Search

The health of an individual is determined by the interaction of genetic and individual factors with wider social and environmental elements. Public health approaches to improving the health of disadvantaged populations will be most effective if they optimise influences at each of these levels, particularly in the early part of the life course. In order to better ascertain the relative contribution of these multi-level determinants there is a need for robust studies, longitudinal and prospective in nature, that examine individual, familial, social and environmental exposures. This paper describes the study background and methods, as it has been implemented in an Australian birth cohort study, Environments for Healthy Living (EFHL): The Griffith Study of Population Health. EFHL is a prospective, multilevel, multi-year longitudinal birth cohort study, designed to collect information from before birth through to adulthood across a spectrum of eco-epidemiological factors, including genetic material from cord-blood samples at birth, individual and familial factors, to spatial data on the living environment. EFHL commenced the pilot phase of recruitment in 2006 and open recruitment in 2007, with a target sample size of 4000 mother/infant dyads. Detailed information on each participant is obtained at birth, 12-months, 3-years, 5-years and subsequent three to five yearly intervals. The findings of this research will provide detailed evidence on the relative contribution of multi-level determinants of health, which can be used to inform social policy and intervention strategies that will facilitate healthy behaviours and choices across sub-populations. Keywords Child * Cohort studies * Longitudinal studies * Epidemiology * Methods, Introduction The health of an individual is determined by the interaction of a number of factors operating at multiple levels [1, 2], including the environment, economic and social context, family [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2009.06.021 Byline: Elizabeth Kendall (a), Deborah Terry (b) Abstract: This study examined two models for predicting emotional well-being following traumatic brain injury (TBI), namely the mediated model of stress and coping and the stress-buffer hypothesis (). The mediated model suggests that antecedent variables (i.e., personal and environmental resources) will predict emotional well-being, but their effect will be mediated through cognitive variables, such as appraisal and coping. In contrast, the moderated (buffer) hypothesis suggests that resources will protect individuals from the effects of stress, so will have different relationships with outcome at different levels of perceived stress. Ninety individuals with TBI were recruited from a major hospital in Brisbane, Australia. They and their relatives completed questionnaires at three time intervals: discharge, one month and nine months post-discharge, discharge being in 1998. Hierarchical regression was used to examine the relationships among the proposed predictors, mediators and outcomes. Support was found for some aspects of both models in the short-term. In the long-term, stress-buffer effects were no longer apparent. However, with the exception of family support, the predictors all influenced long-term adjustment through their impact on short-term adjustment. The role of family support as a direct predictor of emotional well-being in the long-term is highlighted. The findings have the potential to enable the identification of 'at risk' individuals prior to discharge and can highlight important foci for rehabilitation. Specifically, the study has identified the importance of early psychological intervention to address appraisal and the need to engage families in rehabilitation. Author Affiliation: (a) Centre of National Research on Disability and Rehabilitation Medicine, Griffith University, Logan Campus, University Drive Meadowbrook, Logan, Queensland 4131, Australia (b) University of Queensland, Australia Article Note: (footnote) [star] Thanks are due to the staff and patients of the Princess Alexandra Hospital, Australia, for their co-operation and participation in this study. Acknowledgement is due to Professor Timothy Elliot for helpful feedback and review.

Coping efforts have been recognised as an important aspect of resilience following traumatic brain injury, but little is known about what constitutes effective coping in this population. This longitudinal research examined the usefulness of the Goodness-of-Fit hypothesis, drawn from the Lazarus and Folkman [(1984). Stress, appraisal and coping. NY: Springer,] theory of stress and coping, as a way of understanding coping effectiveness. The hypothesis suggests that the nature and success of specific coping strategies will be associated with the controllability of the event, If an event is relatively uncontrollable, then emotion-focused or perception-focused coping may be more effective than problem-focused coping. In contrast, a controllable event may be best managed through problem-focused coping. Ninety people with traumatic brain injury, drawn from the inpatient rehabilitation unit of a major metropolitan hospital in Australia, and their relatives participated in this longitudinal study. No support was found for the Goodness-of-Fit model, either in the short term or the long term. Although the use of problem-focused coping strategies was positively associated with short-term and long-term role functioning, it was not associated with long-term emotional well-being if the situation was perceived to be controllable. The findings suggest that the persistent use of problem-focused coping in response to the difficulties created by traumatic brain injury can be associated with emotional distress in the long term. Reasons for this finding are explored and its implications are discussed. Keywords: Traumatic brain injury Goodness-of-Fit hypothesis Coping Psychosocial adjustment Australia

Researchers have a responsibility to cause no harm, but research has been a source of distress for indigenous people because of inappropriate methods and practices. The way researchers acquire knowledge in indigenous communities may be as critical for eliminating health disparities as the actual knowledge that is gained about a particular health problem. Researchers working with indigenous communities must continue to resolve conflict between the values of the academic setting and those of the community. It is important to consider the ways of knowing that exist in indigenous communities when developing research methods. Challenges to research partnerships include how to distribute the benefits of the research findings when academic or external needs contrast with the need to protect indigenous knowledge. (Am J Public Health. 2008;98:22-27. doi:10.2105/ AJPH.2006.093641)

Current stroke rehabilitation tends to focus on the bio-medical course of disability, often responding to psychological and social issues only when they have been implicated in crises. Although this situation is costly, little evidence exists in relation to how psychological and social outcomes can be facilitated or how psychosocial decline can be prevented. In the area of adjustment following traumatic injury, there has been some suggestion that rehabilitation should focus on the expansion of resources, skills and self-efficacy as this will enable individuals to cope more effectively with their medical condition and circumstances. The current study was a longitudinal randomised controlled trial involving 100 people with stroke, 58 of whom were randomly allocated to an intervention based on the notion of psychosocial skill expansion. All were patients of a major hospital in Queensland, Australia. An existing self-management intervention (The Chronic Disease Self-Management Course, Lorig et al., 2001) was used to operationalise the concept of psychosocial skill expansion. The control group reported declines in functioning during the first year following stroke in the areas of family roles, activities of daily living, self-care and work productivity, that were not reported by the intervention group. Although the groups had reached similar levels by one year post-stroke, this intervention may have a protective function, presumably by improving capacity to manage the functional requirements of daily life. However, the intervention did not appear to have its impact through self-efficacy, as was expected, and failed to influence outcomes such as mood or social participation. Nevertheless, the intervention warrants further investigation, given that it appears to improve rehabilitation outcomes, at least in the short-term. Keywords: Self-management education; Self-efficacy; Stroke recovery; Rehabilitation; Australia

Psychosocial adjustment following acquired disability is often represented as a linear sequence of stages which do not sufficiently address the complexity of this process. In contrast to the linear model, some researchers have suggested that adjustment is best described as a recurrent process, characterized by ongoing sorrow. The purpose of the current paper is to integrate existing knowledge about psychosocial adjustment, using the recurrent model as a framework. The model conceptualized in the current paper should provide rehabilitation counselors with a comprehensive understanding of psychosocial adjustment that can be used to guide rehabilitation efforts., Psychosocial adjustment problems among people with acquired disabilities have been associated with extensive costs in terms of long-term community welfare and health service utilization (Browne, Arpin, Corey, Fitch & Gafni, [...]

Get Happy: The Life of Judy Garland. Gerald Clarke. New York: Random House, 2000. 510 pp. $Can44.95; $29.95. 'One of the reasons Clarke pays so much attention to [the] early […]

Consumers use a variety of decision-making styles. This paper conceptualizes eight basic characteristics of these styles and develops a Consumer Styles Inventory to measure them empirically. Factor analysis of the Consumer Styles Inventory validates these eight consumer characteristics. A valid and reliable method for presenting a Profile of Consumer Style, based on measures of the eight style characteristics, is described. Unique findings of the research are discussed, and applications of the Consumer Styles Inventory in consumer education, consumer research, and family counseling are suggested. (Reprinted by permission of the publisher.)