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The health and wellbeing needs of veterans: a rapid review
Get PDFThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background: For the majority of serving members, life in the military has a positive effect on wellbeing. However,
the type, intensity and duration of service, along with the transition from fulltime military to civilian life, may have a
negative effect on veterans’ wellbeing. Such negative consequences, alongside the growing veteran population,
indicate the need for greater exploration of veterans’ physical, mental and social wellbeing.
Methods: The current paper reports on the findings of a rapid review of the literature on the health and wellbeing
needs of veterans, commissioned by the Australian Department of Veterans’ Affairs to inform future programs and
services. The databases Embase, Medline, Cinahl, PubMed, Web of Science and Cochrane Database were searched
for systematic reviews reporting on veterans’ physical, mental and social wellbeing published in English in peerreviewed
journals.
Results: A total of 21 systematic reviews were included. The reviews reported on a range of mental, physical and
social health problems affecting veterans. While there was limited information on prevalence rates of physical,
mental and social health problems in veterans compared to civilian populations, the reviews demonstrated the
interconnection between these domains and the effect of demographic and military service factors.
Conclusions: A key finding of the review is the interconnection of the mental, physical, and social health of
veterans, highlighting the importance that an integrated approach to veterans’ wellbeing is adopted. It is
suggested that understanding key factors, such as demographic factors and factors relating to military service, can
support improved service provision for veterans.Conduct of the review was part of a project funded by the Australian Department of Veterans Affairs
Including health in environmental impact assessments of three mega transport projects in Sydney, Australia: A critical, institutional, analysis
No full text© 2017 Elsevier Inc. All rights reserved.This article details how health impacts came to be assessed in three mega, billion dollar, transport infrastructure projects, two road tunnels and one light rail, in Sydney Australia. The known health impacts of transport decisions include environmental, behavioural and social factors. EIA practice prioritises environmental risks, and there has been scant attention to understanding why this is persistently the case. Here we provide a critical theory lens, using critical realist methodology, to analyse empirical data collected through interviews and documents for the three cases. Our analysis focusses on EIA practice within its institutional context, building on ‘new institutional’ approaches to policy analysis that emphasise actors (the stakeholders involved in the EIA), structures (the ‘rules of the game’ that influence practice in systems), and power. We find that the various actors engaged in the EIAs principally to address particular goals that were pre-determined by the system in which they worked or belonged. Structurally, each EIA was undertaken as a compliance process relatively late in the planning process. Considering project options was not part of the EIA's purpose. Resources to undertake the EIAs were provided by those funding the projects (“the proponents”) and determined the types of issues to be considered. The full range of links between transport and health were not identified. Concerning power, health impacts were considered through inter-professional technical negotiation. The inability to engage in the fundamental options driving projects meant impacted communities questioned the validity of the EIA, and the health assessment within this. Our institutional analysis provides important knowledge about how the EIAs preferenced a focus on specific health risks to the detriment of the known broader determinants that shape the health impacts of transport
Volunteer Perspectives on the Impacts of International Development Volunteering
Get PDFCopyright © Flinders University 2016. This report is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/Summary of results The impacts of international development volunteering are multidimensional. They touch host organisations and volunteers, range from skills building and organisational change to employability and life experience, and can change participants’ world views, their understanding of development and aid, and their attitude to volunteering. In this report we focus on the volunteer perspectives on volunteering as a form of development assistance, and on three important areas of impact: capacity development, relationship building, and cosmopolitan orientations.
Development volunteering.
According to research participants, volunteering can be distinguished from other forms of development work by a stronger focus on the host organisation’s priorities and on developing collaborative relationships. Less pressure to produce outputs creates more opportunity for sharing knowledge and experience with local colleagues. This can make the impacts of volunteering more sustainable, but also less predictable.
Capacity development.
All volunteers hope to contribute positively to the capacity of their host organisation. They learn that capacity cannot be developed unilaterally through their own efforts but with the active engagement of their host organisation colleagues. When volunteers understand this and have succeeded in establishing a solid collaborative learning space, they find that they are able to work towards significant changes in the host organisation’s ability to mobilise and attract resources, plan and operate strategically, improve the quality of service and performance, and broaden its network of partnerships. In working with host organisations, volunteers also develop their own capacity to translate their skills to a different context, work with cultural difference and diverse knowledges, and understand their host country’s economic and political systems, development challenges, and cultural norms and values.
Relationship building impacts.
Most volunteers see relationship building as an important means of capacity development and as a valued outcome of volunteering. As a means, building relationships with host organisation staff is a pre-requisite to achieving the above-mentioned capacity development outcomes. Volunteers achieve much more if they work as a member of a team in their host organisation, rather than as a lone capacity builder working to a pre-established program. The host organisation, too, must invest in the relationship and find how and where the volunteer’s skills and knowledge can be most effectively used. Time, a shared language, cultural confidence, experience with managing volunteers in the organisation and clarity about where the volunteer’s accountability lies, are all necessary ingredients for building productive and equitable relationships.
Public diplomacy impacts.
Volunteers see the people-to-people relationships they build in host organisations and beyond as a significant outcome of volunteering. The personal friendships and bonds with people from their host country facilitated information exchange which increased the knowledge stock on both sides and laid the foundations for a better, deeper, mutual understanding. Many volunteers found that host organisations and communities made them feel welcome, but they also encountered stereotypes of Westerners (both positive and negative), and questioned some of their own taken-for-granted assumptions about their host country and Australia. Volunteering gives participants the opportunity to act on their sense of solidarity and shared humanity with others, while at the same time gaining a deeper understanding of cultural difference and the importance of contex
Taking the alternative route: Women's experience of intranasal fentanyl, subcutaneous fentanyl or intramuscular pethidine for labour analgesia
Get PDF© 2017 Elsevier Ltd. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/Objective
To compare women’s experience of receiving either intranasal fentanyl, subcutaneous fentanyl or intramuscular pethidine for labour analgesia.
Design
A content analysis was undertaken as part of the third phase of a larger randomised controlled trial, using the per-protocol dataset to examine women’s experiences of treatment received. Healthy women birthing at term, who received intranasal fentanyl (n=41), subcutaneous fentanyl (n=37) and/or intramuscular pethidine (n=38) for labour analgesia, were contacted at 6 weeks postpartum to complete a phone questionnaire.
Setting
A tertiary and regional maternity unit in South Australia.
Findings
Over 80% of women who received intranasal or subcutaneous fentanyl reported that they would use the treatment again compared to 44.8% of women who had received pethidine (self-administered intranasal fentanyl provided more expressive responses emphasising the route provided a strong sense of control and enablement.
Key conclusions
Route of administration influenced the women’s experience, more women who self-administered intranasal fentanyl reported positive emotional responses, with women reporting increased autonomy and satisfaction. Whereas, women who relied on the midwife to administer subcutaneous fentanyl or intramuscular pethidine, were more often focused on the physical effect of the drug. Pethidine was the least preferred option due to adverse effects.
Implications for practice
For women requesting parenteral analgesia, fentanyl administered by less invasive routes offers women additional options that may better meet their emotional, cognitive and physical needs than the current practice of administering intramuscular pethidine
Neuropsychiatric aspects of frontal lobe meningioma
Get PDF© 2017 Elsevier B.V. This manuscript version is made available under the CC-BY-NC-ND 4.0 license:
http://creativecommons.org/licenses/by-nc-nd/4.0/Brain tumours are known to typically present with neurological signs. Rarely, psychiatric symptoms can be the only manifestation of a brain tumour (Madhusoodanan et al., 2015). Though it is not uncommon for patients to present with psychiatric symptoms as the first clinical manifestation of a brain tumour, they are often non-specific and do not assist in localising the lesion. With the limited available research, it is found that neuropsychiatric disturbances are more frequently associated with frontal and temporolimbic lesions (Filley and Kleinschmidt-DeMasters, 1995). We present a case of a woman with frontal lobe meningioma who presented with a neuropsychiatric syndrome.
Ms S is a 50 years old woman with chronic schizophrenia that was stable for several years on a combination of 4 mg of Risperidone and 50 mg of Quetiapine. In early April, she presented with abrupt onset of fever, tremors, generalised weakness, lethargy, confusion, vomiting and loose bowels. On examination, she was noted to have a body temperature of 37.8 °C with borderline tachycardia, bradykinesia, cogwheel rigidity and increased deep tendon reflexes. She did not have diaphoresis or autonomic instability. Laboratory tests showed elevated Creatine Kinase (CK) of 1800 U/L and neutrophilia. With clinical suspicion for NMS, her antipsychotic medications were ceased leading to a decrease in her CK to 60. She was discharged after being commenced on Olanzapine 2.5 mg daily, with positive effect for her psychotic symptoms.
Nine days following discharge Ms S presented again with some symptoms of NMS such as worsening tremors, two episodes of fever, rigidity, bradykinesia and was disoriented to time. Her CK and white cell count, however, were within normal levels. She also had catatonic features such as increasingly withdrawn behaviour, mutism and negativism. On hospital presentation, she was afebrile and septic screen was negative, and she was admitted to the psychiatric unit for further investigation. Whilst assessment by the emergency physician suggested that the etiology of her symptoms were related to psychotropic drugs, the psychiatrist opined that it was more likely to be delirium and also considered a differential diagnosis of organic catatonia. CT head was done following the recommendation of the psychiatrist and it showed left frontal lobe meningioma with 12 cm midline shift with surrounding oedema. Ms S then was referred to the neurosurgery department and underwent surgical resection of the meningioma, which was successful.
Ms S was a patient with a stable psychiatric illness, who presented with overlapping features of NMS and catatonia but no overt psychotic symptoms. Her neuropsychiatric symptoms were likely to be the pressure effect of a left frontal meningioma. The nature of her presentation made the process of diagnosis challenging, especially with the initial absence of neuroimaging, which resulted in a delay in diagnosis and appropriate treatment.
Frontal lobe tumours have higher chances of producing mental status and personality changes with left sided lesions being more associated with inhibition of motor activity, impairment in motor and initiative aspect of speech, diminished generalization ability and general inertia of mental processes as seen in Ms S (Belyi, 1987). Given the absence of frank neurological symptoms to help localise the lesion, a high degree of clinical suspicion is usually required for early diagnosis. In patients suffering from schizophrenia, these symptoms can be explained by the illness itself and the side effects of the medications, thereby increasing the chances of missing the organic pathology due to diagnostic overshadowing of the primary psychiatric illness.
Neuroimaging should be considered in patients with atypical psychiatric symptoms, new-onset psychosis, recurrence of previously well-controlled psychiatric symptoms, and if they become refractory to psychiatric treatment (Madhusoodanan et al., 2015). Clinical suspicion must be raised when these symptoms are vague, rare, non-specific, with no clear cause or trigger and are associated with several causative etiologies.
Despite the many studies that have been done to correlate clinical presentation to the location of brain lesions, symptoms are still extremely unreliable diagnostic tools, and neuroimaging should be done when there is high suspicion index for organic pathology
Work pay$: evaluation of a program to teach everyday money skills to young people with disabilities
Get PDF© [2017] Flinders University / Australian Industrial Transformation InstituteThis report presents the findings of the development and pilot of the Work Pay$ program designed to improve the ability of young people with intellectual and multiple disabilities to engage with their finances as they transition from school to work. The project supported the development and evaluation of a financial literacy module for this cohort to be piloted within Bedford Group’s School to Work Transition Program (STWTP).
Three schools agreed to participate in the program with parents or guardians providing informed consent for the participation of 23 students. Most students had rudimentary money skills at commencement and had self-identified money goals to learn about savings and understanding payslips
Whole exome sequencing implicates eye development, the unfolded protein response and plasma membrane homeostasis in primary open-angle glaucoma.
Get PDFAuthor version made available in accordance with publisher's policy.Purpose: To identify biological processes associated with POAG and its subtypes, high-tension (HTG) and normal-tension glaucoma (NTG), by analyzing rare potentially damaging genetic variants.
Methods: A total of 122 and 65 unrelated HTG and NTG participants, respectively, with early onset advanced POAG, 103 non-glaucoma controls and 993 unscreened ethnicity-matched controls were included in this study. Study participants without myocilin disease-causing variants and non-glaucoma controls were subjected to whole exome sequencing on an Illumina HiSeq2000. Exomes of participants were sequenced on an Illumina HiSeq2000. Qualifying variants were rare in the general population (MAF < 0.001) and potentially functionally damaging (nonsense, frameshift, splice or predicted pathogenic using SIFT or Polyphen2 software). Genes showing enrichment of qualifying variants in cases were selected for pathway and network analysis using InnateDB.
Results: POAG cases showed enrichment of rare variants in camera-type eye development genes (p = 1.40×10-7, corrected p = 3.28×10-4). Implicated eye development genes were related to neuronal or retinal development. HTG cases were significantly enriched for key regulators in the unfolded protein response (UPR) (p = 7.72×10-5, corrected p = 0.013). The UPR is known to be involved in myocilin-related glaucoma; our results suggest the UPR has a role in non-myocilin causes of HTG. NTG cases showed enrichment in ion channel transport processes (p = 1.05×10-4, corrected p = 0.027) including calcium, chloride and phospholipid transporters involved in plasma membrane homeostasis. Network analysis also revealed enrichment of the MHC Class I antigen presentation pathway in HTG, and the EGFR1 and cell-cycle pathways in both HTG and NTG.
Conclusion: This study suggests that mutations in eye development genes are enriched in POAG. HTG can result from aberrant responses to protein misfolding which may be amenable to molecular chaperone therapy. NTG is associated with impaired plasma membrane homeostasis increasing susceptibility to apoptosis
Review of A Passion for Exploring New Countries: Matthew Flinders and George Bass by Josephine Bastian
No full textReview of A Passion for Exploring New Countries: Matthew Flinders and George Bass by Josephine Bastia
Review of Mapping Gendered Routes and Spaces in the Early Modern World edited by Merry E. Wiesner-Hanks
No full textReview of Mapping Gendered Routes and Spaces in the Early Modern World edited by Merry E. Wiesner-Hank