The Regular Visitors of Nursing Homes: Who Are They?

Few Australian studies have examined the social interaction of older people once they have entered nursing homes. Much of the existing literature reports the frequency of contacts that the elderly in nursing homes have with family and friends rather than explaining the factors that influence which people are more likely to visit regularly and why. This paper examines the interrelationship between frequency of visits and the charac teristics of aged residents, visitors and nursing homes, and the processes which explain these levels of interaction. A question naire was administered to aged residents in nursing homes and data was collected on the resident's network members, fre quency of contact and perceptions of the influence of placement in a nursing home on relationships. The results show that (1) the resident's perceived quality of the relationship and the location of the nursing home are important factors determining frequency of visiting, and (2) the placement in a nursing home does not necessarily weaken family ties.

Alcohol and drug use in Australian male sex workers: Its relationship to the safety outcome of the sex encounter

This paper describes the self-reporting patterns of alcohol and drug consumption among male sex workers (MSWs) in three Australian cities during commercial sex encounters, and examines to what extent alcohol and drugs are used and whether this is related to the safe/unsafe outcome of the commercial sex encounter. One hundred and eighty-six MSWs from Brisbane, Sydney and Melbourne completed a diary following each commercial sex encounter over a two-week period. MSWs reported 2,087 commercial sex encounters during the study period. Alcohol or drug consumption was reported in 50.5% of the encounters. There were 488 instances of marijuana use reported before or during a commercial sex encounter, 210 instances of volatile inhalants use, 149 instances of heroine use and 151 of other drug use, including benzodiasepines, ecstasy, speed and cocaine. These substances were consumed either alone or combined. Marijuana consumption was associated with the commercial sex encounter occurring at the MSWs' place of residence and consumption of alcohol, marijuana and nitrites with the client's place. The results also reveal that consumption of drugs and alcohol was statistically related to length of the encounter, and that clients obtained through escort agencies or brothels were significantly associated with marijuana, other drug consumption and heroine use. Interestingly, a multivariate analysis indicated that encounters where the MSW consumed marijuana or did not consume any substance were less likely to have an unsafe outcome. The paper argues that it is necessary to identify and target risk groups and behaviours that are usually not included in broad based health education messages.

Self-reported and clinically determined oral health status predictors for quality of life in dentate older migrant adults

OBJECTIVE

This paper reports the impact of oral health on the quality of life (QOL) of Southern European, dentate older adults, living independently in Melbourne, Australia. Participants were recruited through ethnic social clubs and interviewed about oral health, general health, socio-demographics, and QOL using the Medical Outcomes Study Short-Form 12 (SF-12). The SF-12's physical and mental health component summary scores (PCS and MCS, respectively) were computed. The Oral Health Impact Profile (OHIP-14) assessed the specific impact of oral health on QOL. Participants were also given a clinical oral examination.

RESULTS

A total of 603 eligible older adults volunteered; 308 were from Greek background and 295 were from Italian background. Mean age was 67.7 years (SD 6.2), with 63.7% being female. The PCS score had a mean value of 45.8 (SD 11.8), and MCS had a mean of 47.8 (SD 5.7). PCS was associated with, periodontal status, chronic health condition, self-perceived oral health needs, self-assessed oral health status, oral health impact score and the interaction between gender and level of education [F(11 552) = 10.57; P < 0.0001]. These independent variables accounted for 16% of the variance in PCS. The multivariate model predicting MCS had only one significant variable (self-reported gingival bleeding), explaining 1.5% of the variance. The OHIP-14 ranged from 0 to 48 with a mean score of 5.6 (SD 9.3). The model predicting OHIP-14 contained four significant variables: perceived oral health treatment needs, number of missing natural teeth, reports of having to sip liquid to help swallow food, and gender [F(4576) = 33.39; P < 0.0001], and explained 18% of the variance. The results demonstrated a negative association between oral health indicators and both the oral health-related QOL and the physical component of the SF-12.

CONCLUSION

The present findings support a growing recognition of the importance of oral health as a mediator of QOL. However, the self-selected sample and modest predictive power of the multivariate models suggest that further research is needed to expand this explanatory model.

Profile of the oral health among ambulant older Greek and Italian migrants living in Melbourne

BACKGROUND

Over the last 50 years an increasing number of migrants have settled in Australia. These immigrants now constitute a large proportion of the Australian population, and some research suggests that they may be at high-risk for oral diseases.

METHODS

This paper presents data on the oral health status of a convenience sample of 721 ambulant Greek- (n = 367) and Italian-born (n = 354) adults aged 55 years or older. The volunteer participants were recruited through ethnic social clubs located in Melbourne, Australia.

RESULTS

The sample was largely a dentate one (83.6 per cent); with a mean DMFS score of 67.5 (s.d. 37.4). Dentate participants had 13 per cent of their restorative care unmet, and 57.3 per cent needed oral hygiene instruction plus removal of stain and hard deposits on their teeth. Almost 8 per cent required complex periodontal therapy and 30 per cent of those fully edentulous were in need of full dentures.

CONCLUSIONS

Comparing these findings with existing data on oral health of older adults in Australia, the participants in this study appear to have lower DMFS scores and a higher prevalence of gingivitis, but less need for complex periodontal treatment. Inequalities were apparent in the proportion of unmet restorative and prosthetics needs.

Does physician bias affect the quality of care they deliver? Evidence in the care of sexually transmitted infections

BACKGROUND

Primary care providers are well placed to control the spread of sexually transmitted infections (STI); however, care is likely to be influenced by their attitudes and beliefs. The present study investigates the relationship between general practitioner's (GP) self-reported level of comfort in dealing with patients with STI and the care they deliver.

METHODS

A postal survey was conducted using a stratified random sample of 15% of GPs practising in New South Wales, Australia, to assess practitioners' management of STI. A total of 409 GPs participated in the study yielding a response rate of 45.4%.

RESULTS

Although over two-thirds (69-72%) of GPs were comfortable in managing STI in heterosexual or young patients, fewer than half (40-46%) felt comfortable caring for patients who were sex workers, indigenous, people who inject drugs, gay or lesbian. Practitioners who were comfortable were more likely to offer sexual risk assessment, safe-sex counselling, and were less likely to report limited ability to influence patients' risk behaviours. Practitioner discomfort was positively associated with reporting constraints in sexual history-taking and the need for training in sexual health.

CONCLUSIONS

Practitioners' care and support for patients with STI are influenced by their inexperience, lack of skills and/or attitudes. The reasons for GP discomfort in managing STI patients need further exploration as does its impact on patient care.

Sexual harassment in healthcare: classification of harassers and rationalizations of sex-based harassment behavior

This study identified how 16 Australian registered nurses classified sex-based harassers and explained their own behavior and the behavior of the harasser. A qualitative research design, relying on in-depth interviews, was used to collect the data. The study found that harassment is linked to gender roles and that the harassed are reluctant to blame the harasser--the harassed had "sound" rationalizations for harassment. Awareness of the interactional dynamics of self-blame and these rationalizations will help nurse executives ensure a harassment-free workplace.

Older people's knowledge and practice about lifestyle behaviors that may prevent vascular dementia

This study examined the relationship between knowledge and practice of healthy lifestyle behaviors in the prevention of vascular dementia. Data presented here are derived from a convenience sample of 296 participants recruited through senior citizen agencies in Australia. Lifestyle was measured using the Health-promoting Lifestyle Profile (HPLP). Seven knowledge subscales were developed, consistent with the HPLP. Data were analyzed using multiple regression analysis. Correlations among the lifestyle and knowledge indicated statistically significant results. However, the strength of these associations was generally weak. Multivariate analysis found that six variables explained 20% of the variance in the lifestyle score. These included: knowledge of interpersonal relations, knowledge of physical activity, medical knowledge, medical history, self-assessment of general health, and use of alcohol. The results indicate that knowledge, by itself, does not necessarily ensure that people engage in self-practising healthy lifestyle behaviors, and those who experience illness and, perhaps exposure to risk factors, had higher HPLP scores. Recommendations for how older people can be supported to reduce some of the attitudinal barriers that reduce healthy lifestyle behaviors are discussed.

Knowledge, risk perceptions and condom usage in male sex workers from three Australian cities

The study identifies factors associated with knowledge and perception of risk of HIV/AIDS, as well as attitudes to and usage of condoms by a sample of male sex workers (MSW). One hundred and eighty-five male sex workers completed a self-reported questionnaire, including knowledge about HIV transmission, attitudes to condom use and perceptions and personal susceptibility to HIV and sexually transmitted infection (STI) risk, and a two-week diary recording use of condom during commercial sex encounters. The findings reveal that condom use was found in 77.7% of the encounters with clients and the majority of the respondents perceived themselves to be at no risk for HIV because of sex work. Independent sex workers from Melbourne and workers who owned their place of residence used condoms in a significant lower proportion. Generally speaking, knowledge about the risks associated with AIDS was high, with respondents showing lower knowledge about the risks associated with unprotected receptive or active oral sex. Participants held a positive attitude to condom use; most considered the provisions of condoms to be their responsibility rather than clients; and they were more worried about contracting an STI than HIV. Those who scored higher on the knowledge scale had more positive attitudes to condom use and those who had a more positive attitude to condom use recorded a perceived lower risk of contracting STI but not HIV. The study discusses the relevance of these findings for public health risk reduction and sexual health education campaigns.

Recognizing and labeling sex-based and sexual harassment in the health care workplace

PURPOSE

To explore how registered nurses (RNs) recognized and labeled incidents of sex-based and sexual harassment in the Australian health care workplace.

DESIGN

Qualitative, using 16 unstructured interviews with registered nurses in Australia.

METHODS

Verbatim transcripts were analyzed largely by inductive analysis. Key categories were identified as themes or concepts for analysis.

FINDINGS

RNs reported several indicators of sexual harassment, including the invasion of space, confirmation from others, lack of respect, the deliberate nature of the behavior, perceived power or control, overly friendly behavior, and a sexualized workplace. RNs rarely labeled harassing behaviors as sex-based or sexual harassment.

CONCLUSIONS

Many forces reduce the likelihood that RNs will correctly recognize and label unwelcome sexualized behavior as sexual harassment. Recognition is associated with a variety of workplace behaviors that sometimes precede harassment. Implications for the health care workplace are discussed.

Male sex workers in three Australian cities: socio-demographic and sex work characteristics

This article describes the socio-demographic and sex work characteristics of sex workers in Sydney, Melbourne, and Brisbane. A total of 185 male sex workers completed the questionnaire component of the study. The results of this study serve to debunk many of the myths surrounding the popular view of the male sex worker (MSW). The respondents in this study were on average 27 years old, and the majority had completed secondary education, with 30% having gained some form of tertiary qualification. Interestingly, those MSWs who had not completed secondary education were mostly street workers and were generally aged under 25 years. The majority of sex workers lived in rented accommodation, with only 6% reporting to be homeless. Half of all respondents identified as being "gay," 31% as "bisexual" and 5.5% as "straight." More than half of the respondents were in a permanent relationship. Only 7.3% of this group reported using heroin daily, although the majority consumed alcohol, tobacco, marijuana, and ecstasy. The majority of sex workers had been in the profession for less than six months, although some had been working in the industry for more than ten years. Most of the sex workers reported having taken an HIV test and a preference to offer safer sex. The article highlights ways in which the work context of MSW can be better understood and supported by education and public policy programs.

An instrument to measure safer sex strategies used by male sex workers

Several studies have related safe sex in the commercial sex encounter to the ability of sex workers to apply specific safer sex strategies. However, no instrument has been previously available to measure these skills. The Safer-Sex Strategy Scale (SSS) was developed for such purposes. The psychometric properties (reliability and validity) were evaluated with a sample of sex workers recruited from Australian cities. A questionnaire was administered to 184 sex workers aged 18-58 years using a convenience sampling method. Results indicated that the SSS can be conceptualized as a four variation construct and can be reliably (all subscales yielded at least a Cronbach's alpha = .60) and validly measured. Additionally, the relationship of the SSS to various sex work experiences was explored. The results show that the length of time working as a sex worker and contact with sex work organizations and sexual health clinics appear to influence the level of agreement of using the safer sex strategies evaluated.

Sexually transmitted infections and use of sexual health services among young Australian women: women's health Australia study

Our objective was to examine associations between self-reported sexually transmitted infections (STIs) and sociodemographic, lifestyle, health status, health service use and quality of life factors among young Australian women; and their use of family planning and sexual health clinics and associations with health, demographic and psychosocial factors. The study sample comprised 14,762 women aged 18-23 years who participated in the mailed baseline survey for the Australian Longitudinal Study on Women's Health, conducted in 1996. The main outcome measures are self report of ever being diagnosed by a doctor with an STI, including chlamydia, genital herpes, genital warts or other STIs, and use of family planning and sexual health clinics. The self-reported incidence of STI was 1.7% for chlamydia, 1.1% genital herpes, 3.1% genital warts, and 2.1% other STIs. There was a large number of demographic, health behaviour, psychosocial and health service use factors significantly and independently associated with reports of having had each STI. Factors independently associated with use of family planning clinic included unemployment, current smoking, having had a Pap smear less than 2 years ago, not having ancillary health insurance, having consulted a hospital doctor and having higher stress and life events score. Factors independently associated with use of a sexual health clinic included younger age, lower occupation status, being a current or ex-smoker, being a binge drinker, having had a Pap smear, having consulted a hospital doctor, having poorer mental health and having higher life events score. This study reports interesting correlates of having an STI among young Australian women aged 18-23. The longitudinal nature of this study provides the opportunity to explore the long-term health and gynaecological outcomes of having STIs during young adulthood.

A profile of the clients of male sex workers in three Australian cities

OBJECTIVE

This paper describes the profile of clients as reported by 186 male sex workers in three Australian cities.

METHOD

The data were collected using a diary which was completed after each commercial sexual encounter with a male client over a two-week period. The data reported in this study are based on reports from 2,088 sex encounters and a profile of 1,776 clients.

RESULTS

The findings reveal, for example, that the most common source used for recruiting clients was advertisements, followed by escort agencies, although there were differences between the three cities; the majority of the clients were in their 40s but clients of street workers were younger; clients were most often classified as 'middle class', with differences by source of client recruitment; less than half the clients were identified as being gay and a significant number were identified as bisexual or straight; alcohol and drug use took place in a small percentage of the encounters; most workers had some information about their clients, such as occupation and home number; violence was infrequent; and unsafe sex was requested in a minority of the encounters.

CONCLUSION

Overall, the results reveal that clients of male sex workers are a highly heterogeneous group.

IMPLICATIONS

The paper highlights a number of issues which can further promote safety and public accountability in male sex work.

"Asian" men on the scene: challenges to "gay communities"

This article examines common assumptions behind the notion of "gay community," contrasting these views with the experiences of homosexual men originating from Southeast Asia on the commercial gay scene in Melbourne, Australia. The narratives here reveal fragmented social networks involving various social groups, categories of people and an "In/Out" culture where informants were culturally marginal. Fitting into the scene culture involves processes of assimilation, and loss of connection even with supportive ethnic networks. While all men who look for a place to belong on the scene generally feel pressure to assimilate to a predominantly white middle-class gay culture, Southeast Asian men generally had more cultural distance to cover. Men who are not well assimilated face exclusion, invisibility and discrimination. Differences and discrimination within Southeast Asian based networks also contributed towards fragmented relations. This article raises questions about dominant gay cultural forms, assumptions of gay solidarity, and how ethnic minority men make sense of and negotiate their sexual and social experiences.

Young women's sexual risk taking behaviour: re-visiting the influences of sexual self-efficacy and sexual self-esteem

This study investigates the influences on young women's sexual risk taking of (a) attitudes such as sexual self-efficacy and sexual self-esteem and (b) personal and sexual characteristics, such as age, the age of first sexual experience, the number of sexual partners and reported overall amount of sex. Three hundred and thirty-one young women participated in this study. With respect to regular sexual relationships, the results show that risk taking behaviour is directly and positively associated with sexual self-esteem. The effect of sexual self-efficacy on risk taking in regular relationships, however, is indirect and positive, being mediated by the overall amount of sexual activity. In contrast, with respect to casual sexual relationships, risk taking behaviour is negatively associated with self-esteem and positively associated with sexual self-efficacy. In addition, sexual self-esteem influences casual risk taking indirectly and positively, the effect being mediated by the overall amount of sexual activity. The findings in relation to sexual self-esteem and sexual self-efficacy are contrary to the expectations that these variables would be negatively associated with sexual risk taking behaviours. The implications for safe sex education are discussed.

The social construction of anticipatory grief

As medical technology prolongs life and facilitates the early diagnosis of terminal illnesses such as AIDS, the concept of anticipatory grief requires further scrutiny. The original concept of anticipatory grief has become widely accepted. This paper, however, argues that the uncritical acceptance of this concept rests primarily on the authority of the biomedical model, which has focused analysis on the predictable symptomatology of the grief process, integrating this understanding into health care. This paper provides a critical review of the concept of anticipatory grief, highlighting conceptual shifts which are required if the concept is to be relevant to the subjective experiences of people who are confronted with life-threatening illness. The paper discusses the relevance of understanding the conceptual confusion which exists in the literature between "anticipatory grief" and "forewarning of loss". It is argued that grief may be the response to a loss of meaning, and that the psychological process of adjustment to loss requires individuals to engage in the reconstitution of purpose and meaning in their lives. Distinguishing between what is being expressed for past and present losses and what responses occur when individuals focus on various aspects of their future may shed light on some of the inconsistent and contradictory findings surrounding research on anticipatory grief.

University students' knowledge of STDs: labels, symptoms and transmission

A sample of 630 Victorian university students, aged between 17 and 24, completed a questionnaire on knowledge of sexually transmitted diseases (STDs). Overall students demonstrated moderate levels of knowledge about the names of diseases which are transmitted by sexual contact, symptoms and medical facts and transmission modes of common STDs. However, they had more knowledge about the labels than they did about symptoms and transmission modes and were misinformed about certain clinical aspects of STDs. It was found that the different levels of knowledge varied with the type of STD. Knowledge about symptoms of transmission did not correlate with a disease's incidence or clinical aspects. Sexual experience and having an Australian born mother correlated with higher scores. This study suggests that young people do not have high levels of knowledge about common STDs they may encounter. Identification of a label is of limited personal value if there is no concurrent knowledge about disease transmission and prognosis.

Research directions in male sex work

This paper provides a critical review of the literature relating to male sex work and outlines approaches to theorizing about and researching male sex work. The adequacy of these models to explain the male sex work industry is discussed. The literature reveals that earlier studies conceptualized male sex work as deviance and focused on the individual sex worker and his reasons for engaging in sex work. Although the research agenda has recently moved away from the individual sex worker towards the sex work industry, the focus of the investigation continues to be from a deviance rather than a work perspective. A number of aspects of male sex work have received little attention in the literature. These include the interpersonal dialogues and power relations that constitute the commercial sexual negotiation, the role of political and economic forces, and expressions of male sexuality within the practice of commercial sex. The paper suggests future research directions and argues that researchers need to draw on the strengths of the male sex work community in order to promote safe sex practices in commercial researchers need to draw on the strengths of the male sex work community in order to promote safe sex practices in commercial sexual settings.

The social meanings behind male sex work: implications for sexual interactions

This qualitative study explores the meanings of the commercial sexual encounter between male sex workers and their clients. The study highlights the various social meanings male sex workers attribute to having sex, their typologies of clients, the psychic contexts of male commercial sex, safer sex interactions, and how these issues inform sexual behaviour. The data shows that the meaning attached to the act of having sex is an important aspect of the way in which participants perceive their partners, conduct themselves during sexual encounters, and engage in safe sex practices. Clients are categorized by sex workers according to their perceptions of 'them', which include 'marrieds', 'easy trade', 'undesirables', 'sugar daddies' and 'heaven trade'. Different types of clients pose alternate levels of risk to the safe sex practices of sex workers. The sex worker's definition of commercial sex as work enables him to separate work and personal sex and define work sex as 'not real sex', in which safe sex practices symbolize both the degree of self that is shared and protective work equipment. It was also found that this sample of sex workers do not negotiate safe sex. Rather they use 'modes of interaction' which direct the encounter either towards safe sex, or they refuse to continue with the transaction. The interactive modes identified are 'natural', 'educative', 'challenge', 'other options' and 'walk-out'. These modes of interaction are effective strategies for ensuring safe sex, and can be used by the broader community to gain partner compliance in safe sex practices.

Knowledge and practice of sexual safety in Melbourne gay men in the nineties

Despite the impact of education programs, the ability of gay men to sustain sexual safety still comes under public scrutiny. A self-administered questionnaire was distributed in 1990 to a convenience sample of 284 gay-identified Melbourne men recruited from gay groups, health clinics, gay pubs and nightclubs, sex-on-premises venues, and the social networks of these men. The questionnaire measured the perceived safety of various sexual practices and the practice of unprotected anal intercourse over the previous three months. These results were compared with results from other Australian studies. Whereas nearly all the men were sexually active, only a small proportion considered activities such as oral sex without ejaculation and anal sex with condoms to be 'totally safe'. The majority considered these activities to be 'more safe than unsafe', suggesting a risk-reduction rather than a 'no-risk' approach to sex. Comparisons with other Australian studies suggest that gay men are becoming more confident in the safety of sexual activities labelled as 'safe' by the AIDS Council. There was no elevated practice of unprotected anal sex at 'sex-on-premises' venues. Most men who had anal sex used condoms all of the time, whether sexual partnerships were 'once only' or were 'ongoing', suggesting that 'condoms always' is still a viable option in various partnerships. There was some evidence that a minority of men abandoned condoms in ongoing partnerships. If specific education campaigns are developed to promote 'negotiated safety' in partnerships, then such campaigns should not contradict the 'condoms always' strategy.

Young gay men and HIV: running the risk?

HIV research often depicts 'adolescents' and 'youth' as having 'unique' qualities which predispose them to sexual risk. Yet, the evidence points to unsafe sexual behaviour as not being socially uniform. At a time when the idea of 'risk groups' for HIV is being subjected to increasing public scrutiny, researchers also need to question assumptions about youth 'risk'. This study examines whether young gay men are at greater risk for unsafe sexual behaviour than older gay men. A questionnaire was administered to 284 predominately gay identified men in Melbourne, Australia, recruited from gay groups, health clinics, gay pubs and nightclubs, sex on premises venues, and the social networks of these men. The results show that, while there was no difference in the level of recent unprotected anal intercourse between age groups, young men (under 25 years) from gay commercial venues or who did not belong to a gay organization(s) had a significantly higher level of recent unprotected anal sex than other young gay men. These results suggest that sexual safety may be more appropriately explained as a social process, rather than a youthful characteristic, and that researchers should include cohort effects into their analyses.

Why choose to work in geriatrics? Factors which affect physiotherapists' decisions to work with older people

The paper examines the factors which influence physiotherapists' decisions to practise geriatrics. Some 233 physiotherapists returned a questionnaire aimed at identifying the major issues which affected work preference. The questionnaire included items on previous work experience with older people, attitudes towards ageing and elderly clients, and professional issues which influence career choice. The results indicated that most physiotherapists preferred to work in areas other than geriatrics. The majority who practised geriatrics were females aged 41-65, employed part-time. The decision not to work in geriatrics appeared to be related to lack of work experience with older people and employment conditions. Greater negative bias towards elderly people was shown by physiotherapists without postgraduate education in gerontology. In addition, there was a perception amongst clinicians that gerontological physiotherapy offered few opportunities for professional advancement and lacked status.