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Background Although a 'person-centred focus' is a legislated objective for both aged-care and disability services sectors in Australia, evidence suggests limited translation into systems and practices due to entrenched silos. This paper proposes a Best Practice Framework to mitigate these silos. Methods Mixed-methods research comprising key informant interviews with major stakeholders across both sectors; a survey of people with/without intellectual disability aged 60+ years; qualitative in-depth interviews; and survey of health professionals. Results There is an urgent need to develop inter-sectoral 'integrated care systems'. Key components include choice in accommodation; regular assessment of health and well-being indicators; development and adoption of nationally consistent policies/standards across integrated aged- and disability-care sectors; improved strategies for workforce planning; and upskilling of existing staff including place-based collaboration. Conclusions An integrated service model requires collaboration on broader public policy instruments, appropriate planning and resourcing. A strategic shift is required to ensure better quality person-centred support systems.

Background The progressive increase in life expectancy of people with intellectual disability (ID) has resulted in enhanced survival into old age and has also seen a growth in research on both lifelong and emerging ageing-related health issues. Health issues amongst provider-supported adults have been previously studied, but these studies have not always included older community-dwelling adults with ID. Methods A study examining the extent of mental health of 391 community-dwelling adults with ID age 60 and older in both metropolitan and rural areas of two East Coast Australian states was undertaken using a cross-sectional survey. Examined were a range of demographic (age, sex, living arrangements, employment and socio-economic status) and life (co-morbidities, adverse life events and social support) factors. Data were parsed by two age groupings (60-65: n = 234 and >65: n = 157). Results Findings revealed that older community-dwelling adults with ID have many of the same mental health disorders as do other ageing people, with the exception of significant psychiatric disorders often associated with older age. Over a third (35%: n = 137) reported some one or more mental health disorders. Age, sex, location (rural or urban), financial hardship, social support or type of living arrangement were not statistically significant as risk factors for poor mental health. However, employment status was a clear predictor. Stepwise regression models showed a strong association between mental ill-health and adverse life events and between mental ill-health and multiple physical co-morbidities. Conclusions The cross-sectional nature of the study limits causal inference. The cumulative effect of chronic health conditions and adverse life events cannot be prevented retrospectively. However, greater awareness amongst both health professionals and care staff that older adults with ID have a high likelihood of significant and/or repeated traumas and need better health care to limit physical co-morbidity may assist in providing support that is better tailored to individual needs in older age to reduce the burden of mental ill-health.

Ageing is a global concern with major social, health, and economic implications. While individual countries seek to develop responses to immediate, pressing needs, international attention and collaboration is required to most effectively address the multifaceted challenges and opportunities an ageing global population presents in the longer term. The Ageing, Longevity and Health stream of the International Alliance of Research Universities (IARU-ALH) was built on a solid foundation of first-class interdisciplinary research and on innovative outreach and communication centres. This interdisciplinary network conducts projects that span biology, medicine, social sciences, epidemiology, public health, policy, and demography, and actively engages with the public and other societal stakeholders. Here we posit that such international interdisciplinary networks are needed and uniquely placed to address major challenges related to health and ageing and ultimately will produce new understanding and knowledge to promote the awareness of healthy ageing and encourage societal change via novel, science-informed interventions. Global interdisciplinary research presents great potential and opportunities to accelerate our understanding of human ageing and to produce new, more effective solutions to a pressing, complex problem. However, more focused, strategic efforts and investments are required in order to deliver on these potentials and reap maximum benefits for individuals and societies. IARU-ALH members are determined to contribute, in collaboration with others, to delivering on this vision.

Purpose Some of Australia’s most severe and protracted workforce shortages are in public sector community mental health (CMH) services. Research identifying the factors affecting staff turnover of this workforce has been limited. The purpose of this paper is to identify work factors negatively affecting the job satisfaction of early career health professionals working in rural Australia’s public sector CMH services. Design/methodology/approach In total, 25 health professionals working in rural and remote CMH services in New South Wales (NSW), Australia, for NSW Health participated in in-depth, semi-structured interviews. Findings The study identified five work-related challenges negatively affecting job satisfaction: developing a profession-specific identity; providing quality multidisciplinary care; working in a resource-constrained service environment; working with a demanding client group; and managing personal and professional boundaries. Practical implications These findings highlight the need to provide time-critical supports to address the challenges facing rural-based CMH professionals in their early career years in order to maximise job satisfaction and reduce avoidable turnover. Originality/value Overall, the study found that the factors negatively affecting the job satisfaction of early career rural-based CMH professionals affects all professionals working in rural CMH, and these negative effects increase with service remoteness. For those in early career, having to simultaneously deal with significant rural health and sector-specific constraints and professional challenges has a negative multiplier effect on their job satisfaction. It is this phenomenon that likely explains the high levels of job dissatisfaction and turnover found among Australia’s rural-based early career CMH professionals. By understanding these multiple and simultaneous pressures on rural-based early career CMH professionals, public health services and governments involved in addressing rural mental health workforce issues will be better able to identify and implement time-critical supports for this cohort of workers. These findings and proposed strategies potentially have relevance beyond Australia’s rural CMH workforce to Australia’s broader early career nursing and allied health rural workforce as well as internationally for other countries that have a similar physical geography and health system.

Experiences of ageism are associated with poorer health outcomes. Sexual activity and interest are areas in life where the impact of ageism may also be evident as popular culture often depicts the older body as asexual, undesirable or sexually impotent. We explore the possible links between experiences of ageism and sexual activity/interest in later life using data from a study of Australians aged 60+. We explored characteristics of those who were more likely to have experienced ageism (measured using the Ageism Survey) and the relationships between experiences of ageism and measures of sexual interest/activity in later life (N = 1,817). Experiences of ageism were greater among those without a partner, unemployed participants, those with lower incomes and poorer self-rated health. Adjusting for these differences, experiences of ageism were more likely to be reported by those who had not had sex in the past two years and were not sure about their hopes/plans for sex in the future. Those who reported their sexual interest had increased or decreased since 60 also reported greater levels of ageism experience, as did those who wanted to have sex more frequently in the future. Ageism appears to impact sexual activity and interest in different ways. It is critical that social policy aims to reverse attitudes that reinforce the view of the ageist asexual and unattractive older body or person.

Background Increasing life expectancy for people with intellectual disability is resulting in greater need for end-of-life care services. However, limited knowledge is available regarding what barriers to accessing end-of-life care support are evident, particularly comparatively across rural and metropolitan locations. Methods Focus group interviews were undertaken with 35 direct-care staff from four rural and two metropolitan locations. A semistructured interview guide was used, with a focus on health service access. All focus group data were independently transcribed, with thematic analysis then performed. Results Frequency analysis identified 262 statements relating to health services access. Thematic analysis identified four key areas of “isolation,” “support from doctors,” “general health support access” and “internal staffing issues.” Conclusions Improved access to end-of-life services is urgently required across both rural and metropolitan areas. Development of specialist training and support models for both disability and general healthcare staff may assist to reduce some identified barriers.

This study is based on findings from the Attitudes to Ageing in Australia (AAA) component of Australian Survey of Social Attitudes (AuSSA). The AAA Study is funded by the ARC Centre of Excellence in Population Ageing Research (CEPAR)

Background There is paucity of research from Australia about comorbidity in older people with intellectual disability (PwID). This paper examines the burden of chronic diseases and associated sociodemographic correlates in a cohort of PwID aged 60+. Methods A cross-sectional survey was used with community-dwelling older PwID in urban/rural regions of two Australian states. Recruitment was undertaken via a multi-prong approach and each subject (N = 391; 236 urban/155 rural) personally interviewed. Results Findings show older PwID experience considerable multimorbidity (X = 3.8; 53.5% had 2-6 conditions). Conditions included arthritis (40%), diabetes (26%), cardiovascular diseases (23.6%), asthma (16.1%), carcinomas (10.0%) and mental health disorders (34.5%). Conclusions There was significant multimorbidity in older PwID, with evolution of life trajectories of select conditions associated with socioeconomic disadvantage and heath facility access barriers. Greater scrutiny of progressive health debilitation leading into older age and increased engagement by healthcare systems is required earlier in the lives of PwID.

Summary Objectives To describe the essence of the nurses’ lived experience and explore the meaning of their involvement in end-of-life care after a do-not-resuscitate decision has been made. Research methodology/design The research design embraced qualitative, exploratory and descriptive approaches utilising aspects of phenomenology. Purposive sampling of twenty-six registered nurses was used. Data was collected using the reflective journaling technique and were analysed using an integrated approach. Field notes were also used as a mean to enrich the description of the findings contextually. Setting Medical units in Saudi Arabia. Results Three main themes emerged: exhausted medical treatment, continuity of nursing care and cultural considerations in nursing care. Related sub-themes were also identified as an extension to the description of the main themes. Conclusion The findings affirm that nurses working on medical units continue to maintain a constant level of care for patients and families after the do-not-resuscitate decision. Nurses found that caring for dying patients was a rewarding and worthwhile experience, albeit a challenging and demanding one. The findings suggest that improvement in end-of-life care would be best achieved by collaborative and interdisciplinary practices amongst the health care team members.

Introduction Rural health workforce shortages are a global phenomenon. Countries like Australia, with industrialised economies, large land masses and broadly dispersed populations, face unique rural health challenges in providing adequate services and addressing workforce shortages. This article focuses on retention of early-career nursing and allied health professionals working in rural and remote Australia. Some of Australia's most severe and protracted rural workforce shortages, particularly among early-career health professionals, are in public sector community mental health (CMH), a multidisciplinary workforce staffed primarily by nurses and allied health professionals. This study investigated how employment and rural-living factors impacted the turnover intention of early-career, rural-based CMH professionals in their first few years of working. Methods A constructivist grounded theory methodological approach, primarily guided by the work of Charmaz, was selected for the study. By implication, the choice of a grounded theory approach meant that the research question would be answered through the development of a substantive theory. Twenty-six nursing and allied health professionals working in CMH in rural New South Wales (NSW) for the state health department services participated in in-depth, semi-structured interviews. The study sought to identify the particular life factors - workplace conditions, career-advancement opportunities and social and personal determinants - affecting workers' turnover intention. The substantive grounded theory was developed from an identified core category and basic social process. Results The turnover intention theory provides a whole-of-person explanation of turnover intention. It was developed based on an identified core category of professional and personal expectations being met and an identified basic social process of adjusting to change. The theory posits that an individual's decision to stay or leave their job is determined by the meeting of life aspirations, and this relates to the extent of the gap between individuals' professional and personal expectations and the reality of their current employment and rural-living experience. The extent of individuals' professional and personal expectations can be measured by their satisfaction levels. A major finding from the identification of the basic social process was that, in the adjustment stages (initial and continuing), turnover intention was most strongly affected by professional experiences, in particular those relating to the job role, workplace relationships and level of access to continuing professional development. In this stage, personal satisfaction mostly concerned those with limited social connections in the town (ie non-local - newcomers). Having reached the 'having adapted' stage, the major influence on turnover intention shifted to personal satisfaction, and this was strongly impacted by individuals' life stage. By drawing on the turnover intention theory and the basic social process, it is possible to make a risk assessment of individuals' turnover intention. Three levels of risk were identified: highly vulnerable, moderately vulnerable and not very vulnerable. Conclusions The study offers a holistic explanation of life factors influencing the turnover intention of early-career health professionals working in public health services in rural NSW. These findings and the turnover intention risk matrix are thought to be suitable for use by Australian public health services and governments, as well as in other highly industrialised countries, to assist in the development of policies and strategies tailored for individual health professionals' work-experience level and life stage. By adopting such a whole-of-person approach, health services and governments will be better positioned to address the life aspirations of rural-based, early-career health professionals and this is likely to assist in the reduction of avoidable turnover.

Objective This paper aims to contribute to the development of a more sustainable Australian rural community mental health workforce by comparing the findings from a literature search investigating impacting factors on retention with the experiences of community mental health service managers running services in rural Australia. Design Semi-structured interviews. Setting Public health sector, rural New South Wales. Participants Five community mental health managers, running services in rural Australia. Main outcome measures Interviews were undertaken as a pilot for a broader qualitative study investigating factors influencing the decision to stay or leave among community mental health professionals working in rural positions. The purpose of undertaking this pilot study was to test for validity and relevance of the retention phenomena and help inform the research design for the main study. Results Three key retention focussed themes were identified: (i) Staffing is a persistent challenge; (ii) Small remote towns pose the biggest challenge; and (iii) The decision to stay or leave is complex and multifactorial. Conclusions The findings of this pilot study support previous research and contribute to the understanding of influences on retention among health professionals working in rural community mental health services. Importantly, those who have worked for several years in rural positions hold important information through which to explore factors that impact retention in rural and remote regions.

Intimate partner violence (IPV) is known to be linked to significant negative physical and mental health outcomes. This study addresses a gap in the Australian IPV literature by investigating lifetime IPV prevalence by rurality of residence, using data from a population-based sample of young women. The overall lifetime IPV prevalence rate in the sample was 21.6%, but there were significant differences in IPV rates from major cities (19.6%), inner regional areas (24.4%) and other rural areas (26.1%). After adjusting for demographic variables, multivariable analysis revealed that there were still significantly raised odds of women from inner regional (OR 1.16, 95% CI 1.01–1.33) and other rural areas (OR 1.31, 95% CI 1.11–1.56) reporting lifetime IPV compared to women from major cities. Multivariable analysis also showed that a history of IPV was significantly associated with women being separated/divorced/widowed, having lower levels of education, income hardship and limited available social support.

Australia’s rural communities rely heavily on public-sector provided community mental health services and these services face major recruitment and retention challenges, with many long-term unfilled positions and high staff turnover. This paper aims, by undertaking a comprehensive literature review of Australian peer-reviewed studies, to identify the impacting factors on retention among community mental health clinicians working in rural Australia. Thirteen studies were found and thematic analysis identified three key main categories (1) the nature of the work; (2) the multidisciplinary team; and (3) the attractors and detractors of working rurally. This literature identifies that community mental health workers have demanding and stressful roles and carry heavy workloads. Clinicians working in rural positions experience additional challenges arising from extra work demands and workplace stresses. The impacts of the interdisciplinary generic casework approach and rurality within community mental health ha...

In high income countries the life expectancy of people with Down syndrome (DS) rose significantly during the 20th century, from around nine years in 1949 to 57 years by 2000, equating to an increase of approximately 1 year of age per calendar year. This presentation quantifies survival patterns for people with DS using comprehensive population-based data collected over a 56-year period (1953–2009). All known persons diagnosed with DS were sourced from four complementary health and disability State-based databases (Disability Services, Death Registrations, Hospitalisations and Birth Defects Notifications) in Western Australia. Survival to 2010 was confirmed by the absence of a death registration between 1969 and 2010. Life expectancy was assessed using Kaplan Meier survival using the 1,948 cases born since 1953, which ensured that no death records were lost prior to the start of the earliest database. Deaths had occurred in 590 cases (25.3%). The results showed that survival rates started to decline between 55–60 years of age. Gender disparity was apparent, with females observed to have a slightly lower mean survival age than males throughout the lifespan. Although major improvements in the survival of children with DS are evident in recent decades, overall life expectancy appears to have plateaued with only minor increases in more recent years. The study findings suggest the possibility of a current natural upper survival limit for people with DS of around 60 years of age, and/or gaps in addressing health needs later in life through appropriate screening and early treatment.

Sexually transmitted infections (STIs) in Vietnam have been increasing. Control of STIs among female sex workers (FSWs) is important in controlling the epidemic. Effective STI control requires that physicians are skilful in taking sexual history for FSW patients. Three hundred and seventy-one physicians responded to a survey conducted in three provinces in Vietnam. The respondents were asked whether they asked FSW patients about their sexual history and information asked during sexual history taking. The respondents were also asked about their barriers for taking sexual history. Over one-fourth (27%) respondents always, over half (54%) respondents sometimes and 19% respondents never obtained a sexual history from FSW patients. Multivariable analysis revealed that factors associated with always taking a sexual history were being doctor, training in STIs and working at provincial level facilities. Physician’s discomfort was found to be inversely associated with training on communication with patients, seeing 15 or fewer patients a week, working at provincial level facilities. Issues in sexual history taking among FSW patients in general practice in Vietnam were identified. These issues can help STI control for FSW patients and need due attention in order to improve STI management in Vietnam.

Data from a national, population-based longitudinal study of Australian women (26-34 years) were analyzed to investigate the association between domestic relocation and multiple explanatory factors, namely intimate partner violence (IPV), metropolitan versus non-metropolitan residence, education, income, housing tenure, number of children, and changes in relationship status. Experience of IPV in the past 12 months was significantly associated with increased odds of domestic relocation. This association remained significant after controlling for age, social support, area of residence, income, number of children, education, and housing situation. Change in relationship status attenuated the association between recent IPV and domestic relocation. Metropolitan versus non-metropolitan residence had no major influence on these results.

Injecting drug use plays a critical role in the transmission of HIV in Vietnam. This paper provides a comprehensive review of studies on risks of HIV infection among injecting drug users (IDUs) in Vietnam. Current research evidence shows that the age at which drug initiation starts is becoming younger and the transition time between non-injecting to injecting drug use becoming shorter. The practice of needle sharing and unprotected sex was quite common among the IDUs. Although most of the IDUs generally had good knowledge of HIV transmission routes, most IDUs were not aware of their infection status. Data from a national surveillance programme shows that a third of the IDUs were HIV positive. Amongst all HIV positive cases, almost two-thirds had a history of intravenous drug use. A number of studies have identified a range of risk factors and barriers to minimize the risk of HIV infection in IDUs. This paper discusses these issues and makes recommendations for changes to HIV/AIDS policies, programme interventions as well as future research on the topic.

Contact with family and friends, in the form of visiting, is very important to the quality of the lives of rural nursing home residents. However, there has been little recent research that examines the frequency and determinants of visits to rural nursing homes and none in the rural Australian context. This study aimed to address this gap in the literature. A telephone survey with a close family member (N=257) of each participating resident in the rural New England area of New South Wales, Australia gathered data about 3,738 people who formed the potential social networks of these residents. This study found that the wider, potential, social networks of rural nursing home residents comprised approximately 17 people and involved a wide range of family and friends. However, their actual social networks consisted of approximately two females, daughters and friends, who had high-quality relationships with the resident and who visited at least once per month. In contrast to previous assertions that nursing home residents have robust support from their family and friends, the actual social networks of these residents have dwindled considerably over recent years, which may place them at risk of social isolation. This study has implications for nursing home policy and practice and recommendations for addressing the risk of social isolation that rural nursing home residents face are made.

Accessible summary • People with learning disability are just as likely as people in the general population to get cancer. • In this study we have looked at how often clients who get cancer are admitted to hospital. • We found that clients who get cancer are admitted to hospital much more often than clients who do not get cancer. • We also looked at the experiences of two clients to show what clients have to go through when they get cancer. • This research could help parents/carers and clients to know what to expect when people with learning disability need treatment and care for cancer. Summary In Australia, general health and medical services are subsidised by the government. This includes care for people with disabilities, screening and diagnostic services for common diseases, including cancer, and care and treatment for various medical conditions. In Western Australia, the majority of state-provided health services are well documented in linkable databases. We have examined data from a large cohort of people receiving services for learning disability from the state and linked this with the state cancer registry and hospital records. While people with learning disability appear to be at similar risk for cancer, they may have poorer treatment outcomes as they already experience a range of health conditions which can exacerbate medical complications associated with treatment and/or other primary or secondary co-morbid conditions. Our results show that the mean number of hospital admissions were higher for the cancer group, even when adjustments were made for conditions such as childhood leukaemia and renal dialysis both of which often require frequent hospitalisations. Multivariate regression analyses showed that younger age, female sex and severe or unspecified level of disability were significant contributors to the frequency of hospital admissions. Qualitative information gleaned from detailed chart reviews showed that in addition to considerable morbidity, some patients were admitted repeatedly either because of lack of supportive environments and/or lack of compliance with treatment. Issues in providing appropriate support services for individuals and their carers are discussed.

Background Down syndrome is one of the commonest causes of intellectual disability. As life expectancy improves with early and more intensive surgical and medical treatments, people with the disorder are more likely to exhibit classic morbidity and mortality patterns and be diagnosed with diseases such as cancer. Methods A profile of cancer cases among people with Down syndrome has been compiled, based on the analysis of a linked data set that included information from the Disability Services Commission of Western Australian and the State Cancer Registry. Results and conclusions Although the total age- and sex-standardized incidence ratios (SIRs) for people with Down syndrome were similar to that for the general population, SIRs for leukaemia were significantly higher while the incidence of certain other types of cancers was reduced. Overall, there was a lower incidence of solid tumours in Down syndrome, possibly reflecting the age profile of the study cohort.

Background: Down syndrome (DS) affects ∼1 per 650-1000 live births and is the most common known genetic cause of intellectual disability. A highly significant change in the survival of people with DS has occurred during the last two generations, with life expectancy estimates increasing from 12 to nearly 60 years of age. Subjects and Methods: Detailed information on 1332 people in Western Australia with DS was abstracted from a specialist statewide database for the period 1953-2000 and electronically linked with three other state or national health and mortality data sources and the state Birth Defects Registry. Results: Over the last 25 years the percentage of women over 35 years giving birth increased from 4.8 to 18.6%, accompanied by an increase in the overall prevalence of DS from 1.1 to 2.9 per 1000 births. Four life stages of DS were identified: prenatal, childhood and early adulthood, adulthood, and senescence. Although pneumonia, or other types of respiratory infections, was the most common cause of death across the entire lifespan, ranging from 23% of deaths in adulthood to 40% in senescence, each life stage exhibited a particular profile of comorbidities. Congenital heart defects were common causes in childhood (13%) and adulthood (23%), whereas in senescence coronary artery disease (10%) and cardiac, renal, and respiratory failure (9%) were leading causes of mortality. Conclusions: A major re-appraisal in attitudes towards DS is required to ensure that the medical and social needs of people with the disorder are adequately met across their entire lifespan. In particular, specific recognition of the comorbidities that can arise at different ages is needed, accompanied by the provision of appropriate levels of care and management.

Objectives: The aim of the study was to determine the extent and nature of consanguinity in the Qatari population and its effects on common adult diseases. Subjects and Methods: The study was conducted in urban and semi-urban areas of Qatar between October 2004 and May 2005. The total sample of 1,050 married Qatari females 15 years of age and over were approached for study. The degree of consanguinity between each female and her spouse and the degree of consanguinity between their parents were recorded. Results: Of 1,050 married Qatari females who were approached, 876 agreed to participate in the study, giving an 83.4% response. The rate of consanguinity in the present generation was 51% (95% confidence interval = 47.7–54.4) with a coefficient of inbreeding of 0.023724. The consanguinity rate and coefficient of inbreeding in the current generation were significantly higher than the maternal rate (51.0 vs. 40.3%; p < 0.001; 0.023724 vs. 0.016410 maternal). All types of consanguineous marriages were higher in this generation, particularly first cousins (26.7 vs. 21.4% paternal and 23.1% maternal) and double first cousins (4.3 vs. 2.9% paternal and 0.8% maternal). The current generation of consanguineous parents had a slightly higher risk for most diseases: cancer, mental disorders, heart diseases, gastro-intestinal disorders, hypertension, hearing deficit and diabetes mellitus. All reported diseases were more frequent in consanguineous marriages. Conclusion: The study showed that in a population with a high rate of consanguinity, there is a significant increase in the prevalence of common adult diseases like cancer, mental disorders, heart diseases, gastro-intestinal disorders, hypertension and hearing deficit.

Recently scholars have examined more closely the topic of female sexual self-concept as an aspect of sexual well-being. Few studies have focused on migrated women’s life experiences cross-culturally, and how that informs a woman’s view of herself as a sexual being. This is particularly true about most middle-eastern cultures, including Iranian-American women. Four case studies draw on qualitative data from interviews with first generation Iranian-American women in the USA to describe the sexual self-concepts evolving as a result of life in both cultures. Applying narrative methodology and feminist theoretical perspectives two themes were revealed. These are i) the influence of family power, and ii) patriarchal social practices. The analysis introduces a multidimensional aspect and process associated with each woman’s view of her sexual self-concept, which takes into account their behaviours, cognitions, and emotions developed in each life stage, and inform her sexual subjectivity (view of herself as a sexual being). Implications of these findings for clinicians and policy makers involved in sexual health care for women are briefly discussed. Keywords: sexual self-concept, cross-cultural, Iranian-American women, sexuality, power relations

The majority of people with dementia, even at advanced stages, receive most of their care and support from family members, friends, and neighbors, rather than formal support systems. This qualitative research undertaken in the Australian state of Queensland explored how family carers of people with dementia living in the community successfully manage and sustain informal caring. It also considers challenges these carers anticipated in continuing to support their family member with dementia in the future. What emerges through this analysis of the carers’ perspective on the sustainability of care is the impact of factors including the living arrangements, generational cohort and life stage of the carer, financial issues, and ability to effectively combine caring with their other roles and responsibilities in life.

© R Hussain, M Maple, SV Hunter, V Mapedzahama, P Reddy, 2015. Context: Rural Australians experience poorer health and poorer access to health care services than their urban counterparts, and there is a chronic shortage of health professionals in rural and remote Australia. Strategies designed to reduce this rural-urban divide include fly-in fly-out (FIFO) and drive-in drive-out (DIDO) services. The aim of this article is to examine the opportunities and challenges involved in these forms of service delivery. This article reviews recent literature relating to FIFO and DIDO healthcare services and discusses their benefits and potential disadvantages for rural Australia, and for health practitioners. Issues: FIFO and DIDO have short-term benefits for rural Australians seeking healthcare services in terms of increasing equity and accessibility to services and reducing the need to travel long distances for health care. However, significant disadvantages need to be considered in the longer term. There is a potential for burnout among health professionals who travel long distances and work long hours, often without adequate peer support or supervision, in order to deliver these services. A further disadvantage, particularly in the use of visiting medical practitioners to provide generalist services, is the lack of development of a sufficiently well-resourced local primary healthcare system in small rural communities. Lessons learned: Given the potential negative consequences for both health professionals and rural Australians, the authors caution against the increasing use of FIFO and DIDO services, without the concurrent development of well-resourced, funded and staffed primary healthcare services in rural and remote communities.

The aim of the study was to estimate the prevalence and sociodemographic predictors of consanguineous unions in the State of Qatar and to assess the association between consanguinity, fertility and child health. A representative sample of 1800 Qatari women aged > or =15 years was approached for the study. Of these, 1515 (84.2%) women agreed to participate. The consanguineous marriage rate was 54.0% with estimated population confidence limits of 52.3-55.7%. First cousin unions were the most common form of cousin marriage. The level of parental consanguinity (both in the respondent's parents and her parents-in-law) was quite high. In a multivariable analysis, both education of the respondent and her husband as well as parental consanguinity were found to be strong predictors of consanguineous unions in the index generation. Although fertility was high in both groups, the mean number of pregnancies was somewhat higher in respondents with first cousin unions. Concomitantly they also had a slighter higher rate of livebirths than women in non-consanguineous unions. The occurrence of asthma, mental retardation, epilepsy and diabetes was significantly more common in offspring of all consanguineous than non-consanguineous couples.

The uptake of mammography for breast cancer screening is considerably lower among women with intellectual disability than for women in the general population. The purpose of the present study was to investigate carer perceptions of barriers and enablers to mammography use by these women.To determine the reasons why women with intellectual disability are not utilising screening services, a series of focus groups were held with social trainers working in accommodation provided for people with intellectual disability.The major themes identified included the need for a medical referral or invitation from the mammography service to motivate people to attend; the belief that many women with intellectual disability would not understand the procedure or why it needs to be done and therefore would experience fear and anxiety to a greater extent than women in the general population; and that physical disabilities comorbid in many of the women would limit their ability to be adequately accommodated by the machines used to take a mammogram.The social trainers agreed that many of the barriers to screening would be difficult to overcome and supported alternative strategies to mammography, such as clinical breast examination.

Objective: During the last 50 years there have been significant improvements in life expectancy among people with intellectual disability (ID), and so their incidence of age-associated diseases, such as cancer, is rising. The aim of this study was to compare the rate of cancer in people with ID with that found in the general population. Methods: Information on 9409 individuals registered with the Disability Services Commission of Western Australia was linked to the State Cancer Registry, with 200 cases of cancer detected over 156,729 person-years. Standardised incidence ratios (SIRs) and 95% confidence intervals were calculated for both sexes separately by 5-year age groups for the period 1982-2001. The same procedures were adopted in the estimation of SIRs for specific types of cancers. Results: The age-standardised incidence of all cancers in people with ID was not significantly different from the general population. However, males with ID were observed to have a significantly increased risk of leukaemia, brain and stomach cancers, and a reduced risk of prostate cancer, while leukaemia, corpus uteri and colorectal cancers were significantly higher in females. Conclusions: Health practitioners need to be aware that with improvements in life expectancy the incidence of cancer in people with ID is likely to rise. More proactive health promotion campaigns may be needed for people with ID, who are likely to be poor users of screening services and whose symptoms may not be reported until they are in more advanced, less treatable stages of disease.

Objectives:To examine associations between history of domestic violence and health service use among mid-aged Australian women, adjusting for physical and psychological health status and demographic factors. Methods:Population-based cross-sectional postal survey (1996) of the Australian Longitudinal Study on Women's Health. Of 28,000 women randomly selected, 14,100 (53.5%) aged 45–50 years participated. Logistic regressions were used to assess associations between domestic violence and health service use. Results:After adjusting for demographic variables, multivariate analysis revealed associations between ever having experienced domestic violence and three or more consultations in the previous 12 months with a family doctor (OR 2.07, 95% CI 1.68–2.55), hospital doctor (OR 1.77, 95% CI 1.44–2.17), or specialist doctor (OR 1.54, 95% CI 1.35–1.75), or being hospitalised (OR 1.36, 95% CI 1.20–1.54). After adjusting for demographic variables and physical and psychological health status, these associations were attenuated: three or more consultations with family doctor (OR 1.36, 95% CI 1.09–1.70), hospital doctor (OR 1.16, 95% CI 0.92–1.45), or specialist doctor (OR 1.14, 95% CI 0.98–1.32), and being hospitalised (OR 1.10, 95% CI 0.96–1.26). Conclusions:Physical and psychological status accounted for the associations between domestic violence and higher health service use, with the exception of GP consultations, which remained associated with domestic violence. Implications:Physical health status only partially explains the increased health service use associated with domestic violence, while both physical and psychological health status explained higher usage of specialist and hospital services. It seems likely that women who have experienced domestic violence may be seeking consultations from GPs for reasons additional to health status.

Cohort studies have indicated that the survival of individuals with Down's syndrome has dramatically increased over the past 50 years. Early childhood survival in particular has shown major improvement, due largely to advances in cardiac surgery and in general health management. The present study was based on a continuous cohort of 1332 people with Down's syndrome in Western Australia, registered for intellectual disability services between 1953 and 2000. Their life expectancy was 58.6 years, 25% lived to 62.9 years, and the oldest living person is 73 years of age. Life expectancy for males was greater than females by 3.3 years. The substantial increase in survival across the study period means that the life expectancy of people with Down's syndrome is approaching that of the general population, but accompanied by a range of significant mid-life health problems. The findings are of relevance to all developed countries and have considerable implications in terms of the counselling information provided to families at risk of having a child with Down's syndrome.

To explore, among middle-aged women, the relationship between having ever had cosmetic surgery and the frequency of use of other health services.Retrospective analysis of cross-sectional survey data from the Women's Health Australia (WHA) study.A nationally representative sample of the "mid-aged" (45-50 years) cohort of women who participated in the 1996 WHA baseline postal survey. Responses were received from 14 100 women (a response rate of 54%).Seven per cent of women reported ever having had cosmetic surgery. After adjusting for demographic variables, multivariate analysis confirmed that women who had had cosmetic surgery were significantly more likely to use health services more frequently (eg, surgical procedures, consultations with specialists and alternative healthcare providers). Cosmetic surgery was also associated with a greater number of chronic illnesses and use of medication for anxiety and sleep problems.Further research is needed to determine whether cosmetic surgery is directly related to health conditions or to attitudinal or psychosocial variables. Such research should examine whether alternative interventions may be more cost-effective in dealing with the issues that motivate women to seek cosmetic surgery.

The preliminary findings from an ongoing large-scale Australian study assessing health, well-being and health service use for older people with intellectual disability (PwID), compared to their normative age-peers, have revealed the nature of the burden of chronic disease experienced by PwID aged ≥60 years (n=356). Preliminary results confirm a significant burden of chronic disease including: arthritis (41%), persistent pain (28%), diabetes (23%), asthma (16%), heart disease (15%), cancers (8.7%), depression (22%), anxiety (20%), schizophrenia/bipolar (3.3%) and dementia (2.2%). Many respondents reported multiple co-morbidities. For most conditions, there was a noted discrepancy in the proportion of respondents with a chronic disease diagnosis versus those who were prescribed medication, which alludes to inadequacy of appropriate healthcare for PwIDs by primary-care physicians. Comparative data from OECD countries reveal patterns of chronic disease for older PwID; given this there are significant challenges of healthcare service provision across disability and aged-care services.

Background Sexually transmitted infections (STIs) are a public health problem in Vietnam with sub-optimal care in medical practice. Identifying practitioners’ perceived barriers to STI care is important to improve care for patients with STIs. Methods A cross-sectional survey was conducted among 451 physicians. These physicians were dermatology and venereology (D&V) doctors, obstetrical/gynaecological (Ob/Gyn) doctors, general practitioners, and assistant doctors working in health facilities at provincial, district and communal levels in three provinces in Vietnam. Results Almost all (99%) respondents mentioned at least one barrier to STI care. The barriers were “lack of STI training” (57%), “lack of professional resources” (41%), “lack of time” (38%), “lack of reimbursement” (21%), “lack of privacy/confidentiality” (17%), “lack of counselling” (15%), and “not the role of primary care provider” (7%). Multivariable logistic regression analysis showed that “lack of professional resources” was associated with respondents being in medical practice for ten years or under (vs. 11–20 years), and working at district or communal health facilities (vs. provincial facilities); “lack of time” were associated with respondents being female, seeing more than 30 patients a week (vs.

Rural Australians comprise a third of the population. However, there are relatively few research studies that have focused on issues for children with developmental disabilities in rural regions. In particular, there is very limited research that gives voice to parents regarding challenges faced by them due to their location in rural regions.This article is based on the qualitative component of a mixed-methods study undertaken in rural settings. In-depth, face-to-face interviews were conducted with 17 parents yielding 30 h of information rich taped data. Thematic analysis techniques were used to identify major issues.Three core themes emerged from analysis of the qualitative data regarding information and support needs: an ongoing lack of timely and relevant information about disabilities and support services; inadequacies in interactions with service providers particularly doctors and allied health staff; and considerable challenges and barriers to access and use of health services.Within the constraints of limited rural service provision, there are still opportunities for considerable improvements, through focussed in-service training to narrow the information gap, improve provider-client interaction around attitudinal issues and uptake of tele-health to minimise the long waiting times and the need to regularly travel long distances to access services and setting up online support groups.There is limited information on challenges faced by parents of children with developmental disabilities in rural Australia. The challenges around lack of information about support systems available add to parental stress as does limited experience, frequent staff turnover and poor attitude of many service providers. There is a need to improve rural service provision. Feasible options within resource constraints include focussed in-service training to narrow the information gap, improve provider-client interaction around attitudinal issues, and uptake of tele-health services. Setting up of parent-professional support groups as well peer support groups using digital technologies will help reduce the sense of isolation for rural carers and minimise impediments related to travelling long distances.

The emerging phenomenon of ageing with an intellectual disability has become subject to an increasing research focus in recent years. However, there remains little knowledge regarding the specific impediments that community workers face in supporting this cohort. The aims of the current study were to identify the major factors that, direct care staff believe, have most impact upon individuals ageing with an intellectual disability in the community. A three-round Delphi project was conducted across rural areas of New South Wales in Australia with 31 disability support workers to gain their perspectives on the main impediments facing a person ageing with intellectual disability. The 2010 study identified that the issue of ageing with an intellectual disability was presenting significant problems for community-based service delivery to this group of people. The panel identified 25 different impediments to the provision of support. A thematic analysis of the items indicated three main themes of 'funding', 'training' and 'access to services'. By identifying these impediments to supporting people ageing with an intellectual disability in the community, both services and government funding bodies have the ability to plan to overcome both current and future problem areas. This identification of impediments may facilitate individuals to receive more appropriate assistance, which in turn may lead to an improved quality of life and maintenance of a community-based placement rather than premature admission to the congregate-care system. This study is particularly timely, given that Australia is in the midst of implementing a National Disability Insurance Scheme, and is an opportunity for all levels of government to agree on the mechanisms to appropriately assist individuals with an intellectual disability to continue to be supported in the community as they age.

Dementia is one of the major causes of disability and dependence amongst older people and previous research has highlighted how the well-being of people with dementia is inherently connected to the quality of their relationships with their informal carers. In turn, these carers can experience significant levels of emotional stress and physical burden from the demands of caring for a family member with dementia, yet their uptake of formal services tends to be lower than in other conditions related to ageing. This paper is based on a qualitative study undertaken in the Australian state of Queensland and explores issues of access to and use of formal services in dementia care from the perspective of the informal family carers. It identifies three critical points at which changes in policy and practice in the formal care system could improve the capability of informal carers to continue to care for their family member with dementia: when symptoms first become apparent and a diagnosis is sought; when the condition of the person with dementia changes resulting in a change to their support needs; and when the burden of informal care being experienced by the carer is so great that some form of transition appears to be immanent in the care arrangement.

BACKGROUND The present study was undertaken to evaluate the determinants of acute (30-day) mortality after spontaneous intracerebral hemorrhage (ICH) in a developing country setting, and to compare these findings with those available from studies conducted in the West. METHODS Medical records of 146 patients admitted to a major tertiary hospital in Karachi, Pakistan between 1990 and 1991 with a diagnosis of spontaneous ICH were reviewed. The level and intensity of care provided to these patients was similar to that available at modern neurosurgical centers. The salient prognostic indicators that were studied included hypertension, pulse pressure, GCS score, neurologic deficits, and CT-scan predictors including site, size, and intraventricular spread of hemorrhage. These data were used to determine independent predictors of 30-day mortality by univariate and multivariate analysis. Additionally, 30-day survival probabilities for these outcome predictors were also computed. RESULTS The 30-day mortality after spontaneous ICH was 39.7%. Two-thirds of the patients had a history of hypertension. The important clinical predictors at the multivariate level included GCS score ≤8 and progressive increase in pulse pressure. The CT scan predictors included intraventricular spread of hemorrhage, ventricular enlargement, and size of the bleed. Location of the lesion did not appear to significantly influence mortality. Survival analysis showed a large clustering of deaths within the first 72 hours of hospitalization. CONCLUSIONS The 30-day mortality rate and prognostic predictors for spontaneous intracerebral hemorrhage were found to be similar to those reported in the Western hemisphere. However, the correlation of incremental increase in pulse pressure with deteriorating prognosis was a new and significant finding.

Childhood pneumonia continues to be the second highest contributor to childhood morbidity and mortality in all ethnic groups in Pakistan. Information on community perceptions and management is largely limited to the Punjabi populace. In this study, ethno-specific illness terminologies, recognition and severity indicators and resort to treatment options for childhood pneumonia are explored among the two main ethnic groups in Sindh. Results are based on focus group discussions with 90 caretakers and 16 case history interviews. The findings indicate that pneumonia recognition is almost universal. The main recognition and severity indicator was pasli chalna (chest indrawing) followed by signs and symptoms relating to the quality of breathing and presence of high fever, lethargy and anorexia. Recognition of rapid breathing was low and mostly associated with fever. Exposure to thand (cold) through a variety of mechanisms was perceived to be the dominant causal model. The concept of contagion was virtually non-existent. Despite this, belief in efficacy of allopathic care was very high. Most caretakers reported seeking outside care within one to three days of the onset of symptoms. However, unrealistic expectations of cure often led to change in physicians and treatment regimen, if no improvement was observed by the second day. On the other hand, the quality of care provided by the physicians (both licensed and unlicensed) left much to be desired. Female autonomy and mobility did not appear to be a major constraint in seeking outside care other than for hospitalisation. Implications of these findings for the national acute respiratory infections control programme and future research are discussed

Socioeconomic and health disadvantage is widespread within and across indigenous communities in the world, leading to differentials in morbidity and mortality between indigenous and non-indigenous populations. Sexually transmitted infections (STIs), including HIV/AIDS, among indigenous populations are an emerging public health concern. The focus of this paper is on examining the STI epidemiology in indigenous communities in various parts of the world utilizing a range of data sources. Most of the STI research on global indigenous communities has concentrated on developed countries, neglecting more than half the world’s indigenous people in the developing countries. This has resulted in major gaps in data at global level for STIs and HIV/AIDS among indigenous populations. Available data show that the prevalence of STIs is increasing among the indigenous communities and in several instances, the rates of these infections are higher than among non-indigenous populations. However, HIV still remains low when compared with the rates of other STIs. The paper argues that there is an urgent need to collect more comprehensive and reliable data at the global level across various indigenous communities. There is also an opportunity to reverse current trends in STIs through innovative, evidence-based and culturally appropriate targeted sexual health programmes.

INTRODUCTION Although there have been great strides in the prevention, care and treatment of sexually transmitted infections (STIs, including HIV) in Australia, the increasing trend towards higher rates of some STIs is of concern, especially reports of higher rates of chlamydia in inner regional areas. Reasons for these changes are unclear but suggest there is an inconsistent use of prevention measures and ambivalence towards acting responsibly around sexual behaviours. Understanding an individual's response to the circumstances or contexts in which knowledge about STIs are operationalised in rural communities becomes central to recognising how individuals experience health and illness, especially for developing interventions to prevent the transmission of STIs. The aim of this research is to understand how individuals in rural communities make sense of their experiences in relation to STIs and how rurality influences discussion about STIs and health-seeking behaviours. METHOD In-depth interviews with 24 participants, 18 females and 6 males, aged between 19 and 65 years provide the data for the study. Methodological principles of 'grounded theory' underpin the analysis. An eclectic approach to grounded theory was used in the current study that was derived from a number of authors. RESULTS The findings revealed that a number of contexts shape the actions and reactions of rural individuals towards STIs. These include 'public and private world of individuals', 'forms of talking in rural communities' and 'managing information and use of health services'. Factors that shape social life in rural communities such as the social bonds that are present, the relationships developed, and the way in which people behave influence the public and private aspects of rural life. Different forms of talk were identified that indicate that sexual issues are discussed in a number of informal ways and encompass distinct experiences of conveying information with regard to sex and STIs. Managing information and use of health services occurs when individuals assess and identify the need to access services for STIs. CONCLUSIONS The strength of this research lies in the identification of a number of contexts such as the private-public divide and types of talk where informal mechanisms encourage individuals to conform and comply with community rules and values. Using informal talk as a health promotion and or prevention strategy in rural locations can provide an alternative approach to potentially changing social norms. It would be possible to extend the idea of positive informal talk to include symbols and imagery that encourage individuals to seek treatment and provide a more positive view of 'reputation'. Engaging rural individuals in positive talk about sexual risk, access to treatment for STIs, and provision of accurate knowledge can help to build new 'social norms' that encourage new interpretations.

Objective To report on self-reported physical and mental health of informal carers in rural regions of New South Wales, Australia. Methods A cross-sectional community-based sample (n=222) of carers completed a questionnaire incorporating self-reported measures of health from validated international instruments including Medical Outcomes Study Scale (SF-36), the Centre for Epidemiology-Depression (CES-D) and Kessler-10 (K-10) Psychological Distress Scales, along with information on participant demographics and other key caregiving characteristics such as health condition of care recipient. Results Rural carers’ self-reported health was poor as evident on the SF-36 Physical and Mental Health component scores as well as each individual domain of the SF-36. Results from the CES-D and K-10 scores indicated very high rates of depressive symptoms and psychological distress. Over 70% of carers within the current study had CES-D scores indicative of depressive symptoms. Scores on the K-10 indicate almost half the carers were experiencing high levels of psychological distress, which is over 4 times the rate reported in the general Australian population. Conclusions and implications Results from this study were compared to Australian population normative data and were found to be significantly below Australian age-matched population norms for SF-36, CES-D and K-10. These findings illustrate the poor health profile of informal carers relative to the general Australian population, especially in terms of depressive symptoms and psychological distress. This highlights the need for additional support for rural carers in order to ease the accumulated mental and physical health burdens of this group.

Objectives. Partner violence is linked to cervical cancer and other gynaecological conditions. However, results of current research into associations between partner violence and cervical cancer screening have been inconclusive. Therefore, the current research investigates the association between partner violence and inadequate cervical cancer screening. Methods. Participants were 7312 women aged 45-50 years who responded to the Australian Longitudinal Study on Women's Health population-based surveys in 1996 and 2004. The women self-reported frequency of Pap smears via mailed questionnaire. Results. Women who had experienced partner violence at least eight years earlier, compared with those who had not, were more likely to report current inadequate screening (OR: 1.42, 95%CI: 1.21; 1.66). After adjusting for known barriers to preventive screening (education, income management, marital status, general practitioner visits, chronic conditions) and depression, partner violence was independently associated with inadequate Pap tests (OR: 1.20, 95%CI: 1.01; 1.42). This association was no longer significant once access to a GP of choice was added to the model (OR: 1.18, 95%CI: 0.99; 1.40). Conclusions. The significance of this study lies not just in confirming a negative relationship between cervical cancer screening and partner violence, but in suggesting that good access to a physician of choice appears to significantly decrease this negative relationship. (C) 2008 Elsevier Inc. All rights reserved.

Summary The aims of the present study were to explore aspects of sexually transmissible infections (STI) prevention in general practice and to examine general practitioners' (GPs) perceived barriers to sexual-health promotion. The data from a postal survey of 409 GPs practising in New South Wales, Australia (response rate 45.4%) are analysed to explore the prevention of STI in general practice and to examine practitioners' perceived barriers to sexual-health promotion. About 49% of GPs reported having STI leaflets/pamphlets for patients in their clinic, while 21% had posters on STI displayed in their waiting room. Two-third (67%) of GPs provided STI-specific printed materials/leaflets to patients with STI. Female GPs were more likely to be proactive in STI prevention. Time and funding appear to be the major barriers to sexual-health promotion, followed by inadequate access to counselling. One-fifth (22%) of GPs felt that they had little influence in changing patients' risk behaviour, while about 28% emphasized the need for further preventive care training. The present study identifies inconsistencies in STI-prevention activities in general practice along with barriers to undertake sexual-health promotion. This area warrants further attention if GPs are to contribute fully to the control of STI.

In this article we explore women's perceptions and experiences of sexual violence in marital relationships and its effects on reproductive health. We conducted a qualitative study composed of key informant interviews, focus group discussions, and in-depth interviews in two low- to middle-income areas of Karachi, Pakistan. Results show sexual coercion and nonconsensual sex were common and not limited to abusive relationships. Difficulties in negotiating safe sex resulted in unwanted pregnancies, some leading to unsafe abortions. The women reported escalation of violence during pregnancy to be common. Social norms prevented disclosure of sexual violence leading to limited support or intervention or both. The link between women's social status, marital violence, and reproductive health is discussed.

Objectives: To assess willingness of general practitioners (GPs) to offer chlamydia testing to patients, and to identify demographic and practice correlates associated with willingness to offer chlamydia testing. Methods: A postal survey of practising GPs in New South Wales was undertaken in 2002 to assess management of STIs in general practice. A 15% (n=1,020) stratified random sample, based on sex and area of practice, was selected. The overall response rate was 45.4% (n=409). Results: More than four out of five study participants reported that chlamydia testing should usually be offered to patients who had recently changed sexual partners or inconsistently used barrier methods such as condoms. While 76% of GPs would like to offer testing to young women, 65% were in favour of testing young men. Just over half (56%) felt that chlamydia testing should usually be offered to patients at the time of a Pap smear. Multivariate analyses revealed that female GPs were more likely to offer testing to young patients and to female patients at the time of a Pap smear. GPs who had postgraduate training in STIs had double the odds of offering testing to young men and to female patients at the time of a Pap smear. Conclusions and Implications: This paper reveals variations in GPs' willingness to offer chlamydia testing to patients. Special education programs highlighting the adverse health effects of chlamydial infection have the potential to improve GP involvement in chlamydia screening.

Summary Objectives The study investigates the demographic profile, caseload and treatment for depression provided by homeopathic practitioners in Australia. Design A postal survey comprising a self-administered questionnaire which included a combination of close-ended and open-ended response categories. Setting The questionnaire was mailed to 128 homeopathic practitioners working in the metropolitan areas of Sydney, Australia. Results The demographic profile of the respondents showed that most were in the 45–50 year age group, and female practitioners comprised 68% of the sample. Symptoms of depression reported in the homeopathic practice had parallel description of symptoms listed in the ICD-10. Overall, treatment of mental health disorders, such as depression, grief, anxiety and phobia were a significant feature of the practice caseload of the respondents. Eighty-four percent of the respondents had patients presenting for homeopathic treatment that were also receiving some form of external therapy, most commonly antidepressant medications. Sixty percent of the respondents incorporated ‘concurrent’ therapies in the treatment approach, most commonly counselling, nutrition and lifestyle management. Conclusion The paper shows that most homeopathic practitioners provide a pluralistic approach to management of depression which is in accordance with principles of holistic care. The implications of the research findings are discussed.

Background: Physicians’ inadequate involvement in sexual risk assessment has the potential to miss many asymptomatic cases. The present study was conducted to explore sexual risk assessment by physicians in clinical practice and to identify barriers in eliciting sexual histories from patients. Methods: A stratified random sample of 15% of general practitioners (GP) from New South Wales was surveyed to assess their management of sexually transmissible infections (STI). In total, 409 GP participated in the survey with a response rate of 45.4%. Results: Although nearly 70% of GP regularly elicited a sexual history from commercial sex workers whose presenting complaint was not an STI, this history taking was much lower (

Background: The health and well-being of Indigenous people is a significant global problem, and Aboriginal Australians suffer from a considerably higher burden of disease and lower life expectancy than the non-Indigenous population. Intellectual disability (ID) can further compromise health, but there is little information that documents the prevalence of ID among indigenous populations. This study provides information on ID among the Aboriginal population of Western Australia. Methods: The Disability Services Commission (DSC) of Western Australia has maintained a statewide database of people with ID since 1953. Data on people of Aboriginal descent were extracted from the DSC database and linked to two other state-based databases, the Hospital Morbidity Data System and the Deaths Registry, with additional linkage to the National Death Index. The linked data were used to assess the prevalence, survival patterns and causes of death in Aboriginal people with ID. Results: Although comprising 3.5% of the population, Aboriginal Australians represented 7.4% of all people registered for ID services. The level of ID was assessed as borderline or mild in 40.7% of cases, moderate in 19.9%, severe or profound in 12.1%, but had not been specified in 27.2% cases. Median survival was 55.1 years for men and 64.0 years for women, with a mean age at death (n = 102) of 19.6 years. The leading causes of death were respiratory diseases, diseases of the circulatory system, and accidents. Conclusions: The study presents unique population summary data for ID in the Aboriginal community of Western Australia. To provide appropriate prevention and intervention strategies, there is an urgent need for more detailed information on the prevalence and patterns of ID.