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ISSUE ADDRESSED: Indigenous Australians have higher morbidity and mortality rates than non-Indigenous Australians. Until recently, few health promotion interventions have had more than limited success in Indigenous populations. METHODS: This community-based health promotion initiative introduced traditional Indigenous games into schools and community groups in Cherbourg and Stradbroke Island (Queensland, Australia). A joint community forum managed the project, and the Indigenous community-based project officers co-ordinated training in traditional games and undertook community asset audits and evaluations. RESULTS: The games have been included in the activities of a range of community organisations in Cherbourg and Stradbroke Island. Several other organisations and communities in Australia have included them in their projects. A games video and manual were produced to facilitate the initiative's transferability and sustainability. CONCLUSIONS: Conventional approaches to health promotion generally focus on individual risk factors and often ignore a more holistic perspective. This project adopted a culturally appropriate, holistic approach, embracing a paradigm that concentrated on the communities' cultural assets and contributed to sustainable and transferable outcomes. There is a need for appropriate evaluation tools for time-limited community engagement projects.

Available literature concentrates on infertility concerns of young women with breast cancer, while attention to psychosocial issues related to maintained or regained fertility is scarce. As part of a longitudinal, qualitative study of experiences of young women with breast cancer (diagnosed at 40 years or younger); (n = 13), concerns about fertility, contraception, pregnancy, and breastfeeding after breast cancer were expressed. Using semistructured, one-to-one interviews over three time phases, we explored these women's experiences. Perceptions of fertility changed over time. Contraception issues were raised together with recurrence fears related to pregnancy and breastfeeding after breast cancer. Decisions related to unplanned pregnancies and breastfeeding were described as particularly onerous.

Nutrition represents a significant area of care for elderly people. Quality of life, independence and overall health are influenced by nutritional status. The prevalence of malnutrition in the elderly appears to be disturbingly high: between 40% to 60% and as high as 85% has been reported, particularly in those who have been hospitalised, live alone or live in residential care.----- Much is known about the antecedents and consequences of malnutrition in the elderly. Weight loss and malnutrition are associated with increased mortality and morbidity, increased risk of pressure ulcer development and infections, increased risk of falls, reduction in ability to perform self care activities, apathy,and loss of quality of life, mobility and independence.----- However, there exists little information concerning the processes involved in assessing and managing this issue in aged care facilities. A key issue in our current aged care environment is that many nurses lack sufficient knowledge of nutritional care and as a consequence have difficulty in recognising it as a priority over competing responsibilities.

Worldwide evidence pinpoints the importance of effective early care and education services. Initiatives such as Head Start (United States) and Sure Start (United Kingdom) suggest that access to, awareness and responsiveness of community services are enhanced when services are integrated. We propose that service integration can also contribute to social capital and sense of community. This paper reports on research by a partnership of government and non-government agencies into the impact of Child Care and Family Support Hubs in Queensland, Australia. These community-driven hubs are a recent state government initiative designed to improve and integrate service provision, particularly in rural and disadvantaged communities. The paper reports on findings from the pilot work, the ACCESS Study (2000-2001), as well the ongoing three-year Queensland Hubs Study.

A substantial body of research evidence indicates that integrated care and education services for young children and their families accrues them considerable social and educational benefits. This paper explores research being conducted by a research consortium comprised of university, government and non-government representatives. The research focus is the impact on children, families and communities of a Queensland-wide innovation to provide integrated child and family services or hubs. The research uses quantitative and qualitative methods to gather data from children, parents, community members and service providers about social capital in the Hub community. Social capital dimensions include: neighbourhood connections; family and friend connections; proactivity in a social context; feelings of trust and safety; and tolerance of diversity.

Study objective: To examine the association between area- and individual-level socioeconomic status (SES) and food purchasing behaviour. Design: The sample comprised 1000 households and 50 small areas, selected using a stratified two-stage cluster design. Data were collected by face-to-face interview (66.4% response rate). SES was measured using a composite area index of disadvantage (mean 1026.8, sd=95.2) and household income. Purchasing behaviour was scored as continuous indices ranging from 0 to 100 for three food-types: fruits (mean 50.5, sd=17.8), vegetables (61.8, 15.2), and grocery items (51.4, 17.6), with higher scores indicating purchasing patterns more consistent with dietary guideline recommendations. Setting: Brisbane metropolitan region, Australia, 2000 Participants: Persons aged 16-94 who were primarily responsible for their household’s food purchasing. Main results: Controlling for age, gender, and household income, a two standard deviation increase on the area-based SES measure was associated with a 2.01 unit-increase on the fruit purchasing index (95% CI -0.49 to 4.50). The corresponding associations for vegetables and grocery foods were 0.60 (-1.36 to 2.56) and 0.94 (-1.35 to 3.23). Prior to controlling for household income, significant area-level differences were found for each food, suggesting that clustering of household income within areas (a composition effect) accounted for the food purchasing variability between them. Conclusions: Living in a socioeconomically disadvantaged area was associated with a tendency to have a healthier food purchasing profile, however, the magnitude of the association was weak-to-moderate and the 95% confidence intervals for area-SES included the null. Even though urban areas in Brisbane are differentiated on the basis of their socioeconomic characteristics, it seems unlikely that where you live shapes your procurement of food over and above your personal characteristics. This is in contrast to metropolitan regions

This paper reports on the first phase of a multi-strategy health promotion project which uses a whole-school approach to promote resiliency in children of primary school age in school, family and community settings in an urban and rural/remote location in Queensland, Australia. The study population comprised students from Years 3, 5, and 7 (ages 8, 10, 12 years), their parents/care-givers, and staff across 20 primary schools. Evidence emerging from this phase of the project confirms that the school environment makes a major contribution to the development of psychological resilience in children. Schools in which students reported more positive adult and peer social networks and feelings of connectedness to adults and peers, and a strong sense of autonomy were associated with higher self ratings of resiliency in the students. There was also high concurrence by parents and caregivers regarding perceptions of the school environment. These schools rated more highly according to ‘health promoting school’ (HPS) attributes and principles. Characteristics of such schools included features like shared decision-making and planning, community participation, a supportive physical and social environment, good school-community relations, clearly articulated health policies and access to appropriate health services.

Objective: To determine whether socioeconomic groups differ in their food intakes for fruit and vegetables, their consumption of fruit and vegetables dense in vitamin A, folate and vitamin C, and their nutrient intakes of vitamin C, folate and vitamin A. Methods: The 1995 Australian National Nutrition Survey collected food intake data from 8883 adults aged 18-64 years using a 24-hour dietary recall. Fruit and vegetable was measured as amount (g) consumed. Intakes of nutrients were estimated from the 24-hour dietary recall data. Participants were categorised whether or not they consumed fruits or vegetables high in vitamin A, folate and vitamin C. Gross annual household income was used to measure socioeconomic position. Results: Participants from low-income households consumed a smaller quantity of fruits and vegetables. They were also less likely to consume fruits and vegetables high in vitamin C, folate and vitamin A. Consistent with these findings, men and women from disadvantaged socioeconomic groups had lower intakes of vitamin C and folate compared to their more affluent counterparts. These differences were small to moderate in magnitude. Vitamin A intakes were not significantly related to income. Conclusion: As well as promoting healthy dietary practices, nutrition-promotion strategies should target improving the nutrient intakes of lower socioeconomic groups. These programs should focus on improving the quantity and choice of fruits and vegetables consumed by people from low-income households.

This 6-month prospective study investigated the outcomes of foot surgery performed by Fellows of the Australian College of Podiatric Surgeons. The study recruited 140 patients who were treated for orthopedic, neurological, or integumentary diseases of the foot. The majority of subjects who underwent podiatric surgery experienced significant postoperative improvements in a range of health-related quality-of-life dimensions as measured by the disease-specific Foot Health Status Questionnaire (FHSQ) and the generic Short Form 36 (SF-36) questionnaire. Subjects reported a reduction in foot pain, increased levels of physical function, improved general foot health perception, and improved footwear-related quality of life. No significant adverse outcomes or unplanned re-admissions to the hospital were reported. This study demonstrates the advantage of assessing health-related quality of life as opposed to patient satisfaction.

The findings presented in this paper are part of a research project designed to provide a preliminary indication of the support needs of postdiagnosis women with breast cancer in remote and isolated areas in Queensland. This discussion will present data that focuses on the women's expressed personal concerns. For participants in this research a diagnosis of breast cancer involves a confrontation with their own mortality and the possibility of a reduced life span. This is a definite life crisis, creating shock and needing considerable adjustment. Along with these generic issues the participants also articulated significant issues in relation to their experience as women in a rural setting. These concerns centred around worries about how their partner and families cope during their absences for treatment, the additional burden on the family of having to cope with running the property or farm during the participant's absence or illness, added financial strain brought about by the cost of travel for treatment, maintenance of properties during absences, and problems created by time off from properties or self-employment. These findings accord with other reports of health and welfare services for rural Australian and the generic literature on psycho-oncology studies of breast cancer.

This paper presents the recent findings from a study on the postdiagnosis support needs of women with breast cancer living in rural and remote Queensland. The findings presented in this discussion focus on support needs from the perspective of the women experiencing breast cancer as well as health service providers. The tyranny of distance imposes unique hardships, such as separation from family and friends, during a time of great vulnerability for treatment, the need to travel long distances for support and follow‐up services, and extra financial burdens, which can combine to cause strains on the marital relationship and family cohesion. Positive indications are, however, that the rural communities operate on strong, informal networks of support. This network of family, friends and community can, and does, play an active role in the provision of emotional and practical support.

The health status of indigenous Australians is significantly poorer than that of other Australians. One of the major health problems for this population is type 2 diabetes which has been reported to have much higher prevalence rates than those in the rest of the Australian population. The significance of diabetes as a health issue has recently been reinforced by its inclusion as one of the six National Health Priorities. The recently developed National Diabetes Strategy is now in its implementation phase. Diabetic retinopathy is an important complication of diabetes. However, its prevalence within the indigenous population of Australia is not well documented. In this paper, we give a brief overview pertaining to this topic and include two case reports to illustrate some of the specific issues related to the management of diabetic retinopathy in this population.