- Rural Health - Theses
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Item'It keeps me in the loop': re-thinking social networking sites from the perspective of young ruralWAITE, CATHERINE ( 2012)Young people and their incorporation of social networking sites into everyday social life has become an increasingly central topic in public discussion. Emotive debate is characterised by assumptions regarding how young people integrate information technologies into their lives and interact with others using the site. Ulrich Beck’s (1986) risk society theory is utilised to analyse debate and attribute responses within a risk-laden context. Understanding fears associated with young people’s use of social networking sites can be conceptualised as constituent of broader discourses of risk. Locating dominant discourse in this respect and acknowledging that these do not necessarily reflect how young people incorporate the medium into their broader lives, this thesis seeks alternative understandings to account for this lack. A qualitative study was designed to address this gap in understanding. Undertaken in two rural towns in North/Central Victoria, 40 young people aged 16-22 years took part in the interview based study. Recruited via local sporting clubs and through other sources, respondents were invited to discuss the ways in which they maintained important social relationships. Conversations naturally flowed towards technology and the social networking site Facebook arose as the most common social networking site among participants. Data was also collected from respondents Facebook profile pages. Analysis resulted in several broad themes being identified. Principally, the social networking site Facebook was used as a virtual platform to maintain important peer and other face-to-face based relationships. Erving Goffman’s (1959) presentation of self theory was used to discuss the ways in which young people ‘performed’ identity in online contexts. It became clear during data analysis that Facebook resembled a type of stage which the young people used to construct performances for audiences made up of their friends and others known in material contexts. In this sense, presentations were anchored in material contexts, mostly depicting actual individuals in the form of photos and other symbolic representational forms. The virtual nature of social networking sites necessarily influenced the nature of interactions. Inherent spatial/temporal allowances supported a heightened level of control in terms of presentation of self. Respondents enthusiastically embraced the opportunity afforded by the virtual environment to construct idealised versions of themselves on the site. Donna Haraway’s (1991) cyborg theory was applied to examine the relative positioning of everyday life and social networking sites as described by the young respondents. Cyborg theory (1991) was valuable in its ability to articulate the fluid melding of apparently dichotomous virtual/material categories into one blurred, permeable form. The ways in which young people reported incorporating material selves within virtual contexts, with the unique, mutually exclusive properties of each medium informing interactions, explicated the cyborg elegantly. In the case of this thesis, the cyborg metaphor is applied to Facebook itself. The concepts of individualism, complexity and contradiction embraced within Haraway’s cyborg theory (1991) were also exemplified and captured as much as possible among the young interviewees of this study. This thesis argues for a reconsideration of the ways in which young people and information technologies are understood. Challenging dominant understandings by privileging young people’s perspectives, this thesis advocates for understandings which take into account the ways in which common applications such as Facebook are used. In exploring how Facebook mediated relationships are interconnected with other material relationships among young people in two rural Victorian towns, this thesis identified numerous complexities. Material lives were subtly melded with, and indelibly embedded within virtual contexts. In this sense, Facebook can be best understood as an individualised extension of young people’s broader social lives. It is part of a larger suite of information technologies, social media and other mediated sociality but ultimately anchored in materially based, face-to-face interactions.
ItemHow do premature babies exposed to opiates in utero withdraw? A comparison of withdrawal symptoms in preterm and term babies exposed to opiates in uteroPerera, Niroshini ( 2012)OBJECTIVE: The aim of this research is to discover the rate and pattern of withdrawal observed in premature babies exposed to opiates (heroin, methadone and buprenorphine) in utero. METHODOLOGY: To determine the incidence and severity of neonatal abstinence syndrome in term and preterm babies, a retrospective case note review was undertaken of all women who delivered at a tertiary obstetric hospital, from January 2003 to December 2007 inclusive, who were regularly using heroin, or prescribed methadone, or buprenorphine. Neonatal abstinence syndrome (NAS) was diagnosed using the modified Finnegan NAS scoring system. A control group of non-opiate-exposed mothers and babies matched for gestation, gender and postcode as a marker of socioeconomic status were also selected. Their postnatal course and incidence of co-morbidities was compared to the preterm opiate-exposed cohort. RESULTS: There were 149 opiate-exposed babies included in our study. 108 were term and 41 were preterm. The overall rate of NAS was 32.9%, with no significant difference between term and preterm babies. The mean gestation of those babies with NAS was 37.5 weeks. Those babies with NAS had significant difficulty in establishing feeding, particularly in the term group. Length of stay between preterm and term babies with NAS was comparable. Preterm opiate-exposed babies took significantly longer to regain their birth weight when compared to non-opiate-exposed controls. Length of stay in hospital was increased, only if neonatal abstinence syndrome was diagnosed. CONCLUSION: Opiate-exposed babies experience withdrawal across gestations. Preterm opiate-exposed babies take significantly longer to return to their birth weight. This could reflect stress, which manifests as poor weight gain.
ItemWorkplace violence in healthcare: stakeholder views on strategies to address client-initiated aggression in the Victorian public healthcare sectorSAUNDERS, DONNA ( 2011)Workers’ rights to be safe at their workplace are fundamental to occupational health and safety (OHS). In healthcare, client-initiated aggression is a prevalent form of workplace violence and occupational hazard that affects workers’ safety and quality of healthcare. Healthcare services must balance the needs of the client and their obligation to address healthcare service hazards. A multifaceted, organisation-wide strategy to assess, prevent and manage client-initiated aggression is important, one that balances social policy, responds to the risk, reduces exposure and incidents of the hazard, and is responsive to the needs of the client. The research described in this thesis identified key factors for inclusion in a strategy designed to manage client-initiated aggression in the Victorian public healthcare sector. This research is important because it explores the interplay of workplace violence, client stakeholder views, barriers and enablers of implementation, and methods to sustain a strategy. Previous Australian studies found that the healthcare workforce is in the top seven industry groups exposed to workplace violence and subject to the second highest rate of physical assault. The hazard is generated by ill-health, stress, healthcare discipline practice, and organisational, social and economic factors. Workplace violence affects remote, rural and metropolitan healthcare services in Australia and the costs and impacts are significant. The severity and frequency of incidents per capita and the impacts on the community are higher in rural than metropolitan settings, and highest in remote areas. Using a qualitative approach, interviews and focus groups were conducted with stakeholders in the healthcare sector to understand the phenomenon of client-initiated aggression and factors to include in a prevention and management strategy. These are presented around key themes according to the literature and other themes stemming from the data. These themes were refined (according to the scope of text within the interviews and focus groups) into twelve sets reflecting both a content and thematic analysis. The twelve factors are policy, procedure and practice, workplace design, training and education, monitoring and review, risk management, funding, an overarching approach, prevention, practice management, organisation and culture, bullying and harassment and client perspectives. The research established that these twelve factors, in addition to evidence and consultation, are required in a client-initiated aggression strategy. All factors must aim to achieve continuous improvement in quality, safety and standardisation in the healthcare setting. Executive commitment throughout an organisation is required through monitoring and review processes. The key to an effective strategy is to proactively promote prevention measures, to state organisational tolerance to client-initiated aggression, and uphold a rights and responsibilities statement for clients, staff and the healthcare organisation.
ItemDiabetes prevention in women with previous gestational diabetesSwan, Wendy Elizabeth ( 2009)Gestational diabetes mellitus is a risk factor for future diabetes, a condition largely preventable by healthy eating, increased physical activity and weight management. Postpartum women with young children face many barriers to adopting healthy lifestyle programs including time constraints, multiple commitments, tiredness and resuming work. Clearly, to prevent diabetes occurring health professionals need to understand how to help post-partum women adopt healthy lifestyles. Behaviour change occurs in five stages and matching healthy lifestyle information to stage of change can promote readiness to change. The aim of the current study was to identify whether a stage-matched intervention could promote diabetes risk reduction behaviours in a cohort of women with previous GDM in the Goulburn Murray catchment area. A total of 210 eligible women, identified from medical records as GDM in the past five years were invited to participate in a healthy lifestyle program incorporating stage-matched information reinforced with telephone contact or to receive routine information only. Data were collected via a mailed health behaviour questionnaire incorporating validated tools; the Active Australia Survey, Stage of Change tool and Fat and Fibre questionnaire at baseline and post-intervention. At follow-up women answered a series of open-ended questions describing the promoters of and the barriers to behaviour change. Results were coded and analysed using Statistical Package for the Social Sciences (Version 14). Seventy-seven women (mean age 35 years) agreed to participate and were randomly assigned to a treatment or control group. Eighty-eight percent completed the six-month assessment. The attrition rate was similar in both groups. There was a positive trend towards increased readiness to be active (progression of one or more stages, p< 0.05) in the intervention group compared to standard information only. There was no difference between groups in progression of stage readiness to reduce fat intake or lose weight. Both groups increased the total amount of activity undertaken by approximately 60 minutes per week and the proportion of women meeting activity guidelines increased to a similar extent in each group. There was minimal difference between the groups for weight loss or reducing fat intake. The women stressed the importance of having a goal, especially a health goal, and strong social support as important promoters of health behaviour change. In contrast, low mood, emotional eating, tiredness, lack of time and support reduced the likelihood that behaviour change would occur. Conclusion: It is possible to implement and meaningfully evaluate an intervention incorporating stage-matched information and regular telephone reminder calls for women with a history of GDM. Despite the small sample size, this intervention can increase readiness to be more active compared to routine health promotion information. However, the intervention was unable to produce any difference between the groups in engagement in any of the diabetes risk reduction behaviours measured. Further research is needed to explore these findings in a larger population, such as with a multi-centre study. The intervention should be enhanced with strategies to address social support, post-natal depression, self-efficacy for behaviour change, mood and emotional eating.