This study assessed the effectiveness of a health intervention, in diabetes education and risk assessment, to motivate men to take positive action, within the framework of the Health Belief Model. The worksite-based intervention targeted 525 men aged between 40 and 65 years from 27 organizations in the south-west of Western Australia in 1999/2000. Men identified as high risk were referred to their general practitioner. The adopted strategy had a number of strengths, namely that the health risk assessment was topic-specific, personalized, conducted on the worksite and combined with an educational component and a medical follow-up. The focus groups component of the study gave further understanding as to why the adopted strategy had been appropriate for men's needs.
A regional success story in capacity building in terms of workforce development in rural Western Australia is described. A rural and remote distance education program in mental health was delivered in 1999 across 10 rural sites to 31 health professionals (26 general nurses, four allied health and one Aboriginal health worker) who are in contact with mentally ill patients at the primary level in country areas. Evaluation on completion of the program and at 4 months postprogram was extremely positive, with participants reporting that they have gained knowledge of mental health management regimens, developed mental health assessment skills and enhanced their clinical practice. Both participants and their line managers identified that the program had greatest impact on improving relationships with the mental health team. The program has also been an example of capacity building in terms of innovative resourcing to address a statewide need in mental health education for those at the forefront of rural practice.
The association between antidepressant treatment and suicidality in children and adolescents has been the subject of a great deal of recent discussion and controversy. Appropriate warnings have been attached to these drugs by governing bodies in the United Kingdom and the United States. However, the data upon which these deliberations have been based derive almost exclusively from clinical trials supported by the manufacturers of the respective drugs; data that are rigorous, in some respects, but which may not capture the clinical realities of antidepressant treatment in real-world settings. Data are presented from a neuropsychiatry clinic where 128 children and adolescents were treated with modern antidepressants over the past 14 months. Behavioral side effects, including suicidal ideation and self-injurious behavior, were not an uncommon accompaniment of antidepressant treatment. The problems, however, were mild and decidedly nonlethal and easily managed in the clinic setting. Ironically, 34 of 36 patients who had developed behavioral side effects to antidepressants were subsequently managed, without further incident, either on an alternative antidepressant or on lower doses of the offending agent.
The objective of this study was to assess the impact of a suicide intervention program from a consumer perspective. Self-administered questionnaires were distributed to consumers who had been referred to a suicide intervention counsellor in the 2-year period of the programme in rural southwest Western Australia. Three-quarters of respondents were positive about their experience with the service, with half of the respondents no longer having thoughts of suicide and only 20% of all respondents reporting having attempted deliberate self-harm postcounselling. Reported suicidal ideation and attempted self-harm were much higher in the dissatisfied group. Dissatisfaction of respondents stemmed from the history of their treatment and 'the hassle created by the many systems for them to access care'. However, the overall outcome of this study is that, from the consumer's perspective, a high intensity approach to suicide intervention resolved or improved the presenting problem and their ability to deal with it.
A project to promote men's health through diabetes education and screening was undertaken throughout rural industries in 1999/2000 in the south-west of Western Australia. Five hundred and twenty-five men aged 40-65 years participated from 27 industries. Sixty-four per cent of these men were identified at high-risk of developing diabetes and were referred to their general practitioner (GP) for follow-up. Seventy-six per cent of those at-risk visited their GP and hence the strategy adopted has been appropriate in engaging men in the preventive concept of seeking care, that is, getting them to attend their GP when they only have the risk factors but not the disease. However, men were left short of knowing how to achieve a change in their lifestyle behaviour and take appropriate action. Given the constraints of rural practice and the need to prioritise those with disease and gaps in service provision for both health services and GPs, there are two challenges: identifying those at-risk and modifying their behaviour.
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