Moral uncertainty and distress about voluntary assisted dying prior to legalisation and the implications for post-legalisation practice: a qualitative study of palliative and hospice care providers in Queensland, Australia

OBJECTIVES

There is little research on moral uncertainties and distress of palliative and hospice care providers (PHCPs) working in jurisdictions anticipating legalising voluntary assisted dying (VAD). This study examines the perception and anticipated concerns of PHCPs in providing VAD in the State of Queensland, Australia prior to legalisation of the practice in 2021. The findings help inform strategies to facilitate training and support the health and well-being of healthcare workers involved in VAD.

DESIGN

The study used a qualitative approach to examine and analyse the perception and anticipated concerns of PHCPs regarding challenges of providing assisted dying in Queensland. Fourteen PHCPs were recruited using a purposive sampling strategy to obtain a broad representation of perspectives including work roles, geographical locations and workplace characteristics. Data were collected via one in-depth interview per participant. The transcripts were coded for patterns and themes using an inductive analysis approach following the tradition of Grounded Theory.

SETTING

The study was conducted in hospital, hospice, community and residential aged care settings in Queensland, Australia. These included public and private facilities, secular and faith-based facilities, and regional/rural and urban facilities.

PARTICIPANTS

Interviews were conducted with fourteen PHCPs: 10 nurses and 4 physicians; 11 female and 3 male. The median number of years of palliative care practice was 17, ranging from 2 to 36 years. For inclusion, participants had to be practising palliative and hospice care providers.

RESULTS

PHCPs are divided on whether VAD should be considered part of palliative care. Expectations of moral distress and uncertainty about practising VAD were identified in five areas: handling requests, assessing patient capacity, arranging patient transfers and logistical issues, managing unsuccessful attempts, and dealing with team conflicts and stigma.

CONCLUSIONS

The possibility of having to practise VAD causes moral distress and uncertainty for some PHCPs. Procedural clarity can address some uncertainties; moral and psychological distress, however, remains a source of tension that needs support to ensure ongoing care of both patients and PHCPs. The introduction of VAD post-legalisation may present an occasion for further moral education and development of PHCPs.

HIV Health literacy beyond the biomedical model: an innovative visual learning tool to highlight the psychosocial complexities of care

The HIV care continuum represents a linear clinical pathway from testing to viral suppression; however, it does not capture the psychosocial complexities of contemporary HIV care. We developed an innovative and appealing visual learning resource to extend the scope of HIV health literacy beyond biomedical constructs. Based on the lived experiences of recently diagnosed people living with HIV in Queensland, the "Journeys through the HIV Care Continuum" Map presents the continuum as a complex journey incorporating challenges such as poor health literacy, health service access and stigma alongside facilitators to care, including emotional and peer support. Designed for audiences who may not access academic literature, the Map can be used to facilitate conversations between recently diagnosed people living with HIV and peer navigators, and as a learning tool for health professionals, carers and students. The Map highlights opportunities to support PLHIV in meaningful ways that will reduce stigma and promote care access.

Understanding the Social and Emotional Dimensions of HIV Self-Management: A Qualitative Study of Newly Diagnosed People Living With HIV in Queensland, Australia

ABSTRACT

Understanding of HIV self-management increasingly focuses on treatment adherence and associated health-related behaviors, yet people living with HIV (PLWH) seldom perform these actions in a social vacuum. Thus, delivering comprehensive self-management support programs for PLWH requires an understanding of the social and emotional dimensions of HIV self-management. Through thematic analysis of in-depth interviews with 35 newly diagnosed PLWH, this descriptive qualitative study highlights these dimensions and their effect on experiences of HIV diagnosis and care. HIV self-management involves interpersonal interactions that affect efforts to seek support and reimagine one's personal identity in a changed reality. Managing disclosures and navigating stigma constitute everyday work for many PLWH. Because stigma continues to impede care engagement and well-being for PLWH, health practitioners must extend focus beyond viral suppression and prioritize support for emotional and social self-management. Nurses can create safe, nonstigmatizing spaces for conversations about HIV, uphold the rights of PLWH around disclosure, and ensure that PLWH are connected to peer support services.

Enduring stigma and precarity: A review of qualitative research examining the experiences of women living with HIV in high income countries over two decades

The lived experience of HIV for women remains poorly understood. In particular, there has been little attention to the consequences for women living with HIV (WLHIV) of changing social, epidemiological, biomedical and policy contexts, or to the implications of long-term treatment and aging for the current generation of HIV-positive women. We reviewed qualitative research with WLHIV in selected high-income countries (Australia, Canada, New Zealand, the UK and the USA) to identify the most prevalent experiences of HIV for women and trends over time. Our synthesis highlights the relative consistency of experiences of a diverse sample of WLHIV, particularly the enduring prevalence of gendered HIV-related stigma, sociostructural barriers to healthcare and support, and negative encounters with health professionals. We also identified gaps in knowledge. Understanding women's experiences, particularly their changing needs and strategies for coping as they live long-term with HIV, is key to effective support and services for WLHIV.

A call for better understanding of social media in surveillance and management of noncommunicable diseases

Using social media for health purposes has attracted much attention over the past decade. Given the challenges of population ageing and changes in national health profile and disease patterns following the epidemiologic transition, researchers and policy-makers should pay attention to the potential of social media in chronic disease surveillance, management and support. This commentary overviews the evidence base for this inquiry and outlines the key challenges to research laying ahead. The authors provide concrete suggestions and recommendations for developing a research agenda to guide future investigation and action on this topic.

Retrospective self-reported dietary supplement use by Australian military personnel during deployment to Iraq and Afghanistan: results from the Middle East Area of Operations Health Study

The use of dietary supplements is popular among military personnel. However, there is a lack of understanding about the changes in use during deployment and the specific factors associated with such changes. This study retrospectively examined changes in the pattern of supplement use among Australian veterans during their deployment to Iraq (n = 8848) and Afghanistan (n = 6507) between 2001 and 2009 and identified work-related circumstances that were associated with these changes. The frequency of use of supplements at present and during deployment was assessed. Multiple logistic regression analysis was used to compare the use of supplements among different groups and among those with different deployment experiences. The study found that overall use of supplements was highest on deployment to Afghanistan (27.8%) compared with deployment to Iraq (22.0%, p < 0.001) or after deployment (current use, 21.2%; p < 0.001). Personnel who were younger or who were at the rank of noncommissioned officer were more likely to use dietary supplements. Men were more likely to use body-building supplements, whereas women more often used weight-loss supplements. Those veterans who did not report using supplements regularly on deployment were far less likely to use them subsequently. Combat exposure, mixed duty cycles, and working long hours during deployment were associated with higher supplement use. The findings confirmed that supplement use in the military reflects the unique demands and stressors of defence service.

Factors affecting the decision to initiate antiretroviral therapy in the era of treatment-as-prevention: synthesis of evidence from qualitative research in high-income settings

The emergence of treatment-as-prevention has made early initiation of antiretroviral treatment (ART) a "universal" policy. This review synthesizes qualitative research findings on barriers and facilitators of ART initiation in Organization for Economic Co-operation and Development (OECD) countries published since 2010. Ten articles describing seven research studies were included in the review. Findings confirmed ART initiation as a complicated process involving careful deliberation of the personal risks and benefits of treatment within the broader contexts of everyday life for people living with HIV (PLHIV). They also highlight interpersonal dynamics and concern for the public as increasingly important factors in shaping the decision to initiate treatment. The review provides valuable information for understanding treatment behaviour and maximizing treatment options brought forth by new biomedical advances.

Increasing HIV testing among hard-to-reach groups: examination of RAPID, a community-based testing service in Queensland, Australia

Background

The success of ‘treatment as prevention’ (TasP) to control HIV relies on the uptake of testing across priority population groups. Innovative strategies including; rapid HIV testing (RHT) in community and outreach settings, engaging peer service providers, and not requiring disclosure of sexual history have been designed to increase access. This paper reports on the implementation of ‘RAPID’, a community-based testing program in Queensland, Australia that employs these strategies to increase access to testing.

Methods

Service data, including client registration forms and a satisfaction survey from all clients attending RAPID between August 2014 and July 2015 were analysed.

Results

In 2014/2015 1,199 people attended RAPID to receive a free HIV test. The majority were urban-based gay men. 17.1% were first-time testers and 20.1% of participants were not eligible to access Medicare, Australia’s universal health care scheme.

Conclusions

RAPID’s evidence-based strategies appear to facilitate access to HIV testing, particularly among those who have never tested before; however the implications for the ongoing treatment and care of people ineligible for Medicare, who test positive to HIV warrants careful consideration.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-017-2249-5) contains supplementary material, which is available to authorized users.

How participation in surgical mortality audit impacts surgical practice

Background

Surgical mortality audit is an important tool for quality assurance and professional development but little is known about the impact of such activity on professional practice at the individual surgeon level. This paper reports the findings of a survey conducted with a self-selected cohort of surgeons in Queensland, Australia, on their experience of participating in the audit and its impact on their professional practice, as well as implications for hospital systems.

Methods

The study used a descriptive cross-sectional survey design. All surgeons registered in Queensland in 2015 (n = 919) were invited to complete an anonymous online questionnaire between September and October 2015. 184 surgeons completed and returned the questionnaire at a response rate of 20%.

Results

Thirty-nine percent of the participants reported that involvement in the audit process affected their clinical practice. This was particularly the case for surgeons whose participation included being an assessor. Thirteen percent of the participants had perceived improvement to hospital practices or advancement in patient care and safety as a result of audit recommendations. Analysis of the open-ended responses suggested the audit experience had led surgeons to become more cautious, reflective in action and with increased confidence in best practice, and recognise the importance of effective communication and clear documentation.

Conclusions

This is the first study to examine the impact of participation in a mortality audit process on the professional practice of surgeons. The findings offer evidence for surgical mortality audit as an effective strategy for continuous professional development and for improving patient safety initiatives.

The need for a rights-based public health approach to Australian asylum seeker health

Public health professionals have a responsibility to protect and promote the right to health amongst populations, especially vulnerable and disenfranchised groups, such as people seeking asylum and whose health care is frequently compromised. As at 31 March 2016, there was a total of 3707 people (including 384 children) in immigration detention facilities or community detention in Australia, with 431 of them detained for more than 2 years. The Public Health Association of Australia and the Australian Medical Association assert that people seeking asylum in Australia have a right to health in the same way as Australian citizens, and they denounce detention of such people in government facilities for prolonged and indeterminate periods of time. The position of these two professional organisations is consistent with the compelling body of evidence demonstrating the negative impact detention has on health. Yet in recent years, both the Labour and Liberal parties-when at the helm of Australia's Federal Government-have implemented a suite of regressive policies toward individuals seeking asylum. This has involved enforced legal restrictions on dissenting voices of those working with these populations, including health professionals. This paper outlines Australia's contemporary offshore immigration detention policy and practices. It summarises evidence on asylum seeker health in detention centres and describes the government's practice of purposeful silencing of health professionals. The authors examine how Australia's treatment of asylum seekers violates their health rights. Based on these analyses, the authors call for concrete action to translate the overwhelming body of evidence on the deleterious impacts of immigration detention into ethical policy and pragmatic interventions. To this end, they provide four recommendations for action.

Health and social correlates of Internet use for diabetes information: findings from Australia’s Living with Diabetes Study

This study investigated the relationship between online information seeking and a broad range of health and social characteristics among a large sample of Australian adults with type 2 diabetes. One in four participants used the Internet for diabetes-related purposes and Internet searching was associated with high patient activation, poor metabolic control, signs of peripheral nerve damage, a recent diagnosis of diabetes and poorer patient-assessed coordination of care. No relationship was found between Internet use and treatment complexity and the presence of comorbid conditions. The findings underline the importance of providing better online health resources and support to diabetes patients, and of targeting potential intervention points where services and information may be particularly beneficial.

Supportive care needs and preferences of lung cancer patients: a semi-structured qualitative interview study

PURPOSE

Lung cancer patients report both high levels of unmet supportive care need and underutilisation of support services, but the existing literature offers limited understanding of their specific needs and preferences for help. This study aimed to address this research gap through qualitative exploration of the supportive care needs and preferences of lung cancer patients.

METHODS

Semi-structured interviews were conducted with ten lung cancer patients recruited from the Chest Clinic, Royal Adelaide Hospital (South Australia). Interviews particularly focussed on four key supportive care domains: medical information, physical symptoms, activities of daily living and emotional needs.

RESULTS

Participants reported low use of supportive care services and resources in all four domains. Verbal information from doctors was preferred over printed or online information, and upfront and honest communication was highly valued. Attitude was viewed as important for coping with physical symptoms. Participants demonstrated strong determination to manage activities of daily living independently and, when this was not possible, preferred to seek help from family over external organisations. Support groups and helplines were not utilised for a variety of reasons, although several benefits of connecting with fellow cancer patients were identified.

CONCLUSIONS

The reasons behind underutilisation of supportive care services by lung cancer patients are more complex than simple lack of awareness or availability of services. Information about patients' needs and preferences reveals opportunities for service improvement and alternative models of supportive care.

{Omega}-3 fatty acid supplement use in the 45 and Up Study Cohort

OBJECTIVE

There has been a dramatic increase in the use of dietary supplements in Western societies over the past decades. Our understanding of the prevalence of Ω-3 fatty acid supplement consumption is of significance for future nutrition planning, health promotion and care delivery. However, we know little about Ω-3 fatty acid supplement consumption or users. This paper, drawing upon the largest dataset with regard to Ω-3 fatty acid supplement use (n=266 848), examines the use and users of this supplement among a large sample of older Australians living in New South Wales.

DESIGN

A cross-sectional study. Data were analysed from the 45 and Up Study, the largest study of healthy ageing ever undertaken in the Southern Hemisphere.

SETTING

New South Wales, Australia.

PARTICIPANTS

266 848 participants of the 45 and Up Study.

PRIMARY AND SECONDARY OUTCOME MEASURES

Participants' use of Ω-3, demographics (geographical location, marital status, education level, income and level of healthcare insurance) and health status (quality of life, history of smoking and alcohol consumption, health conditions) were measured.

RESULTS

Of the 266 848 participants, 32.6% reported having taken Ω-3 in the 4 weeks prior to the survey. Use of Ω-3 fatty acid supplements was higher among men, non-smokers, non-to-mild (alcoholic) drinkers, residing in a major city, having higher income and private health insurance. Osteoarthritis, osteoporosis, high cholesterol and anxiety and/or depression were positively associated with  Ω-3 fatty acid supplement use, while cancer and high blood pressure were negatively associated with use of Ω-3 fatty acid supplements.

CONCLUSIONS

This study, analysing data from the 45 and Up Study cohort, suggests that a considerable proportion of older Australians consume Ω-3 fatty acid supplements. There is a need for primary healthcare practitioners to enquire with patients about this supplement use and for work to ensure provision of good-quality information for patients and providers with regard to Ω-3 fatty acid products.

Current challenges and future directions for naturopathic medicine in Australia: a qualitative examination of perceptions and experiences from grassroots practice

Background

Naturopaths are an increasingly significant part of the healthcare sector in Australia, yet despite their significant role there has been little research on this practitioner group. Currently the naturopathic profession in Australia is undergoing a period of rapid professional growth and change. However, to date most research exploring the perceptions of naturopaths has been descriptive in nature and has focused on those in leadership positions rather than grassroots practitioners. This article explores the perceptions and experiences of practising naturopaths on the challenges and future directions of their profession.

Methods

Semi-structured interviews were conducted with 20 naturopaths practising in the Darling Downs region of South-east Queensland, Australia to explore current perceived challenges in the naturopathic profession in Australia.

Results

Participants perceived a number of internal and external challenges relating to the profession of naturopathic medicine. These included a public misconception of the role of naturopathic medicine; the co-option of naturopathic medicine by untrained or unqualified practitioners; the devaluation of naturopathic philosophy as a core component of naturopathic practice; a pressure to move towards an evidence-based medicine model focused on product prescription; the increasing commercial interest infiltrating complementary medicine, and; division and fragmentation within the naturopathic profession. Naturopaths generally perceived government regulation as a solution for many of these challenges, though this may be representative of deeper frustrations and disconnections between the views of grassroots naturopaths and those in professional leadership positions.

Conclusions

Grassroots naturopaths identify a number of challenges that may have significant impacts on the quality, effectiveness and safety of naturopathic care. Given the significant role naturopaths play in healthcare in Australia the practice and policy implications of these challenges require further research attention.

Complementary and alternative medicine use for headache and migraine: a critical review of the literature

CONTEXTS: An evidence base for complementary and alternative medicine (CAM) consumption within general populations is emerging. However, research data on CAM use for headache disorders remain poorly documented. This paper, constituting the first critical review of literature on this topic, provides a synopsis and evaluation of the research findings on CAM use among patients with headache and migraine.

METHODS

A comprehensive search of literature from 2000 to 2011 in CINAHL, MEDLINE, AMED, and Health Sources was conducted. The search was confined to peer-reviewed articles published in English reporting empirical research findings of CAM use among people with primary headache or migraine.

RESULTS

The review highlights a substantial level of CAM use among people with headache and migraine. There is also evidence of many headache and migraine sufferers using CAM concurrent to their conventional medicine use. Overall, the existing studies have been methodologically weak and there is a need for further rigorous research employing mixed method designs and utilizing large national samples.

DISCUSSION

The critical review highlights the substantial prevalence of CAM use among people with headache and migraine as a significant health care delivery issue, and health care professionals should be prepared to inquire and discuss possible CAM use with their patients during consultations. Health care providers should also pay attention to the possible adverse effects of CAM or interactions between CAM and conventional medical treatments among headache and migraine patients.

Who uses glucosamine and why? A study of 266,848 Australians aged 45 years and older

OBJECTIVES

There has been a dramatic increase in the use of complementary medicines over recent decades. Glucosamine is one of the most commonly used complementary medicines in Western societies. An understanding of glucosamine consumption is of significance for public health and future health promotion. This paper, drawing upon the largest dataset to date with regards to glucosamine use (n = 266,844), examines the use and users of glucosamine amongst a sample of older Australians.

DESIGN

Analysis of the self-reported data on use of glucosamine, demographics and health status as extracted from the dataset of the 45 and Up Study, which is the largest study of healthy ageing ever undertaken in the Southern Hemisphere involving over 265,000 participants aged 45 and over.

RESULTS

Analysis reveals that 58,630 (22.0%) participants reported using glucosamine in the 4 weeks prior to the survey. Use was higher for those who were female, non-smokers, residing in inner/outer regional areas, with higher income and private health insurance. Of all the health conditions examined only osteoarthritis was positively associated with use of glucosamine, while cancer, heart attack or angina and other heart disease were all negatively associated with glucosamine use.

CONCLUSIONS

This study suggests that a considerable proportion of the Australia population aged 45 and over consume glucosamine. There is a need for health care practitioners to enquire with their patients about their use of glucosamine and for further attention to be directed to providing good quality information for patients and providers with regards to glucosamine products.

Health service use among persons with self-reported depression: a longitudinal analysis of 7,164 women

OBJECTIVE

Depression is a common mental disorder and a leading contributor to the global burden of disease. In Australia, depression is reportedly the leading cause of morbidity for young women. In addition to conventional treatments, there is also some evidence that there is common use of complementary and alternative medicine (CAM) among people with depressive symptoms. However, there has been little research focus upon broad health care and practitioner use (including consumption of both conventional and CAM practitioners as well as self-prescribed care) among young adults with depression. This article aims specifically to address this knowledge gap by providing the first longitudinal analysis of the use of health service among women with self-reported depression.

METHODS

Data from a longitudinal cohort study (Australian Longitudinal Study on Women's Health) conducted over a 3-year period on 7,164 young Australian women were analyzed. Information on health status, health service use, and self-prescribed treatments was obtained from two questionnaires mailed to study participants in 2003 and 2006.

RESULTS

The study identified that only a small proportion of the women had sought professional assistance for their self-reported depression. It also shows that many women who reported depression used CAM alongside or as a complement to conventional health care services. In particular, young women who did not seek help for their depression were more likely to self-prescribe CAM than were women without depression.

CONCLUSION

The frequent use of a range of conventional providers and practitioner-based CAM and self-prescribed CAM among women with self-reported depression warrants further investigation.

Complementary and alternative medicine use among older Australian women--a qualitative analysis

Background

The use of complementary and alternative medicines (CAM) among older adults is an emerging health issue, however little is known about older people's experiences of using CAM and the cultural, geographical and other determinants of CAM use in this population. This study used qualitative methods to explore older women's views of CAM and reasons for their use of CAM. Participants for the project were drawn from the Australian Longitudinal Study on Women's Health (ALSWH) 1921-1926 birth cohort. Women who responded positively to a question about CAM use in Survey 5 (2008) of the ALSWH were invited to participate in the study. A total of 13 rural and 12 urban women aged between 83 and 88 years agreed to be interviewed.

Results

The women expressed a range of views on CAM which fell into three broad themes: "push" factors such as dissatisfaction with conventional health services, "pull" factors which emphasised the positive aspects of choice and self-care in health matters, and barriers to CAM use. Overall, the "push' factors did not play a major role in the decision to use CAM, rather this was driven by "pull" factors related to health care self-responsibility and being able to source positive information about types of CAM. A number of barriers were identified such as access difficulties associated with increased age, limited mobility and restricted transport options, as well as financial constraints.

Conclusions

CAM use among older women was unlikely to be influenced by aspects of conventional health care ("push factors"), but rather was reflective of the personal beliefs of the women and members of their close social networks ("pull factors"). While it was also apparent that there were differences between the rural and urban women in their use of CAM, the reasons for this were mainly due to the difficulties inherent in accessing certain types of CAM in rural areas.

A comparison of complementary and alternative medicine users and use across geographical areas: a national survey of 1,427 women

BACKGROUND

Evidence indicates that people who reside in non-urban areas have a higher use of complementary and alternative medicine (CAM) than people who reside in urban areas. However, there is sparse research on the reasons for such differences. This paper investigates the reasons for geographical differences in CAM use by comparing CAM users from four geographical areas (major cities, inner regional, outer region, rural/remote) across a range of health status, healthcare satisfaction, neighbourhood and community factors.

METHODS

A cross-sectional survey of 1,427 participants from the Australian Longitudinal Study on Women's Health (ALSWH) conducted in 2009.

RESULTS

The average total cost of consultations with CAM practitioners was $416 per annum and was highest for women in the major cities, declining with increasing distance from capital cities/remoteness (p < 0.001). The average total cost of self-prescribed CAM was $349 per annum, but this did not significantly differ across geographical areas. The increased use of CAM in rural and remote areas appears to be influenced by poorer access to conventional medical care (p < 0.05) and a greater sense of community (p < 0.05) amongst these rural and remote residents. In contrast to the findings of previous research this study found that health status was not associated with the differences in CAM use between urban and non-urban areas.

CONCLUSION

It appears that a number of factors influence the different levels of CAM use across the urban/non-urban divide. Further research is needed to help tease out and understand these factors. Such research will help support health care policy and practice with regards to this topic.

The use of complementary and alternative medicine during pregnancy: a longitudinal study of Australian women

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.

A longitudinal analysis of complementary and alternative medicine use by a representative cohort of young Australian women with asthma, 1996-2006

BACKGROUND

There is evidence of asthma patients using complementary and alternative medicine (CAM). This article reports the findings of the first ever longitudinal study of CAM use among women with asthma from a large nationally representative sample.

METHODS

A longitudinal analysis of questionnaires completed in 1996, 2000, 2003, and 2006 as part of the Australian Longitudinal Study on Women's Health. The cohort began with 14,701 randomly selected young women (aged 18-22 years). CAM use was defined as a consultation with a range of complementary practitioners in the 12 months prior to each survey. Statistical analyses included the use of generalized estimating equations.

RESULTS

Over the 10-year period, approximately 26% of the women were asthmatic. Asthmatic women were significantly more likely to use CAM (19%, 22%, and 36% for surveys 2-4, respectively) than non-asthmatic women (15%, 20%, and 32% for surveys 2-4, respectively). CAM use increased as time since asthma diagnosis increased. However, only the increase in consultations with a naturopath/herbalist remains statistically significant when the CAM modalities are considered individually alongside asthma status. The longitudinal model suggests that women with asthma are 1.13 (95% CI: 1.05-1.21) times more likely to consult with a CAM practitioner (p< .001). The study also shows that CAM users have a higher dissatisfaction with conventional healthcare services and consultations when compared to CAM non-users.

CONCLUSION

These findings suggest that women with asthma may turn to CAM after conventional care fails to adequately address their healthcare needs.

Attitudes and referral practices of maternity care professionals with regard to complementary and alternative medicine: an integrative review

AIM

This paper presents an integrative literature review examining the attitudes and referral practices of midwives and other maternity care professionals with regard to complementary and alternative treatment and its use by pregnant women.

BACKGROUND

Use of complementary and alternative medicine during pregnancy is a crucial healthcare issue. Recent discussion has identified the need to develop an integrated approach to maternity care. However, there is a lack of understanding of attitudes and behaviours of maternity care professionals towards these treatments.

DATA SOURCES

A database search was conducted in MEDLINE, CINAHL, Health Source, AMED and Maternity and Infant Care for the period 1999-2009.

REVIEW METHODS

An integrative review method was employed. Studies were selected if they reported results from primary data collection on professional practice/referral or knowledge/attitude towards complementary and alternative medicine by obstetricians, midwives and allied maternity care providers.

RESULTS

A total of 21 papers covering 19 studies were identified. Findings from these studies were extracted, grouped and examined according to three key themes: 'prevalence of practice, recommendation and referral', 'attitudes and views' and 'professionalism and professional identity'.

CONCLUSION

There is a need for greater respect and cooperation between conventional and alternative practitioners as well as communication between all maternity care practitioners and their patients about the use of complementary and alternative medicine. There is a need for in-depth studies on the social dimension of practice as well as the inter- and intra-professional dynamics that shape providers' decision to use or refer to complementary and alternative medicine in maternity care.

The urban-rural divide in complementary and alternative medicine use: a longitudinal study of 10,638 women

BACKGROUND

Research has identified women in rural and remote areas as higher users of complementary and alternative medicine (CAM) practitioners than their urban counterparts. However, we currently know little about what influences women's CAM consumption across the urban/rural divide. This paper analyses 10,638 women's CAM use across urban and rural Australia.

METHODS

Data for this research comes from Survey 5 of the Australian Longitudinal Study on Women's Health conducted in 2007. The participants were aged 56-61 years. The health status and health service use of CAM users and non-users were compared using chi-square tests for categorical variables and t-tests for continuous variables.

RESULTS

Women who consulted a CAM practitioner varied significantly by place of residence: 28%, 32% and 30% for urban, rural and remote areas respectively (P < .005). CAM users tended to be more dissatisfied with conventional care than CAM non-users, but this was consistent across the 3 areas of residence. CAM users have higher percentages of most symptoms but the only rural/urban differences were for severe tiredness, night sweats, depression and anxiety. For diagnosed diseases, CAM users have higher percentages of most diagnoses but only hypertension and skin cancer were statistically significantly higher for rural and remote but not urban women (P < .005).

CONCLUSIONS

In contrast to some recent claims, our analysis suggests the lack of access to and/or patient dissatisfaction with conventional health practitioners may not play a central role in explaining higher use of CAM by women in rural and remote areas when compared to women in urban areas.

Complementary and alternative medicine in rural communities: current research and future directions

CONTEXTS: The consumption of complementary and alternative medicine (CAM) in rural areas is a significant contemporary health care issue. An understanding of CAM use in rural health can provide a new perspective on health beliefs and practice as well as on some of the core service delivery issues facing rural health care generally.

PURPOSE

This article presents the first review and synthesis of research findings on CAM use and practice in rural communities.

METHODS

A comprehensive search of literature from 1998 to 2010 in CINAHL, MEDLINE, AMED, and CSA Illumina (social sciences) was conducted. The search was confined to peer-reviewed articles published in English reporting empirical research findings on the use or practice of CAM in rural settings.

FINDINGS

Research findings are grouped and examined according to 3 key themes: "prevalence of CAM use and practice,""user profile and trends of CAM consumption," and "potential drivers and barriers to CAM use and practice."

CONCLUSIONS

Evidence from recent research illustrates the substantial prevalence and complexity of CAM use in rural regions. A number of potential gaps in our understanding of CAM use and practice in rural settings are also identified.

Rhetoric to action: a study of stakeholder perceptions of aging well in two local communities

This qualitative study of local perceptions of policy goals and action in relation to aging reports 31 stakeholder interviews within 2 Australian communities exploring (a) the meaning of aging well; and (b) preferred policy actions to achieve positive aging outcomes. Findings suggest that community perceptions of aging well are broadly consistent with the goals of national and international policy frameworks in focusing on 3 dimensions--health, social engagement, and security. Further, participants believe that achievement of positive aging outcomes requires a mix of self-help, community action, and government intervention--particularly government support and encouragement for aging well initiatives.

A qualitative study of naturopathy in rural practice: a focus upon naturopaths' experiences and perceptions of rural patients and demands for their services

BACKGROUND

Complementary and alternative medicine (CAM) use--of which naturopathy constitutes a significant proportion--accounts for approximately half of all health consultations and half of out-of-pocket expenditure in Australia. Data also suggest CAM use is highest amongst rural Australians. Unfortunately little is known about the grass-roots reality of naturopathy or other CAM use in rural regions.

METHODS

Semi-structured interviews were conducted with 20 naturopaths practising in the Darling Downs region of South-East Queensland to assess their perceptions and experiences of rural patients and demand for their services.

RESULTS

Naturopaths described strong demand in rural areas for their services and perceived much of this demand as attributable to cultural traits in rural communities that served as pull factors for their naturopathic services. Such perceived traits included a cultural affinity for holistic approaches to health and disease and the preventive philosophy of naturopathy and an appreciation of the core tenet of naturopathic practice to develop closer therapeutic relationships. However, cost and a rural culture of self-reliance were seen as major barriers to naturopathic practice in rural areas.

CONCLUSIONS

Demand for naturopathic services in rural areas may have strong underlying cultural and social drivers. Given the apparent affinity for and increasingly large role played by CAM services, including naturopathic medicine, in rural areas it is imperative that naturopathic medicine and the CAM sector more broadly become a core focus of rural health research.

Contextualizing integration: a critical social science approach to integrative health care

This article argues for the importance of examining the phenomenon of integrative health care in broader social and historical contexts. The authors examine mainstream approaches to identify patterns of integrative medicine and criticize them for their neglect of clashes among different philosophical paradigms and the wider social contexts that govern health care in practice. The authors outline a framework and highlight the values of a critical social science perspective in deepening our understanding of recent transformations in health care practice and issues surrounding biomedicine and complementary/alternative medicine (including chiropractic, naturopathy, massage, acupuncture/oriental medicine, etc) and traditional medicine. A critical social science perspective pays special attention to complex power relations, inclusionary/exclusionary strategies, and interprofessional dynamics in medicine. Drawing upon recent research findings, the authors illustrate how such a perspective reveals the intricacies and tensions that surround the integration of different paradigms of health care practice. The authors summarize the importance of situating integrative health care in structural contexts and affirm their commitment to a critical social science approach.

Women's use of complementary and alternative medicine during pregnancy: a critical review of the literature

BACKGROUND

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.

METHODS

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.

RESULTS

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."

CONCLUSIONS

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.

Ethnic experience of cancer: a qualitative study of Chinese-Australians in Brisbane, Queensland

This article reports on the findings of a recent study of cancer experiences of members in the Chinese community in Brisbane, the state capital of Queensland. Results of the study have shown that the belief in fate and luck, as well as stoicism about cancer, is very common among cancer patients and their family members. Their general strategy for coping with cancer is often passive. Families play the most important role in determining the strategy for helping the cancer patients in coping with the illness. Most prefer to keep the illness secret and private within the family. Implications of the findings from this study will be discussed for the development of culturally appropriate programs for cancer prevention and treatment for the Chinese community.

Further evidence in support of a role for hamster sperm hydrolytic enzymes in the acrosome reaction

The effects of trypsin inhibitors and phospholipase inhibitors on the acrosome reaction of washed cauda epididymal sperm of golden hamsters were studied using two different incubation systems. One incubation system, a non-synchronous acrosome reaction inducing system, included the use of a highly purified BSA and a protein-free motility factor preparation from hamster adrenal gland. The other system was a relatively synchronous acrosome reaction-inducing-system utilizing the calcium ionophore A23187. Acrosome reactions were inhibited by three low molecular weight synthetic trypsin inhibitors, benzamidine, NPGB and TLCK, when they were added five minutes prior to the initial occurrence of acrosome reactions in the non-synchronous system or five minutes prior to induction of acrosome reactions by A23187 in the synchronous system. Two phospholipase A inhibitors, p-bromophenacyl bromide and mepacrine, were also effective in inhibiting hamster sperm acrosome reactions in both incubation systems. TPCK, an inhibitor of several non-trypsin-like proteases, indomethacin, a prostaglandin synthetase inhibitor, and soybean trypsin inhibitor, a large molecular weight polypeptide, did not inhibit acrosome reactions. The inhibition of those acrosome reactions induced by A23187 provides further indirect evidence that the effective inhibitors were functioning at a site within the sperm. The overall results provide: (1) further support for our earlier work suggesting the involvement of an internal trypsin-like enzyme (presumably acrosin) rather than an exogenous trypsin-like enzyme in the hamster sperm acrosome reaction and (2) the first evidence suggesting the possibility that a sperm phospholipase may also be involved in the mammalian acrosome reaction.

Biosynthesis of crustacean lipovitellin. III. The incorporation of labeled amino acids into the purified lipovitellin of the crab Pachygrapsus crassipes

Electrophoretically pure subunits were obtained from the lipovitellin (LV) of the intertidal crab, Pachygrapsus crassipes. The molecular weights of these subunits were determined. In addition, it was demonstrated that the ovaries of Pachygrapsus, incubated in vitro, incorporated 3H-leucine into the two principal subunits of lipovitellin. At the end of a 30 hour incubation the specific activity of each of the principal subunits was approximately 30,000 dpm/mg protein. It is concluded that the ovaries of Pachygrapsus crassipes are capable of synthesizing the proteinaceous yolk found in the mature egg.

Biosynthesis of lipovitellin by the crustacean ovary. II. Characterization of and in vitro incorporation of amino acids into the purified subunits

The amino acid composition has been determined for two of the five subunits of the crayfish lipovitellin. In addition the molecular weight of each subunit has also been ascertained. Most importantly, it is demonstrated that following in vitro incubation radioactive amino acids are incorporated into each of three purified subunits. These data strongly support the suggestion that the vitellogenic ovary of the crayfish is capable of in situ synthesis of lipovitellin.

Evidence for the role of a trypsin-like enzyme in the hamster sperm acrosome reaction

Acrosome reactions occurring in vitro in hamster sperm capacitated by bovine follicular fluid were severly inhibited by four synthetic trypsin inhibitors and by Zn2+. Three polypeptide trypsin inhibitors and a synthetic chymotrypsin inhibitor did not inhibit the acrosome reaction, and Ca2+ overcame the inhibition by Zn2+. These results suggest that a trypsin-like enzyme (possibly acrosin) plays a role in the acrosome reaction.