Managing Post-Operative Pain in Orthopedic Patients: An International Comparison.

Introduction: Opioids play a crucial role in post-operative pain management in America, but not in some other countries. We sought to determine if a discrepancy in opioid use between the United States (U.S.

Air Quality in Association With Rural Coal Mining and Combustion in New South Wales Australia.

Purpose: Rural areas may face under-recognized threats to air quality. We tested 2 hypotheses that 1) rural areas in New South Wales, Australia, would have better air quality than metropolitan Sydney, and that 2) the rural Upper Hunter region characterized by coal mining and coal combustion would have worse air quality than other rural areas of the state.

Methods: We analyzed 2017 daily mean values for New South Wales, Australia, for particulate matter (PM2.

Utility of a child abuse screening guideline in an urban pediatric emergency department.

Background: Previous studies have found racial and socioeconomic status bias in the way clinicians screen for and detect child abuse in patients presenting to the emergency department. We hypothesized that implementing a guideline for screening would attenuate this bias.

Methods: An algorithm for child abuse screening in patients younger than 1 year presenting with fractures was developed for a pediatric trauma center emergency department.

Defining the signs and symptoms of Chiari malformation type I with and without syringomyelia.

Objective: There is a lack of correlation between how Chiari malformations are defined and the plethora of signs and symptoms attributed to these malformations. The purpose of this review is to understand the signs and symptoms of Chiari malformations in relation to the newer descriptions that define these malformations.

Methods: We reviewed the literature to determine what are the pertinent signs and symptoms related to Chiari malformations, with special attention to Chiari type I malformations.

Hearing evaluation in pediatric patients treated at the hospital following head injury.

The purpose of this study was to assess the results of a hearing evaluation protocol among 130 pediatric patients with a head injury. Sixteen of these patients failed an audiology evaluation. Ten were thought to have failed based on congestion/middle ear dysfunction, while 6 patients had temporary or permanent hearing loss thought to be related to their injury.

Environmental injustice and air pollution in coal affected communities, Hunter Valley, Australia.

The authors describe environmental injustice from air pollution in the Upper Hunter, Australia, and analyse the inaction of state authorities in addressing residents' health concerns. Obstacles blocking a public-requested health study and air monitoring include: the interdependence of state government and corporations in reaping the economic benefits of coal production; lack of political will, regulatory inertia and procedural injustice; and study design and measurement issues. We analyse mining- and coal-related air pollution in a contested socio-political arena, where residents, civil society and local government groups struggle with corporations and state government over the burden of imposed health risk caused by air pollution.

Control, uncertainty, and expectations for the future: a qualitative study of the impact of drought on a rural Australian community.

Many rural Australian communities continue to endure a prolonged drought. The mental health effects of short-term natural disaster are well known; those of a long-term and chronic natural disaster such as drought are less well understood. However, in addition to immediate distress there are likely to be feelings of loss, grief and hopelessness, all of which are implicated in an increased risk of subsequent psychiatric morbidity.

Creating a database to facilitate multilevel analyses of mental health determinants and outcomes in rural and remote areas.

Objective: The lack of consistent findings regarding comparisons of mental health between rural and urban areas has been attributed in part to methodological shortcomings, including poor conceptualization of 'rurality'. To address the diversity of rural and remote communities, an interdisciplinary collaboration sought to establish a database incorporating a range of domains hypothesised to be major influences on the mental health of individuals, families and communities.

Design: The database domains included health (physical and mental), health service utilisation, sociodemographic characteristics, climate patterns, agricultural activity and primary industry.

Social networks and mental health among a farming population.

Aims: The study investigated the associations between mental health and measures of community support, social support networks, sense of place, adversity, and perceived problems in a rural Australian population. There was a specific focus on farming communities due to previous qualitative research by the authors indicating distress by farmers in response to drought (Sartore et al. Aust Fam Phys 36(12), 990-993, 2007).

Solastalgia: the distress caused by environmental change.

Objective: Solastalgia is a new concept developed to give greater meaning and clarity to environmentally induced distress. As opposed to nostalgia--the melancholia or homesickness experienced by individuals when separated from a loved home--solastalgia is the distress that is produced by environmental change impacting on people while they are directly connected to their home environment. The paper will focus on two contexts where collaborative research teams have found solastalgia to be evident: the experiences of persistent drought in rural NSW and the impact of large-scale open-cut coal mining on individuals in the Upper Hunter Valley of NSW.

Health professionals' attitudes and practices in relation to Functional Capacity Evaluations.

Functional Capacity Evaluations (FCE's) are part of practice in work injury prevention and rehabilitation, and are designed to define an individual's functional abilities or limitations in the context of safe, productive work tasks. Qualitative research methodology was used to investigate the attitudes and behaviours of health professionals in relation to FCE use. The study aimed to identify why health professionals chose a particular FCE, and to identify what factors influence health professionals' clinical judgements when providing results and recommendations for the individual being assessed.

Randomised controlled trial of health assessments for older Australian veterans and war widows.

Objective: To assess the effect of home-based health assessments for older Australians on health-related quality of life, hospital and nursing home admissions, and death.

Design: Randomised controlled trial of the effect of health assessments over 3 years.

Participants And Setting: 1569 community-living veterans and war widows receiving full benefits from the Department of Veterans' Affairs and aged 70 years or over were randomly selected in 1997 from 10 regions of New South Wales and Queensland and randomly allocated to receive either usual care (n = 627) or health assessments (n = 942).

Antimicrobial use in children under five years with diarrhea in a central region province, Thailand.

This cross-sectional study aimed to estimate the prevalence of appropriate antimicrobial prescribing for treating childhood diarrhea within the public hospital system in a central region province, Thailand. Reported are findings of a prospective clinical audit of 424 cases treated by 38 physicians. Appropriate use of antimicrobials was defined as prescribing antimicrobials for managing an invasive bacterial-type, bloody diarrhea or not prescribing antimicrobials for managing a watery-type or non-bloody diarrhea.

"Seeing the baby": pleasures and dilemmas of ultrasound technologies for primiparous Australian women.

The practice of obstetric ultrasound scans has undergone significant expansion in the last two decades and is now a standard part of many women's antenatal care in Australia as elsewhere. This article reviews recent evidence about the value of obstetric ultrasound, summarizing debates and contradictions in research literature and practitioner guidelines. Pregnant women's interpretations of the significance of ultrasound are examined through multiple interviews with 34 study participants.

Factors affecting the intention of providers to deliver more effective continuing medical education to general practitioners: a pilot study.

Background: Despite the importance of continuing medical education (CME) for GPs, there has been little research into how providers decide what types of CME to deliver to GPs. This study aimed to identify factors affecting the intention of providers to provide more effective types of CME; and to design a survey instrument which can be used to test the applicability of Triandis' model of social behaviour to the provision of CME to general practitioners.

Methods: This was a cross-sectional study on a convenience sample of 11 Australian providers of CME for interviews and a random sample of 25 providers for the pilot test.

ORS is never enough: physician rationales for altering standard treatment guidelines when managing childhood diarrhoea in Thailand.

This study explores Thai physicians' rationales about their prescribing practices for treating childhood diarrhoea within the public hospital system in central Thailand. Presented first are findings of a prospective clinical audit and observations of 424 cases treated by 38 physicians used to estimate the prevalence of sub-optimal prescribing practices according to Thai government and WHO treatment guidelines. Second, qualitative interview data are used to identify individual, inter-personal, socio-cultural and organisational factors influencing physicians' case management practices.

Prevalence of pain among nursing home residents in rural New South Wales.

Objective: To measure the prevalence of pain among residents of rural and regional nursing homes in northern New South Wales and to describe the procedures used for pain management.

Design: Cross-sectional survey using interviews and audit of medical records.

Setting And Participants: 917 nursing home residents in 15 nursing homes within a northern NSW area health service in 1998-1999.

Measles immunization acceptance in Southeast Asia: past patterns and future challenges.

Despite substantial increases in immunization rates, measles remains a major health problem in developing countries of Southeast Asia. The authors of this paper undertook separate investigations which examined factors influencing measles immunization acceptance in the rural Philippines, Central Java, Indonesia, and an impoverished neighborhood in Bangkok, Thailand. We briefly summarize the findings of our three field investigations before presenting a synthesizing analysis of the psychosocial and demographic factors which affect measles immunization.

Reliability of the Home Falls and Accidents Screening Tool (HOME FAST) for identifying older people at increased risk of falls.

Purpose: The Home Falls and Accidents Screening Tool (HOME FAST) was designed as part of a comprehensive health assessment instrument to measure falls risk for older people within their home environment. This paper describes the evaluation of the inter-rater reliability of the HOME FAST.

Method: Forty home visits were undertaken, in urban and rural settings of the UK, by pairs of raters, one of whom was an expert rater.

Men's Perceived Health Needs.

Cross-sectional survey data describing health priorities and needs perceived by men and women living in Newcastle, Australia are compared and contrasted with national health policies. The highest prevalence of felt needs for men were stress (13 percent), cost of medical care (10 percent) and money problems (9 percent); while stress (16 percent), overweight (16 percent) and money problems (15 percent) were highest for women. These contrast with the 2000 National Health Priorities of cancer, mental health, injury, cardiovascular health, diabetes and asthma.

Professional perceptions about home safety: cross-national validation of the Home Falls and Accidents Screening Tool (HOME FAST).

The Home Falls and Accidents Screening Tool (HOME FAST) was developed to measure the risk of older people falling within their home environment. If this tool is to be effective, the underlying dimensions perceived by potential raters when using the HOME FAST need to be consistent with the purpose of the tool. The content validation process undertaken to evaluate the HOME FAST and a method to develop a home safety score are described.

A universal precautions education intervention for health workers in Sardjito and PKU Hospital Indonesia.

A non-randomized control trial was conducted to develop and evaluate a culturally appropriate academic detailing intervention on the universal precautions knowledge, attitude and behavior of health care workers in hospitals. Fivety-five health care workers (44 nurses and 11 doctors) participated in the study. They were visited individually to discuss principles of universal precautions as well as the effect of automatic pilot on their work practices.