence is a whole-of-practice problem and strategies for GP and staff safety will need to take a whole-of-practice approach. 2011-07-18T05:10:06.177Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:8233 The use of complementary and alternative medicine has attracted much attention and debate in recent years. The objective of this critical review is to examine the evidence base on use of complementary products and therapies during pregnancy. It examines an important but neglected issue in maternity care. A database search was conducted in MEDLINE, CINAHL, AMED, and Maternity and Infant Care. A total of 24 papers published between 1999 and 2008 met the selection criteria and were included in the review. Findings of these 24 papers were extracted and reported under four themes: “user prevalence and profile,”“motivation and condition of use,”“perception and self-reported evaluation,” and “referral and information sources.” This review highlights four research gaps in the literature, a lack of: large representative samples; in-depth understanding of user experiences and risk perceptions; research comparing consumption patterns across cultures and over time; and work exploring the nature of the therapeutic encounter with complementary practitioners in this area of women's health care. 2011-07-14T01:40:04.182Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:7662 Psoriasis is a common condition with recognised psychological comorbidity in specialist practice. The objective of this study was to investigate the psychological comorbidities in psoriasis in patients from general (family) practices and specialist dermatology practices, using a qualitative methodology. This was a qualitative study, utilising semi-structured interviews and thematic analysis. Twenty-nine patients with psoriasis were recruited from general practices and specialist dermatology practices in an Australian non-capital city. Respondents represented a broad range of ages and psoriasis severities. The principle study finding was that psychological morbidity in psoriasis is considerable. Though mood and anxiety symptoms were present in participants, and were occasionally severe, more prominent sequelae of psoriasis were embarrassment, shame, impaired self-image, low self-esteem, self-consciousness and stigmatisation. Psoriasis was associated with behavioural avoidance and effects on respondents' sexuality. The perception of psoriasis as an incurable disease beyond respondents' control, with consequent pessimism regarding prognosis and treatment efficacy, was a contributor to psychological morbidity. Some respondents reported psoriasis having permanently and adversely affected their personality - avoidant personality traits were ascribed to the experience of living with psoriasis. Our conclusion is that the psychological effects of psoriasis can be considerable and long-lasting and are evident across a broad range of psoriasis severities. Clinicians should be aware that psychological sequelae are complex and encompass a range of psychological morbidities beyond conventional psychiatric diagnoses. 2011-05-03T04:30:19.821Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:7331 Objective: to determine the factors associated with complementary and alternative medicine (CAM) use among older Australian women over time. Methods: a longitudinal analysis of postal questionnaires completed in 1996, 1999, 2002 and 2005 as part of the Australian Longitudinal Study on Women's Health. Results: the percentage of women who consulted a CAM practitioner in the years 1996, 1999, 2002 and 2005 were 14.6%, 12.1%, 10.9% and 9.9%, respectively. Use of CAM increased as the number of reported symptoms increased and physical health deteriorated, for non-urban residents compared to urban residents. Conclusion: use of CAM amongst older women appears to be strongly influenced by poor physical health. There is also a suggestion that lack of access to conventional health care providers increases CAM use. There is also an overall decline in the use of CAM among older women as they age. 2011-03-02T03:50:09.196Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:7253 Evidence-based medicine (EBM) is strongly shaping the nature and direction of biomedical practice and organisational culture. Clinicians are now expected to adopt the principles of EBM and evidence-based practice (EBP) whilst also maintaining such things as professional autonomy, clinical judgement and therapeutic integrity. Little sociological work has been done on the implications of EBM in oncology contexts. Drawing on in-depth interviews with 13 oncology consultants and 12 oncology nurses in Australia, in this paper we explore how oncology clinicians utilise and/or critique types of evidence and statistical probabilities; the organisational systematisation of care; and, wider policies of EBM. The results illustrate significant variation in perception of EBM between the oncology sub-specialties examined, and the central role of organisational structures and intra-professional hierarchies in how evidence is viewed and utilised in practice. The interviews also capture the ways in which oncology specialists are negotiating the systematisation of care under the rubric of EBM, and the contradictory effects of professional de-skilling vis-à-vis the reinforcement of biomedical objectivity/power. Finally, we examine the experiences and perceptions of oncology nurses in relation to evidence and EBM, exploring the interplay of processes of professionalisation and distinction in shaping the evidence-based trajectories of nursing. We contrast these results with previous sociological writings on EBM, reflecting on the applicability and limitations of these theoretical positions when applied to the experiences of oncology clinicians. 2011-02-21T04:30:12.798Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:846 Objective: To establish the prevalence and characteristics of occupational violence in Australian urban general practice, and examine practitioner correlates of violence. Design, setting and participants: Cross-sectional questionnaire survey mailed to all members (n =1085) of three urban divisions of general practice in New South Wales in August and September 2004. The three divisions were chosen to provide a range of socioeconomic status (SES) demographics. Main outcome measures: Occupational violence towards general practitioners during the previous 12 months. Results: 528 GPs returned questionnaires (49% response rate). Of these, 63.7% had experienced violence in the previous year. The most common forms of violence were “low level” violence — verbal abuse (42.1%), property damage/theft (28.6%) and threats (23.1%). A smaller proportion of GPs had experienced “high level” violence, such as sexual harassment (9.3%) and physical abuse (2.7%). On univariate analysis, violence was significantly more likely towards female GPs (P<0.001), less experienced GPs (P= 0.003)and GPs working in a lower SES status area (P< 0.001), and among practice populations encompassing greater social disadvantage (P=0.006), mental health problems (P< 0.001), and drug- and alcohol-related problems (P<0.001). Experience of violence was greater for younger GPs (P= 0.005) and those providing after-hours care (P= 0.033) for after-hours home visits). On multivariate analysis, a significant association persisted between high level violence and lower SES area (odds ratio [OR], 2.86), being female (OR, 5.87), having practice populations with more drug-related problems (OR, 5.77), and providing home visits during business hours (OR, 4.76). More experienced GPs encountered less violence (OR, 0.77) for every additional 5 years of practice. Conclusion: Occupational violence is a considerable problem in Australian urban general practice. Formal education programs in preventing and managing violence would be appropriate for GPs and doctors-in-training. 2011-02-08T23:10:07.447Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:1530 Complementary and Alternative Medicine (CAM) has become increasingly popular amongst healthcare consumers worldwide. As such, CAM is now an important public health issue with serious implications for healthcare organization and delivery. While previous studies have provided a profile of CAM users, there remains very limited analysis of CAM consumption over time. The purpose of this paper is to describe the changing use of CAM practitioners over time by 11,454 rnid-age women in the Australian Longitudinal Study on Women's Health. Over the study period (1996-1998), 10% of women adopted the use of CAM and 9% relinquished CAM. The predominant factor found to be predictive of CAM adoption was changes in health status. Specifically, those women experiencing more illness over time are more likely to adopt CAM than those experiencing no change or better health. CAM relinquishment was associated with use of non-prescription medications, where women were more likely to relinquish CAM if they never used non-prescription medications or if they stopped taking non-prescription medications. This paper constitutes an exploratory investigation into CAM use over time. As such, there is need for further research to provide in-depth examination of the adoption and relinquishment of CAM use over a longer time period. 2010-04-27T06:29:20.192Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:2432 OBJECTIVE: To investigate the psychological sequelae of acne vulgaris. DESIGN: Qualitative study using a grounded-theory approach. SETTING: General practices and specialty dermatology practices in Newcastle, Australia. PARTICIPANTS: Patients with current acne recruited from the practices. METHOD: We used semistructured interviews and recorded participants' comments verbatim. Data analysis was cumulative and concurrent throughout the data-collection period. Coding and analysis was done in the inductive tradition. MAIN FINDINGS: Interviews were conducted with 26 subjects who represented a range of ages and acne severity. Psychological morbidity was considerable. Though participants had mood and anxiety symptoms, these symptoms tended to be subsyndromal and evanescent. More prominent symptoms were embarrassment, impaired self-image, low self-esteem, self-consciousness, frustration, and anger. Some subjects thought that acne had affected their personalities permanently and adversely. Psychological sequelae were attributed to the effects of facial acne on appearance. CONCLUSION: The psychological effects of acne can be considerable. The psychological morbidity is complex and often does not conform to standard psychiatric disease criteria. Recognition and management of the psychological sequelae of acne by general practitioners is of considerable importance. 2010-04-27T06:12:36.776Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:2546 The use of complementary and alternative medicine (CAM) in the general population has grown considerably in recent years. However, little is known about the prevalence of CAM use amongst women with cancer. Our research provides the first step in addressing this gap in knowledge by reporting on a survey of 9,375 Australian women aged 73–78. We found that, for all cancers combined, 14.5% of women with cancer consulted an alternative practitioner. This percentage varied depending on the type of cancer: skin (15.0%), breast (11.5), bowel (8.8%), and other (16.5%). Our findings suggest that CAM is now a significant practice issue for those delivering cancer-patient care and management. 2010-04-27T06:03:46.055Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:236 The aim of this research was to assess the prevalence and predictors of complementary and alternative therapy (CAT) use among cancer patients in Australia. A total of 1492 cancer patients attending nine major public cancer treatment centers in New South Wales, Australia, were asked to complete the Supportive Care Needs Survey. Of the 1354 consenting patients, 888 (65%) returned a completed survey. This article reports the secondary analyses of the survey data, specifically focusing on CAT use. For all cancers, 17.1% of patients were using at least one CAT. The two main demographic characteristics of CAT users were gender and age, where females were more likely to use CAT than males and that CAT use declined as age increased. Time since diagnosis was identified as the only significant clinical predictor of CAT use, where CAT use increased with time until 5 years since diagnosis. Our research shows that herbal treatments and naturopathy are the most popular CAT used by cancer patients (constituting over 30% of all CAT use recorded). The use of CAT among cancer patients is a significant issue in cancer care, especially considering the potential interactions between CAT and conventional medicines. Given that many cancer patients may not be aware of potential risks associated with these interactions it is important that oncologists and others involved in cancer patient care are informed about CAT and its use amongst their patients. 2010-04-27T05:56:32.676Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:317 BACKGROUND: Isotretinoin is an effective acne medication. The evidence for it causing depression and suicide, although widely publicised, remains uncertain. METHODS: Twenty-six semi-structured interviews with patients with acne were coded and subjected to thematic analysis. RESULTS: Isotretinoin was perceived to be effective but dangerous. The most well known adverse effects were depression and suicide. DISCUSSION: The overemphasis of serious psychological adverse events in patients might discourage the use of isotretinoin by those who might benefit from it. 2010-04-27T05:49:17.106Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:55 Complementary and alternative medicine (CAM) is now a significant practice issue for those delivering cancer care with a range of CAM being utilized by a significant number of patients with cancer. While various studies have explored the prevalence of CAM use among cancer patients, little is currently known about naturopathy/herbalism use by patients with cancer in Australia. This paper reports the prevalence of naturopath/herbalist consultations among mid-aged Australian women with cancer. The research was conducted as part of the Australian Longitudinal Study on Women's Health, with the data for this analysis coming from the third survey of 11 202 women aged 50-55, conducted in 2001. For all cancers combined, 15.7% of women with cancer were found to consult a naturopath/herbalist. Mid-aged women with cancer were found to be more likely to consult a naturopath/herbalist than mid-aged women without cancer. Naturopathy/herbalism consultations appear to be utilized by the women with cancer alongside and as a supplement to conventional health services. Given the prevalence of consultations with herbal therapists/naturopaths among mid-aged women with cancer in Australia, it is important that physicians and others involved in cancer patient care and management are informed and educated about naturopathy/herbalism and its use among their patients. 2010-04-27T05:36:37.244Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:4760 Rationale, aims and objectives: Clinicians’ means of stratification of risk of violence hasbeen previously studied in health settings, but not in general practice. This study aimed toinvestigate the means by which general practitioners (GPs) assess risk of violence in their clinical practice. Method: A qualitative design using focus group interviews and written responses on a subsequent questionnaire. Focus group discussions were audiotaped and transcribed. Questionnaires were sent to all members of three Divisions of General Practice offering the opportunity for respondents to make qualitative comments. The focus group transcripts and qualitative questionnaire responses were coded independently by members of the research team and subjected to thematic analysis. The setting was three Urban Divisions of General Practice in New South Wales, Australia. Participants were one hundred and seventy-two urban GPs – 18 participants in four focus groups and 154 GPs providing written responses. Results: Assessment and stratification of risk by GPs conformed to a schema based on the physical environment of the consultation, individual characteristics of the patient, individual characteristics of the doctor, and characteristics of the doctor–patient relationship. Despite this, risk assessment and risk stratification were often on the basis of ad hoc, subjective decision making. An aspect of the ad hoc nature of risk assessment was the preeminence afforded ‘instinct’or ‘intuition’ in subjects’ responses. Conclusion: A schema of factors involved in GPs’ assessment of risk of violence is presented. An appreciation of these will be of clinical and policy importance. 2010-04-27T05:31:09.390Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:3724 In recent years what can loosely be described as a sociology of complementary and alternative medicine (CAM) has begun to emerge. Although work has been conducted with lay therapists, orthodox practitioners, and consumers, overall, research in this area remains patchy and underdeveloped. Despite its role at the forefront of integration, the sociological study of the apparent affinity between nursing and CAM is virtually non-existent. This paper provides an exploratory analysis of how writers within the CAM nursing sub-world adopt a recourse to history (nostalgic and nostophobic referencing) as a strategy to authenticate the relationship between nursing and CAM and so facilitate continuing integration. A text analysis, of articles written on CAM in four nursing journals, was conducted. Eighty papers satisfied the inclusion criteria. Evidence is presented of the way in which writers attempt to authenticate integration of CAM through reference to its apparent interconnectedness with the historically grounded core of nursing values, and more specifically, with the key historical figure of the nurse Florence Nightingale (1820–1910). It is argued that these rhetorical strategies can be understood in the context of the need to engage in (primarily) intra-professional persuasion: to protect and develop the values of their nursing sub-world over alternatives. The findings are preliminary. Themes identified are illustrative of the potential offered by an analysis of nostalgic and nostophobic referencing in this context, and not a definitive account of it. Further research should examine individually produced texts from other sources, and documents produced by relevant professional bodies. 2010-04-27T05:22:35.651Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:4880 Objective: To examine the clinical practices and perceptions of herbalists providing patient care concurrently with conventional medical practice. Method: A postal survey was sent to all full members of the National Herbalists’ Association of Australia (NHAA). There were 649 members in practice at the time of the survey and the total response rate was 58.2%. Results: Most of the patients who visit professional herbalists seek care for chronic conditions have been medically diagnosed and continue to consult a general practitioner (GP). Study findings indicate that many patients who visit herbalists are taking herbal and pharmaceutical medicines concurrently. Therapists reported a high rate of referral to GPs for medical diagnosis,treatment and/or prescription. The majority of herbalists also routinely include a pharmaceutical case history as part of their consultation and patients are encouraged to inform their GPs if they are taking any herbal therapies. The majority of herbalists reported a need for closer collaboration and cooperation with the medical community in the future. Conclusion: Herbalists in Australia are fully aware of the value of medical diagnosis and interreferrals, are well informed about patient medications and require a closer working relationship with the medical community. Further research is needed to investigate potential interactions between herbal and pharmaceutical medicines to maintain high safety standards for the public. 2010-04-27T05:11:00.257Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:4375 Background: Deliberate self-poisoning is a major public heath issue in developing countries. In rural Sri Lanka deliberate self-poisoning is one of the leading causes of hospital death. The majority of patients with poisoning present to rural hospitals for initial treatment that are staffed by nonspecialist and often relatively junior doctors. The treatment of self-poisoning patients poses numerous clinical challenges and further difficulties are experienced if patients are uncooperative and aggressive, intoxicated with alcohol or suffering mental illness. Previous research in developed countries has examined self-poisoning patients and their treatment but little is know about selfpoisoning patient care in the context of rural health provision in developing countries. This study provides the first focused exploration of the experiences and perceptions of primary care rural hospital doctors in Sri Lanka toward the treatment of self-poisoning patients. Methods: Semi-structured in-depth interviews were conducted with fifteen doctors from rural hospitals in the North Central Province, Sri Lanka. All interviews were recorded and transcribed and subject to thematic analysis. Results: Participating doctors did perceive that treating self-poisoning patients in a primary care rural hospital as potentially confidence-building. However, resource issues such as the lack of medication, equipment and staffing were seen as important challenges to treating self-poisoning patients. Other challenges identified included disparity with community and other staff members regarding expectations of care, a sense of professional isolation and a lack of continuing education programs. Conclusion: Addressing professional isolation through educational and trainee programs for doctors and reducing the variance in expectations between professional groups and the community has the potential to improve delivery of care for self-poisoning patients. 2010-04-27T05:01:46.339Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:4900 Qualitative research holds potential for helping understand core aspects of chiropractic. Nevertheless, these methods remain underused in the field. This article overviews a qualitative perspective, introduces qualitative methods, and offers one possible framework to develop chiropractic research. 2010-04-27T04:56:54.546Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:4897 Background: The aim was to explore the prevalence of visitors to CAM practitioners in a total population with reference to sex, self-rated health status and socio-demographic characteristics. Methods: The paper reports findings from the Nord-Trøndelag Health Study (HUNT 2), a total population-based health survey of 42,277 respondents conducted in central Norway who answered questions on visits to a CAM practitioner. Variables included were age, marital status, education, receiving social welfare benefits, lifestyle (daily smoker), Hospital Anxiety and Depression Scale (HADS-TI, self-rated health status, and having a limiting chronic complaint. Results: Some 12.8% (95% CI 12.5-13.1) of the population had visited a CAM practitioner in the last 12 months, with females visiting almost twice as often as males. Multivariate analysis showed that consulting a CAM practitioner was significantly associated in both sexes with being middle-aged (male age 40-49 OR 1.6 (1.2-2.0), female age 30-39 OR 1.4 (1.1-1.6)); poor self-rated health status (male OR 5.1 (3.1-8.51, female 3.9 (2.2-6.8 1); and reporting a chronic complaint (male OR 1.5 (1.3-1.81, female OR 1.4 (1.2-1.6)). Daily smoking of cigarettes was associated with a decreased likelihood for visiting a CAM practitioner (male OR 0.7 (0.6-0.9), female OR 0.8 (0.7-0.9)). In females, both a higher total HADS-T score (score >20 OR 1.5 (1.2-2.0)) and middle-level education (OR 1.2 (1.1-1.4)) were associated with visiting a CAM practitioner. Conclusions: Visitors to CAM practitioners had lower self-reported health than non-users, but socio-demographic variables did not discriminate between users and non-users. 2010-04-27T04:56:52.246Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:5188 Objective: To explore GPs' opinions about the causes of occupational violence in general practice. Design: A cross-sectional qualitative study. Setting: Three urban divisions of general practice in New South Wales, Australia. Participants: A total of 172 GPs: 18 GPs participated in focus group discussions and a further 154 provided written responses. Method: Purposive sampling was used to recruit GPs to participate in focus groups. Discussions were audiotaped and transcribed; each transcript was separately coded by all members of the research team. Focus groups were conducted until thematic saturation was achieved. Further qualitative data were obtained by offering GPs the opportunity, during completion of a written questionnaire sent to all GPs practising in the 3 urban divisions, to provide additional comments regarding their experiences and perceptions of violence. A modified grounded-theory approach, employing thematic analysis of the focus group transcripts and written responses from the questionnaires, was used. Main Findings: All focus group participants and 75% of questionnaire respondents had experienced episodes of violence during their general practice careers. Key themes that emerged in data analysis were used to construct a schema of participating GPs' perceptions of the causes of occupational violence. Elements in the schema include underlying causes, proximate causes, and GP vulnerability. Perhaps the most noteworthy findings within this structure were the emergent constructs - culture of fear, "naïve" practice culture, and GP vulnerability. To date these themes have not been evident in general practice literature on this topic. Conclusion: An understanding of GPs' perceptions regarding the causes of violence will be useful in planning general practice service provision and promoting GP safety. 2010-04-27T04:47:08.719Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:5553 Acne, psoriasis and atopic eczema are common diseases and have been consistently associated with adverse psychological sequelae including stigmatization. Being teased on the basis of appearance has been associated with psychiatric morbidity in children and adolescents. The objective of this qualitative study was to explore the experiences of teasing and bullying in patients with acne, psoriasis and eczema, and the role of appearance-related teasing and bullying as mediators of psychological morbidity in these patients. Data collection consisted of 62 in-depth semi-structured interviews with patients with acne, psoriasis or atopic eczema recruited from both specialist dermatology and general practices. Data analysis was cumulative and concurrent throughout the data collection period reflecting a grounded theory approach. Analysis followed the analytic induction method, allowing themes to emerge from the data. Teasing, taunting or bullying was a considerable problem for a significant minority of acne, psoriasis and atopic eczema participants. Themes that emerged were the universally negative nature of the teasing, the use of teasing as an instrument of social exclusion, and as a means of establishing or enforcing power relationships, teasing related to contagion and fear, the emotional and psychological sequelae of teasing and the theme of 'insensate' teasing. For those who had suffered teasing or bullying, this was causally linked in respondents' accounts with psychological sequelae, especially self-consciousness and effects on self-image and self-esteem. Experiences of teasing and bullying were found to have principally occurred during the adolescence of participants and the perpetrators were other adolescents, but there were findings of respondents with psoriasis also having been subjected to ridicule or derogatory remarks by health professionals. Teasing, taunting and bullying may represent an underappreciated source of psychological morbidity in children and adolescents with these common skin diseases. 2010-04-27T04:46:02.500Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:5153 Rationale, aims and objectives Occupational violence is increasingly recognized as a problem in general practice, and has been suggested as adversely affecting general practitioners' (GPs) provision of services to patients. The aim of this study was to investigate the association of experiences of violence and perceptions of risk of violence with provision of after-hours GP care and home visits. Method A questionnaire-based cross-sectional survey of GPs in three Australian Urban Divisions of General Practice was used. Results Five hundred and twenty-eight GPs completed the survey (response rate 49%). Of the GPs surveyed, 63.7% were subjected to some form of violence in the previous 12 months. Risk of violence influenced 10.2% of GPs' delivery of in-hours home visits and 22.0% of GPs' delivery of after-hours home visits. A further 4.7% of GPs reported not performing after-hours home visits at all during the previous 12 months because of safety concerns. On logistic regression, gender, location of practice and country of medical qualification were significantly associated with provision of in-hours and after-hours home visits. Experience of violence during the previous 12 months was not significantly associated with provision of home visits. Conclusions This study's finding of GPs' self-reported restriction of practice and withdrawal from home visits and after-hours calls in response to risk of violence represents a significant primary health care issue. GPs' decision to provide after-hours calls and home visits is complex, and the finding of lack of significant association of experiences of violence with provision of home visits and after-hours calls is likely to be due to the cross-sectional nature of the study. 2010-04-27T04:44:44.578Z ]]>