Maboo wirriya,be healthy: Community-directed development of an evidence-based diabetes prevention program for young Aboriginal people in a remote Australian town

Supporting healthy lifestyle behaviours is a key aspect of preventing type 2 diabetes which disproportionately affects disadvantaged groups from a younger age. Formative participatory research was undertaken to design a program for young Aboriginal people in a remote town in North West Australia with a high level of health needs and relatively few prevention initiatives. Focus groups and advisory discussions with Aboriginal community members were used to determine the nature of the program. The need for a comprehensive program was consistently expressed and limited healthy lifestyle knowledge and difficulties with healthy eating influenced by food environments were noted to be important. With guidance from the Derby Aboriginal Health Service, findings were integrated with previous international research evidence to develop a program tailored to local Aboriginal people aged 15–25 years and refine it after piloting. This 8-session program, ‘Maboo wirriya, be healthy’ involved an education component consistent with the US Diabetes Prevention Program and practical activities including group exercise. Changes to program structure and documentation were made after piloting for future use. The community-directed approach used in this study is vital to ensure relevance of localised chronic disease prevention programs in a range of settings.     

What are the experiences of women with obesity receiving antenatal maternity care? A scoping review of qualitative evidence

ProblemObesity is a major public health problem and is rising in prevalence in child-bearing women. The complications of pregnancy in women with obesity are well documented. Pregnant women with obesity require different maternity care considerations to normal weight women. How women respond to the care of health professionals, determines how likely they will be to engage with it, and thus research into the current care experiences of women with obesity is valuable.ObjectiveThe purpose of this scoping review was to examine the evidence of the antenatal maternity care experiences of women with obesity (BMI ≥ 30 kg/m²).MethodA systematic literature search was conducted for English language publications 2008–2018 using Medline, Scopus, PsycINFO and CINAHL. Following critical appraisal, and a search of the reference lists of primary articles, 17 articles resulted for this review. A thematic synthesis process was used to collate the findings.FindingsFour major themes were identified: 1) inconsistent or absent information regarding weight management, 2) the stigma and stereotyping associated with their obesity, 3) medicalisation and depersonalisation of pregnant women with obesity, and 4) a desire for information and need for change.ConclusionThe findings suggested that based on women’s experiences there is a need for improved education and communication for health care professionals when caring for pregnant women with obesity. Some conflicting information from women in the studies highlight the need for further research in the area, and the implementation of individualised care and continuity of care for pregnant women with obesity.     

Paperbark and pinard: A historical account of maternity care in one remote Australian Aboriginal town

Background and aimMaternity care in remote areas of the Australian Northern Territory is restricted to antenatal and postnatal care only, with women routinely evacuated to give birth in hospital. Using one remote Aboriginal community as a case study, our aim with this research was to document and explore the major changes to the provision of remote maternity care over the period spanning pre-European colonisation to 1996.MethodsOur research methods included historical ethnographic fieldwork (2007–2013); interviews with Aboriginal women, Aboriginal health workers, religious and non-religious non-Aboriginal health workers and past residents; and archival review of historical documents.FindingsWe identified four distinct eras of maternity care. Maternity care staffed by nuns who were trained in nursing and midwifery serviced childbirth in the local community. Support for community childbirth was incrementally withdrawn over a period, until the government eventually assumed responsibility for all health care.ConclusionsThe introduction of Western maternity care colonised Aboriginal birth practices and midwifery practice. Historical population statistics suggest that access to local Western maternity care may have contributed to a significant population increase. Despite population growth and higher demand for maternity services, local maternity services declined significantly. The rationale for removing childbirth services from the community was never explicitly addressed in any known written policy directive. Declining maternity services led to the de-skilling of many Aboriginal health workers and the significant community loss of future career pathways for Aboriginal midwives. This has contributed to the current status quo, with very few female Aboriginal health workers actively providing remote maternity care.     

Stillbirth in Australia 3: Addressing stillbirth inequities in Australia: Steps towards a better future

Persistent disparities in stillbirth risk and care are present in Australia. Eliminating these disparities is possible with a commitment to enhancing and scaling up models of culturally safe maternity care shown to be effective for Aboriginal and Torres Strait Islander women and those of migrant and refugee backgrounds. Campaigns to improve public awareness of stillbirth also play an important role in reducing stillbirth risk and consequences. To achieve reach and impact in communities at risk, messaging needs to be framed around the social and cultural context of women’s lives. Here we describe important initiatives underway within the Stillbirth Centre of Research Excellence to develop a coordinated national approach to stillbirth prevention and care in communities that bear a disproportionate burden of stillbirth.     

Is the BasicsCard “shaming” Aboriginal people? Exploring the differing responses to welfare quarantining in Cape York

As part of the Cape York Welfare Reform Trial (CYWRT), which has been running in the remote Aboriginal towns of Aurukun, Hope Vale, Mossman Gorge and Coen since 2008, Family Responsibilities Commissioners have the unprecedented ability to quarantine welfare payments. Critics claim this “BasicsCard,” which cannot be spent on alcohol, tobacco, pornography or gambling, brings shame to Aboriginal people – marking them as dependants, deemed incapable of responsible spending. Evaluations of the CYWRT paint a more complicated picture. While many of the “spectators” of the CYWRT report “welfare reform stigma,” the “subjects” themselves are more positive. This paper draws on ethnographic research in Hope Vale to argue that these categories overlap with loosely defined, porous social groups that developed during the town's mission past, described as the “engaged” and “embedded” Hope Valers, respectively. The engaged group tends to be more aware of and sensitive to the views of the dominant society and to subscribe to its “ideology of respectability.” Meanwhile, the latter group tends to adhere to a more egalitarian “ideology of relatedness,” and do not experience the shame, even when their own welfare is quarantined, because the behaviours that trigger quarantining are normalised within their highly circumscribed domain.     

Breastfeeding and emerging motherhood identity: An interpretative phenomenological analysis of first time Chinese Australian mothers’ breastfeeding experiences

BackgroundChinese Australian mothers are more likely than the general Australian mothers to introduce formula in the first month of age. A better understanding of the context of formula introduction in the early weeks of birth can provide a deeper insight into how Chinese Australian mothers can be supported to continue exclusive breastfeeding.MethodsAn interpretative phenomenological analysis approach was used to examine the lived breastfeeding experiences of 11 first time Chinese mothers in Australia. The experiences of those who breastfed exclusively were compared to those who introduced formula in the first month after birth.FindingsAn overarching theme across all participants’ narratives was the meaning ascribed to breastfeeding in their emerging motherhood identity. Breastfeeding could be a pragmatic and a socially desirable method to nourish an infant but lacking personal identification to the mother. These mothers were more vulnerable to the early introduction of formula, especially when the support environment was lacking. Maternal identity conflict was common and negatively impacted exclusive breastfeeding and mothers’ mental health. In contrast, mothers who identified closely with breastfeeding showed greater persistence and enjoyment in breastfeeding and were more likely to continue breastfeeding exclusively. Health professionals were perceived to have an important influence in strengthening maternal breastfeeding motivation and self-efficacy.ConclusionBreastfeeding support to Chinese Australian mothers needs to consider how breastfeeding can be better integrated with their motherhood identity. Health professionals are well-positioned to facilitate this process through a better understanding of mothers’ cultural and social contexts around breastfeeding.     

Juggling and Dealing: The Creative Work of Care Package Purchasing

In conventional diagrams of the new service delivery process, assessment of need is linked to purchase by a single line or arrow; the implication is that purchase follows more or less logically and directly from assessment. This paper focuses on the complex creative work that goes on in the "space" between assessment of need and purchase of service, and the changing influences on that work. "Purchase" is deconstructed to reveal the complex processes and calculations involved, and the ways in which budgets "free" resources and markets influence the final outcome. The paper describes the effects on care package construction and purchase of changing policies, budget arrangements and financial limits; it goes on to outline the difficulties and complications in using information on unit costs in purchasing. Unit costs are only part of a complex equation in which prices are negotiated and total cost juggled in the context of budgets, financial limits, real accessibility and balanced by quality considerations. It is suggested that talk of "playing shops" and use of "off-the-shelf" services underestimates the complexity of care package construction and purchase. Micro-purchase of care services has more in common with dealing and juggling than with lifting standardized, packaged, pre-priced goods off shelves in Sainsbury's.     

独立董事勤勉义务边界与免责路径

独立董事须遵循何种勤勉义务以及践行了何种程度的法律义务方能避免问责?这一看似简单明确的问题,在我国却难以发现一个清晰肯定的答案。采纳结果导向的中国独立董事勤勉义务严格责任标准,无助于公司治理水平的提升。域外独立董事勤勉义务标准的实质趋同与一体化标准适用,有助于独立董事勤勉义务边界的确定。相较于独立董事责任限制与责任保险机制,建构我国法律、行政法规与司法解释三位一体的独立董事经营判断规则的勤勉义务免责标准,或许是一个可行的效率性路径。     

我国高龄老人照料资源分布及照料满足感研究

高龄老人是一个对照料需求更高的群体,目前,高龄老人的照料完全满足感并不高。在居家养老建设不断加快的背景下,高龄老人的照料资源仍然集中在家庭内部,他们对社会服务的利用率极低;高龄老人的年龄、健康状况、经济状况、所在城乡以及照料者类别及其意愿对照料满足感的影响较大。政府及社会在提升高龄老人照料满足感的过程中,要科学规划居家养老服务,关注贫困、认知能力差和空巢高龄老人群体,重视家庭代际和谐建设,加快专业社工队伍发展,加强国际交流。     

The United Kingdom and the Netherlands maternity care responses to COVID-19: A comparative study

BackgroundThe national health care response to coronavirus (COVID-19) has varied between countries. The United Kingdom (UK) and the Netherlands (NL) have comparable maternity and neonatal care systems, and experienced similar numbers of COVID-19 infections, but had different organisational responses to the pandemic. Understanding why and how similarities and differences occurred in these two contexts could inform optimal care in normal circumstances, and during future crises.AimTo compare the UK and Dutch COVID-19 maternity and neonatal care responses in three key domains: choice of birthplace, companionship, and families in vulnerable situations.MethodA multi-method study, including documentary analysis of national organisation policy and guidance on COVID-19, and interviews with national and regional stakeholders.FindingsBoth countries had an infection control focus, with less emphasis on the impact of restrictions, especially for families in vulnerable situations. Differences included care providers’ fear of contracting COVID-19; the extent to which community- and personalised care was embedded in the care system before the pandemic; and how far multidisciplinary collaboration and service-user involvement were prioritised.ConclusionWe recommend that countries should 1) make a systematic plan for crisis decision-making before a serious event occurs, and that this must include authentic service-user involvement, multidisciplinary collaboration, and protection of staff wellbeing 2) integrate women’s and families’ values into the maternity and neonatal care system, ensuring equitable inclusion of the most vulnerable and 3) strengthen community provision to ensure system wide resilience to future shocks from pandemics, or other unexpected large-scale events.