South West Sydney Research Articles

Aboriginal cultural awareness training: policy v. accountability - failure in reality

Despite 42 years progress since the 1967 referendum enabling laws to be made covering Aboriginal Australians their poor health status remains and is extensively documented. This paper presents results of a study into Cultural Awareness Training (CAT) in New South Wales and specifically South West Sydney Area Health Service (SWSAHS) with the aim of improving long-term health gains. The evidence demonstrates poor definition and coordination of CAT with a lack of clear policy direction and accountability for improving cultural awareness at government level. In SWSAHS staff attendance at training is poor and training is fragmented across the Area. The paper proposes actions to improve Aboriginal cultural awareness for health professionals including incorporating Aboriginal CAT into broader based Cross Cultural Training (CCT).

Letter: Children's bicycle safety education does not reduce injuries

Learning to ride a bicycle is a common and joyful experience of childhood (up to 68% of children reported riding a bicycle in a two-week period) that has many health benefits. However, children have the highest bicycle-related injury rates compared to other age groups. In NSW, bicycle injury-related hospitalisations in people aged 5-14 years account for approximately half of all bicycle injury-related hospitalisations. A typical bicycle education program for children will involve a one-session program focusing on safe cycling information, with some time allocated to practising safe cycling skills. However, these programs have not been well documented or evaluated. We conducted a pilot study investigating the effectiveness of a bicycle education program in increasing safe cycling knowledge and behaviour in the Macarthur area of south-west Sydney.

Indigenous Research: A Commitment to Walking the Talk. The Gudaga Study—an Australian Case Study

Increasingly, the role of health research in improving the discrepancies in health outcomes between Indigenous and non-Indigenous populations in developed countries is being recognised. Along with this comes the recognition that health research must be conducted in a manner that is culturally appropriate and ethically sound. Two key documents have been produced in Australia, known as The Road Map and The Guidelines, to provide theoretical and philosophical direction to the ethics of Indigenous health research. These documents identify research themes considered critical to improving the health of the nation’s Indigenous peoples. They also provide values that, from an Indigenous perspective, are foundational to an ethical research process. This paper examines these research themes and values within the context of a current longitudinal birth cohort study of Indigenous infants and children in south-west Sydney: the Gudaga Study. Considerable time and effort have been invested in being true to the values stated in these documents: reciprocity; respect; equality; responsibility; survival and protection; and spirit and integrity. We have learnt that it is vital to be true to these values when conducting Indigenous health research—to quite literally “walk the talk”.

A better model of diabetes self-management? Interactions between GP communication and patient self-efficacy in self-monitoring of blood glucose

ObjectiveThe aim of this exploratory study was to investigate the interaction between patient self-efficacy and GP communication in explaining diabetes self-management in a disadvantaged region of Sydney, Australia. MethodsThis study was undertaken in South West Sydney with the Fairfield Division of General Practice. We used a cross-sectional survey design to assess patients’ self-reported beliefs and behaviours about diabetes self-management. We used hierarchical multiple linear regression to test for interaction effects in diabetes self-management, following tests for clustering using multilevel modeling. ResultsOf those eligible for survey, 105 patients completed the telephone survey (72%). There was a significant interaction between diabetes self-efficacy and GP communication in blood glucose testing; high-ratings of GP communication enhanced self-monitoring of blood glucose when patient self-efficacy was high but impeded self-monitoring of blood glucose when self-efficacy was low. There were no significant interaction effects for the general diet or exercise scales. ConclusionThis exploratory study suggests a complex relationship between patient self-efficacy and GP communication in self-monitoring of blood glucose. It is likely optimal diabetes self-management behaviours are produced by a fit between high patient self-efficacy and high quality GP communication. Practice implicationsThere is a risk that GPs who are sensitive to their patients’ low self-efficacy in self-monitoring of blood glucose may step in and take over the monitoring role and inadvertently reduce self-management.

Landscape‐scale detection and mapping of invasive African Olive (Olea europaea L. ssp. cuspidata Wall ex G. Don Ciferri) in SW Sydney, Australia using satellite remote sensing

AbstractQuestion: Is satellite imagery an effective tool for mapping and examining the distribution of the invasive species Olea europaea L. ssp. cuspidata at a regional landscape scale?Location: Southwest Sydney, Australia.Methods: Remote sensing software was used to classify pixels of Olea europaea L. ssp. cuspidata (African Olive) and major vegetation types from satellite imagery, using a “supervised classification” technique across a 721 km2 study area in the Cumberland Plain region of western Sydney. A map of African Olive distribution was produced from the image analysis and checked for accuracy at 337 random locations using ground observation and comparison with existing vegetation maps. The African Olive distribution data were then used in a GIS analysis with additional spatial datasets to investigate the relationship between the distribution of African Olive and environmental factors, and to quantify the conservation threat to endangered native vegetation.Results: A total area of 1907 ha of dense African Olive infestation was identified, with an omission error of 7.5% and a commission error of 5.4%. African Olive was found to occur on the steepest slopes (mean slope 14.3°) of the vegetation classes examined, with aspect analysis identifying a high prevalence on south‐ and southwest‐facing slopes. The analysis also quantified the level of African Olive infestation in endangered ecological communities, with Western Sydney Dry Rainforest (25% affected) and Moist Shale Woodland (28% affected) identified as most vulnerable to African Olive invasion.Conclusion: The distribution of African Olive can be efficiently mapped at a landscape scale. This technique, used in association with additional spatial datasets, identified African Olive as a significant environmental weed in SW Sydney, occupying a greater area than previously recognised and threatening several endangered native vegetation communities.

Intention to breastfeed and awareness of health recommendations: findings from first-time mothers in southwest Sydney, Australia.

BackgroundIn 2001, the World Health Organisation (WHO) recommended exclusive breastfeeding for the first six months of life. The objectives of this study are to assess awareness of the WHO recommendation among first-time mothers (women at 24 to 34 weeks of pregnancy) and to explore the relationship between this awareness and mothers' intention to exclusively breastfeed for six months.MethodsThis study was part of the Healthy Beginnings Trial (HBT) conducted in southwest Sydney, Australia. We analysed cross-sectional baseline data of the trial conducted in 2008, including 409 first-time mothers at 24 to 34 weeks of pregnancy. The mothers' awareness of the recommended duration of exclusive breastfeeding and their intention to meet the recommendation were assessed through face-to-face interviews. Socio-demographic data were also collected. Factors associated with awareness of the recommendation, or the intention to meet the recommendation, were determined by logistic regression modeling. Log-binomial regression was used to calculate adjusted risk ratios (ARR).ResultsSixty-one per cent of mothers knew the WHO recommendation of exclusive breastfeeding for six months. Only 42% of all mothers intended to meet the recommendation (breastfeed exclusively for six months). Among the mothers who knew the recommendation, 61% intended to meet the recommendation, compared to only 11% among those mothers who were not aware of the recommendation.The only factor associated with awareness of the recommendation was mother's level of education. Mothers who had a tertiary education were 1.5 times more likely to be aware of the recommendation than those who had school certificate or less (ARR adjusted for age 1.45, 95% CI 1.08, 1.94, p = 0.02). Mothers who were aware of the recommendation were 5.6 times more likely to intend to breastfeed exclusively to six months (ARR adjusted for employment status 5.61, 95% CI 3.53, 8.90, p < 0.001).ConclusionAwareness of the recommendation to breastfeed exclusively for six months is independently associated with the intention to meet this recommendation. A substantial number of mothers were not aware of the recommendation, particularly among those with low levels of education, which is of concern in relation to promoting breastfeeding. Improving mothers' awareness of the recommendation could lead to increased maternal intention to exclusively breastfeed for six months. However, whether this intention could be transferred into practice remains to be tested.Trial RegistrationHBT is registered with the Australian Clinical Trial Registry (ACTRNO12607000168459)

Diagnosis and management of childhood obesity: A survey of general practitioners in South West Sydney

To describe general practitioners' (GPs) diagnosis and management of overweight and obesity in children, their attitudes regarding obesity and their awareness of National Health and Medical Research Council (NHMRC) clinical practice guidelines. A cross-sectional written survey of members of the Liverpool Division of General Practice (located in South West Sydney, Australia). Of 137 questionnaires sent, 85 (62%) were returned. Although the majority prescribed the correct interventions, there was variability in complications screening, ranging from 75% screening for psychosocial problems to 30% for fatty liver. Less than a third (28%) of GPs used NHMRC guidelines in their practice and only 9% used body mass index charts to correctly diagnose childhood obesity. GPs felt that childhood obesity was a significant issue and identified parental denial and lack of community support as barriers to treatment. Although NHMRC guideline adherence was far from universal, the GPs in our survey are motivated and aware of the importance of managing childhood obesity. If the primary care approach is to work, then GPs need support and education in an environment where there is greater community awareness of the impact of childhood obesity.

Mr. Big, the Big Fella and the Split: Fault Lines in Bankstown's Labor Politics, 1955

Rodney Cavalier has shown how useful micro local studies can be in shedding light on broader events such as the labour Split of 1954-55. This article returns to one of his case studies in south-west Sydney. The redoubtable figure of Raymond Fitzpatrick, newspaper proprietor and contractor of Bankstown is introduced to Australian labour historiography. Known as the 'Mr Big of Bankstown' Fitzpatrick serves as an uncomfortable reminder that the labour tradition in Australia includes racketeers and gangsters. The article also examines the enduring legacy of the 1931 Split in the Australian labour Party in New South Wales. Twenty-four years later the considerable shadow of former premier J.T. Lang must also be taken into account in negotiating the terrain of labour politics in Sydney. So must the role of local movers and shakers like Ray Fitzpatrick. Local tensions impacting upon Charles Morgan, MHR for Reid, the federal seat surrounding Bankstown, shaped one of Australia's constitutional landmarks, the Fitzpatrick and Browne privilege case of 1955. This article relates how the scheming politician responded to threats to his position posed by Fitzpatrick, Lang and the Split.

Loss and Transformation: Mourning and The Finished People

IF REPRESENTATION CAN BE UNDERSTOOD in relation to kind of it does, one of fundamental aspects of this work is labor of facilitating pleasure, pain, sorrow, or comfort. This essay aims to examine a recent Australian film, The Finished People (2003), in regards to way that its production and its address to an audience operate in terms of value and efficacy of emotions of sadness and loss. One reviewer describes The Finished People as the first real film about cruel country we have become (Byrne). This comment is testament to way characters and events in film reference contemporary Australian public sphere. Composed of multiple narratives dealing with homelessness, poverty, and drug abuse, this film explores lives and desperate decisions made by three young men living in Cabramatta, a Sydney suburb. The despair and despondency demonstrated by these characters will be examined in order to understand how viewer is addressed in a manner that encourages particular kinds of resonance and recognition regarding pain of loss. It is loss not only of material security but of hope, loss of promise of diaspora, that saturates lives of these individuals. The representation of this loss seeks an emotional recognition in audience of particular ethical failings within social and historical world itself, such as deficit of affective bonds of community. In understanding value of these emotions in regards to social function of representation, my aim is not simply to identify a sense of loss for characters and in social imaginary, but to theorize how, through a process of mourning, this loss and sorrow might be transformed, politically, for a reconfigured and enabling approach to these lost or absent objects. I draw on work of psychoanalyst Melanie Klein because her theorization favors productive capacity of emotions and demonstrates what Kathleen Woodward calls metapsychological process, which is concerned with surviving or transforming loss through re-presenting or reinterpreting it (97). Translating this psychical process into an interpretation of a text that tries to affect its audience offers a way of exploring how The Finished People might circulate in very world-contemporary Australia-it seeks to represent. The Finished People is an unusual and difficult text to categorize, both in its generic attributes and because of its awkward fit in taxonomy of recent Australian cinema. This awkwardness owes something to context out of which film emerged: it began as a project at a community welfare center and was scripted by director-producer, Khoa Do, in collaboration with a number of nonprofessional actors who make up cast. The Finished People began with a group of unemployed youth who were taking classes in mathematics and English at Open Family Youth Social Services Centre in Southwest Sydney suburb of Cabramatta. One of them suggested making a film, and Do was asked to work with group. The film evolved out of her classes in camera work and scriptwriting. The group worked with Do in creating characters and drafting a screenplay that reflected environment that exists in and around Cabramatta and attempted to represent subjective experience of homelessness and drug abuse.1 So while narrative's three plotlines are fictional, they draw on experiences of writers. Moreover, filmmakers' use of digital video technology, cinema verite-style camera work, and voice-over commentaries that sound as if they were recorded during an interview, result in a formal sensibility associated with documentary representation. This sensibility coexists with sequences that seem highly choreographed and feature awkward acting and improvised dialogue. The three distinct storylines film is organized around represent condensed chapters in lives of male protagonists. …

BLUNT CEREBROVASCULAR INJURY: AN EVALUATION FROM A MAJOR TRAUMA CENTRE

Blunt cerebrovascular injury (BCVI), although uncommon, is associated with substantial morbidity and mortality and remains poorly understood. This study was conducted to determine the pattern and outcome of BCVI at a major trauma centre. A retrospective review of all trauma admissions between 1996 and 2004 at Liverpool Hospital, the major trauma service for south-west Sydney, was undertaken using the hospital's computerized trauma registry. Fourteen of the 7788 (0.18%) admitted blunt trauma patients sustained BCVI. Blunt carotid injury occurred in 10 of 14 and blunt vertebral injury occurred in 4 of 14 patients. Road trauma accounted for 9 of 14 cases. The median time to diagnosis was 2 days (range 1-45 days). The stroke rate was 36%, and the overall mortality was 29%. This study identified BCVI as a relatively infrequent occurrence but with significant mortality and morbidity rates. Practice guidelines for both the screening and management of this patient group need to be developed and introduced in this major trauma centre.

Social influences for smoking in pregnancy in south western Sydney antenatal clinic attendees

This study examined the needs of and barriers to smoking cessation of 677 women who attended antenatal clinics in south-west Sydney. More than a quarter (26.3%) of the mothers reported smoking at their first antenatal visit. Smokers were more likely to be teenagers, single mothers and less likely to have formal education or employment. They were less aware of the potential health risks of smoking in pregnancy (SIP). High levels of SIP remain a public health problem, and effective interventions are needed.

Investigation into the impact of couch sag on delivered dose

The effect of couch sag on treatment delivery accuracy has been investigated by modelling the variation of delivered dose from planned dose due to the difference between the treatment and simulation couches. The couch sag of the Siemens (Concord, USA) Primus linac was determined relative to the couch sag of the Siemens (Germany) Sensation 4 CT Scanner. A phantom planning study was then undertaken to evaluate the likely clinical impact of the couch sag through an evaluation of changes in dose distribution, dose volume histograms and monitor units. The couch sag was simulated by altering the angle of the CT gantry when obtaining image studysets. A second investigation into the effects of couch sag was undertaken using an existing patient CT studyset. For this investigation, the couch sag was simulated by appropriate rotation of the gantry and collimator angles. The effect of couch sag on calculated monitor units (MU) was found to be statistically insignificant. The small monitor unit changes observed were likely to result from differences in the average linear attenuation coefficient along the beam path to the isocentre. The major differences seen however were in the regions away from the central axis. The dose volume histograms showed that both the bladder and rectum were further spared with increasing tilt angle whilst the PTV dose was unchanged. The only issue at South West Sydney Cancer Services (SWSCS) in terms of patient position variation arises from the angle induced by the couch sag (or more precisely, the difference in couch sag angle between the CT and Linac couches). Due to the relatively uniform structures (of PTV, bladder and rectum), and the proximity of these critical structures to the isocentre, this angular rotation about the isocentre did not cause any major variations to the DVH, MU and isodoses for realistic levels of couch sag (i.e. less than 20mm).

Postnatal depression and post‐traumatic stress after childbirth: Prevalence, course and co‐occurrence

Research relating to the postnatal mental health of women has tended to focus on postnatal depression. There have been increasing calls to consider the issue of post‐partum anxiety disorders, including post‐traumatic stress disorder (PTSD). This study sought to provide further evidence regarding the prevalence and longitudinal course of post‐traumatic stress symptoms resulting from traumatic birth experiences. The study also investigated the extent to which symptoms of trauma and depression occur together in the postnatal period. Four hundred women were recruited from the maternity ward of a public hospital in South West Sydney. Symptoms of birth trauma and postnatal depression were assessed via questionnaires given at birth, 6 weeks, 6 months and 12 months post‐partum. The prevalence of having a PTSD profile at 6 weeks post‐partum was 2%. A further 10.5% of women reported experiencing significant distress related to childbirth and several symptoms of post‐traumatic stress without meeting full diagnostic criteria. The prevalence of a PTSD profile remained relatively stable across the first 12 months post‐partum, with estimates being 2.6% at 6 months and 2.4% at 12 months. The co‐morbidity between post‐traumatic stress and postnatal depression was high at all three time points. The study highlights the potentially chronic nature of PTSD after childbirth and the importance of viewing post‐partum emotional distress in a broader context than simply postnatal depression.

An evaluation of compliance with practice guidelines on interhospital trauma transfer

To prospectively evaluate compliance with current interhospital trauma transfer guidelines in South West Sydney, before and after an implementation programme was instituted. A scoring system was developed to assess compliance with the 11 main components of the guideline. Baseline compliance was measured during an initial 3-month period (pre), followed by an implementation programme to alert staff at referring hospitals to the presence of the guidelines. Following this, compliance was again measured over 3 months (post). Twenty-two patients were transferred during the pre-implementation phase and 35 patients during the post-phase. Overall compliance with the guidelines increased from 62 to 67%. Mean pre-hospital compliance rose from 75 to 95%, and referring hospital compliance rose from 59 to 63%. While there was an improvement in compliance with the use of the dedicated trauma hotline (86-97%), the use of a transfer checklist (41-53%), and appropriateness of transfer (95-100%), none of these reached statistical significance. Practice guidelines have been developed to optimise the process of interhospital trauma transfers. An implementation programme met with limited success in improving compliance with the guidelines. Further work is needed to ensure awareness of these guidelines, with ongoing monitoring to ensure best practice and optimal patient outcome.

Characteristics of the first 1000 clients attending an anxiety clinic in South West Sydney

This paper reports on the clinical and demographic characteristics of the first 1000 consecutive patients attending an anxiety disorders clinic at a district hospital in Sydney, Australia. Data from a large epidemiological study of the Australian population were used as a yardstick for broad comparison. Contrary to past research, a lower prevalence of comorbid anxiety and depression was found in the clinic, possibly because a portion of those patients were filtered out and referred elsewhere for treatment for depression. More female patients attended the clinic than the epidemiological study would predict. Greater numbers of patients with panic disorder, and fewer with posttraumatic stress disorder and social phobia were seen in the clinic than would be predicted by the epidemiological data. Although inferences are tentative because of the differing methods of diagnosis used, the findings indicate the value of comparing epidemiological and clinic profiles to identify those categories of anxiety patients that underutilise services.

What employment programs should health services invest in for people with a psychiatric disability?

Employment has significant health benefits for people with a psychiatric disability, including improved mental health and wellbeing and a reduction in symptoms and rates of relapse. Systematic reviews show that supported employment is more effective than prevocational training in achieving open employment for this group. Health services should invest in developing partnerships and structures to ensure access to evidence-based supported employment programs for people with a psychiatric disability. We draw on exploratory research in south-west Sydney to discuss some of the challenges that a focus on employment presents for mental health services.

Gang Rape in Sydney: Crime, the Media, Politics, Race and Sentencing

In 2001 and 2002, print, radio and television gave extensive coverage to a series of gang rapes in Bankstown and other suburbs of south-west Sydney. The coverage attacked the laxity and inefficiency of the criminal justice system and immigration policy. It fuelled public fears about increases in crime in particular areas and fear of “ethnic gangs” and racially-motivated crime. The sentences imposed on three youths of Lebanese background in the first of these cases to be dealt with attracted widespread criticism from politicians, the media and the public because of their leniency. These events occurred at a time when issues of race were in the news as a result of the arrival of “boat people”, followed by a heightened fear of terrorism because of the events of September 11, 2001. The issue of gang rape by ethnic-minority youth resurfaced in August 2002 when a second group of offenders, again Lebanese-Australian youth, were sentenced, this time with gaol terms which for the most part were applauded for their severity. In parliament, legislation was introduced to increase penalties and political parties engaged in a pre-election law-and-order auction. These events are portrayed as an example of how a localised story about crime can become “racialised” and linked with debates about asylum-seekers and terrorism. This article attempts to draw out some of the criminal-justice issues from this story. In particular it explores some of the flaws in the sentencing process that assisted in inflaming the debate. A pedagogical role for judges is suggested in relation to the public understanding of crime and guideline judgements are recommended.

Knowledge transfer and industry innovation: the discovery of nanotechnology by South-West Sydney organisations

This paper presents an innovative initiative of a regional university stimulating the development of a knowledge hub around nanotechnology applications to businesses. The paper argues that the regional industry structure and competitiveness can be influenced by this type of university-industry partnership that initiate, share, facilitate and transfer new technologies and practices. At the same time the paper indicates the social and ethical impact of introducing radical new technologies.

Building Depression Resilience in Adolescents: A 2-year Evaluation of the Resourceful Adolescent Program (RAP) in a South West Sydney High School

The Resourceful Adolescent Program (RAP), an 11-session depression prevention program, was provided to Year 9 students at a South West Sydney High School. Students were assessed using the Children's Depression Inventory and the Adolescent Coping Scale. These assessments were conducted prior to the start of the program, the end of the program, at 6 months, at 1 year and again at 2 years. Further, at the 2-year time point, students were asked to complete a questionnaire — Use and Usefulness of RAP Skills Evaluation Form (2 years on) — to help ascertain the “practical effectiveness” of RAP. The results provide some support for the efficacy of RAP as a depression prevention program with high-school students of approximately 15 years of age. A significant main effect was found for time on the CDI, with follow-up comparisons showing that pretreatment scores were significantly higher than scores at any of the other subsequent time points. There were no main effects or interactions for ethnicity or sex. For the measures of coping, no change was evidenced. This was a surprising result as one of the main objectives of RAP was to increase positive coping skills. The Use and Usefulness of Rap Skills Evaluation Form (2 years on) showed that most of the students found the program to be of some use; however, less than half stated they had utilised some of the skills taught in the program. More importantly, of the students who stated they had experienced difficult situations over the last 12 months, 23 (66%) said that they had used skills taught in RAP to help them; however, there was limited support regarding the helpfulness of these skills during the difficult situations. In spite of a number of methodological issues limiting the interpretations of the findings, the current long-term evaluation provides an important contribution to the small body of literature available on the effectiveness of RAP.

Section 4 Introduction: Demonstration Projects

Frendin?s article in the previous section describes the funding of 12 self-management demonstration projects under the Commonwealth?s Sharing Health Care Initiative. The first two papers in this section, by Lishman and Mansfield, provide some insight into the nature and conduct of demonstration projects in lower SES areas of Perth and South West Sydney respectively. The next two papers discuss demonstration projects with Indigenous people in Katherine (Mobbs et al.) and Port Lincoln (Ah Kit et al.).