Melbourne School of Population and Global Health - Theses
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ItemKoori kids and otitis media prevention in Victoria( 2007)Otitis media and consequent hearing loss are known to be high in Koori communities. Previous research on otitis media in Koori communities has focused on its identification, treatment and management. Little research has focused on the prevention of otitis media. Victorian Aboriginal communities often have small populations which result in small sample sizes for research projects. Consequently use of traditional quantitative methods to measure of change arising from health interventions can be problematic. The aim of the research was to describe Koori children’s otitis media risk factors using a Koori research method in order to develop, implement and evaluate preventative interventions.
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ItemMemory and resettlement: Somali women in Melbourne and emotional wellbeing( 2003)This thesis derives from ethnographic research that explored the lives of forty-two Somali women who migrated to Australia as a result of the Somali civil war. In particular, it explores Somali women's experiences of depression and emotional well-being. Studies of refugee mental health are frequently premised on an audible discourse that construes refugees as suffering predominantly from war, persecution and trauma. Further, the mental health ‘problems’ of refugees are firmly situated within the bodies and minds of those classified as refugees. The experiences documented in this thesis have a different focus, reflecting the ways in which Somali women's narratives encompassed their histories, changing social relations, and idioms of home and exile. Their accounts of depression lay partly within the language and experience of war and persecution, but emotional distress was frequently attributed to contemporary realities of family separation, loss of community cohesion, marginalisation, isolation, and the hardships of resettlement. Accordingly, this thesis is not an ethnography of a fixed place or social and cultural life, but provides a longitudinal account of a refugee population in Australia. The underlying focus of the research has been 'refugee mental health', however, analysis of the research findings has involved engagement with broader theoretical areas of historical memory, identity, community, home and exile, and transnationalism. The chapters that follow give an account of the idioms through which Somali women situate and give meaning to depression. In so doing, this thesis frames refugee mental health within the broader processes and interconnections of histories, displacement and resettlement, as well as the socio-political context of war.
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ItemNurses drug and alcohol use and dependence: creating understanding( 2002)This exploratory thesis investigated issues related to the phenomenon of Victorian nurses and their drug and alcohol use and dependence. The research was divided into three separate sub-studies: sub-study 1, involved interviews with 39 key informants and stakeholders in nursing in Victoria. Sub-study 2 included eleven in-depth interviews with Victorian nurses who were self-defined as dependent on drugs and alcohol and confirmed using DSM-IV criteria. The interviews were analysed using 'grounded theory' approach. The third sub-study was a cross sectional survey of 535 nurses employed in three hospitals in Victoria. Its purpose was to investigate drug and alcohol use by nurses and to collect demographic data. Nurses in the three sub-studies viewed the use of alcohol, tranquillisers (especially benzodiazepines), tobacco and, to a lesser degree cannabis, as acceptable substances for their personal use. However the nursing profession only viewed these substances as problematic if nurses developed problems and dependencies with their use. The profession negatively regarded use of even small amounts of substances such as heroin, amphetamines and cocaine. When problematic use of any of these substances was evident severe nurse censure would lead to termination of employment of the individual nurse. The three sub-studies indicated that the nursing profession's response to nurses with drug and alcohol problems was one based on mutual secret keeping. This is evident in the secret keeping of individual nurses with problematic substance use and attempts to gain treatment. The nursing profession is itself involved in secret keeping through a culture of acceptance of certain drug use and current difficulty in dealing with problem drug use among nurses. Overall the response of the nursing profession is to leave this issue underground. The dilemma is that by staying underground few realistic strategies and protocols can be put into place, which could help individual nurses, patient care and professional capacity building within the profession.
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ItemThe epidemiology and impact of viral respiratory infections in pre-school aged children( 2009)BACKGROUND: There are significant gaps in our knowledge of the epidemiology of globally endemic respiratory viruses. Current community research methods are expensive, requiring invasive specimen collection at a home visit by health‐care workers. METHODS: Two cohort studies were conducted to collect better information about the epidemiology and impact of community‐managed respiratory illnesses in pre‐school aged children. The pilot study recruited 121 Melbourne children aged one to four years over winter/spring of 2001. Parents collected daily respiratory symptoms and completed an impact diary, including time seeking health‐care and caring for an ill child, when a pre‐defined acute respiratory illness (ARI) occurred. The Respiratory Virus Study (ReVS) followed 234 Melbourne children less than five years of age for approximately one year from January 2003. A combined nose‐throat swab (NTS), collected by parents when an ARI occurred, was added to pilot study methods. NTS specimens were transported to the Victorian Infectious Diseases Reference Laboratory (VIDRL) for polymerase chain reaction (PCR) to test for influenza A, influenza B, respiratory syncytial virus (RSV), parainfluenza viruses I, II, and III, adenoviruses, and picornaviruses (rhinoviruses, enteroviruses). At the end of the study, available specimens and nucleic acid extracts were shipped on dry ice to the Queensland Paediatric Infectious Diseases (Qpid) Laboratory and tested for human metapneumovirus and human coronavirus NL63. RESULTS: The incidence rate for community‐managed ARI in the pilot study was 0.44 episodes per childmonth (95% CI 0.38 to 0.51) with an average cost per illness of $241 (95% CI $191 to $291). The key cost driver was carer time away from usual activities caring for the ill child, making up 70% of costs. There were 730 ARIs identified in ReVS children for a rate of 0.48 ARIs per child‐month (95% CI 0.45 to 0.52). At least one virus was identified in 401 of 543 ARIs (74%) with a specimen returned, and picornaviruses were identified in 269 ARIs (50%). The total cost of all illnesses with a burden diary returned was $161,454, with over one‐third, $52,597, from illnesses where a picornavirus was identified in isolation. The mean cost of all ARIs was $309 (95% CI $263 to $354), and time spent caring for an ill child was again the key cost driver, responsible for 82% of all costs. The point estimate for the mean cost of influenza A illnesses ($904; 95% CI $89 to $1,719) was three times higher than RSV ($304; 95% CI $194 to $415), the next most expensive illness. Collection by a health‐care worker parent, collector‐reported quality, or presence of a throat swab made no difference to the proportion of specimens positive for any virus. DISCUSSION: Acute respiratory illnesses in community dwelling pre‐school aged children are common and a virus can be detected in 74% of parent‐collected specimens. Use of daily symptom diaries and parent‐collected specimens were effective and efficient study methods, and provide a new model for the future conduct of community‐based epidemiological studies for respiratory pathogens, including efficacy studies for new preventative vaccines and treatments.