Background: The issue of ageing within the cohort of people with intellectual disabilities has been an increasing focus for research. However, the training needs of the staff who support them has not been subject of extensive examination. Materials and Methods: A multiround Delphi project was conducted focusing upon the impact ageing issues have on the support provided by disability workers, and what training is required to address the identified areas. Results: Three rounds of the Delphi identified twenty-six separate important issues. A thematic analysis identified five main themes including Generic Training Issues; Medical Issues; Emerging Ageing Issues Requiring Changing Support; Mental Health Issues; and Quality of Life. Conclusions: The study identified a series of training priorities for staff assisting people ageing with an intellectual disability. It would appear possible for many training programmes to be developed and delivered with minimal cost impacts even within rural localities.

Physicians' inadequate involvement in sexual risk assessment has the potential to miss many asymptomatic cases. The present study was conducted to explore sexual risk assessment by physicians in clinical practice and to identify barriers in eliciting sexual histories from patients. Methods: A stratified random sample of 15% of general practitioners (GP) from New South Wales was surveyed to assess their management of sexually transmissible infections (STI). In total, 409 GP participated in the survey with a response rate of 45.4%. Results: Although nearly 70% of GP regularly elicited a sexual history from commercial sex workers whose presenting complaint was not an STI, this history taking was much lower (<10%) among GP for patients who were young or heterosexual. About 23% never took a sexual history from Indigenous patients and 19% never elicited this history from lesbian patients. Lack of time was the most commonly cited barrier in sexual history taking (55%), followed by a concern that patients might feel uncomfortable if a sexual history was taken (49%). Other constraints were the presence of another person (39%) and physician's embarrassment (15%). About 19% of GP indicated that further training in sexual history taking could improve their practice. Conclusions: The present study identifies inconsistent involvement by GP in taking sexual histories, which can result in missed opportunities for early detection of many STI. Options for overcoming barriers to taking sexual histories by GP are discussed.

Objective: During the last 50 years there have been significant improvements in life expectancy among people with intellectual disability (ID), and so their incidence of age-associated diseases, such as cancer, is rising. The aim of this study was to compare the rate of cancer in people with ID with that found in the general population. Methods: Information on 9409 individuals registered with the Disability Services Commission of Western Australia was linked to the State Cancer Registry, with 200 cases of cancer detected over 156,729 person-years. Standardised incidence ratios (SIRs) and 95% confidence intervals were calculated for both sexes separately by 5-year age groups for the period 1982–2001. The same procedures were adopted in the estimation of SIRs for specific types of cancers. Results: The age-standardised incidence of all cancers in people with ID was not significantly different from the general population. However, males with ID were observed to have a significantly increased risk of leukaemia, brain and stomach cancers, and a reduced risk of prostate cancer, while leukaemia, corpus uteri and colorectal cancers were significantly higher in females. Conclusions: Health practitioners need to be aware that with improvements in life expectancy the incidence of cancer in people with ID is likely to rise. More proactive health promotion campaigns may be needed for people with ID, who are likely to be poor users of screening services and whose symptoms may not be reported until they are in more advanced, less treatable stages of disease.

Several studies reported premarital and extra-marital sex in Bangladesh society, including among migrant workers. Some studies documented extra-marital sex among the wives of the migrant workers, confirmed prevalence of HIV among migrant workers' families and transmission of HIV from migrant workers to their wives and children. However, most of these studies concentrated on risky behaviors and knowledge about HIV/AIDS. The social and cultural factors that may shape the risk behaviours of migrant workers and their wives while they live away from each other have largely been ignored. Against this backdrop, the present research aimed to understand and explain the factors associated with risky sexual behaviours of the wives of the migrants and non-migrant workers and their vulnerability to HIV infection. The research particularly focused on the socio-economic factors, and the religious-cultural context that could influence the risk behaviours of migrant and non-migrant men and wives of the migrant men in a rural area in Bangladesh. The present research consists of two components: (i) a descriptive, quantitative part that analyses a secondary data set on the wives of migrants and non-migrant workers, and (ii) an exploratory, qualitative component that probes the socio-cultural issues from in-depth interviews with migrant and non-migrant men and wives of the migrant and non-migrant men.

Contact with family and friends, in the form of visiting, is very important to the quality of the lives of rural nursing home residents. However, there has been little recent research that examines the frequency and determinants of visits to rural nursing homes and none in the rural Australian context. This study aimed to address this gap in the literature. A telephone survey with a close family member (N=257) of each participating resident in the rural New England area of New South Wales, Australia gathered data about 3,738 people who formed the potential social networks of these residents. This study found that the wider, potential, social networks of rural nursing home residents comprised approximately 17 people and involved a wide range of family and friends. However, their actual social networks consisted of approximately two females, daughters and friends, who had high-quality relationships with the resident and who visited at least once per month. In contrast to previous assertions that nursing home residents have robust support from their family and friends, the actual social networks of these residents have dwindled considerably over recent years, which may place them at risk of social isolation. This study has implications for nursing home policy and practice and recommendations for addressing the risk of social isolation that rural nursing home residents face are made.

Welcome to the proceedings of the third Postgraduate Research Conference held in July 2008. The Faculty of The Professions Postgraduate Research conference is now in its third year and brings together higher degree research students from across all Schools in the Faculty including Education, Health, Medicine, Law, Business, Economics and Public Policy. The conference provides a forum for presentation and feedback on all aspects of Higher Degree Research as well access to specialised workshops and skills sessions. The conference proceedings are organised around the three key themes of the Conference. These include: The politics of doing research - papers that focus on discussing issues associated with various aspects of doing the research; Ethics; Sensitivity of data collection; Informing policy development (rural, regional, metropolitan); and International contexts. Theoretical perspectives - papers included in this theme discuss the theoretical framework that underpins the research study such as post-critical approaches (Feminist, Post-structuralist); Post modernism; critical discourse analysis; etc. Diverse methodologies - papers that present findings from the study or discuss various aspects of methodology, research design or the mechanics of data collection and analysis; Qualitative and quantitative perspectives; Analysis of data; Presentation of findings; Publishing and presentation of data; Using technology (NVivo, N*Dist).

Introduction: Rural health workforce shortages are a global phenomenon. Countries like Australia, with industrialised economies, large land masses and broadly dispersed populations, face unique rural health challenges in providing adequate services and addressing workforce shortages. This article focuses on retention of early-career nursing and allied health professionals working in rural and remote Australia. Some of Australia’s most severe and protracted rural workforce shortages, particularly among early-career health professionals, are in public sector community mental health (CMH), a multidisciplinary workforce staffed primarily by nurses and allied health professionals. This study investigated how employment and rural-living factors impacted the turnover intention of early-career, rural-based CMH professionals in their first few years of working.
Methods: A constructivist grounded theory methodological approach, primarily guided by the work of Charmaz, was selected for the study. By implication, the choice of a grounded theory approach meant that the research question would be answered through the development of a substantive theory. Twenty-six nursing and allied health professionals working in CMH in rural New South Wales (NSW) for the state health department services participated in in-depth, semi-structured interviews. The study sought to identify the particular life factors – workplace conditions, career-advancement opportunities and social and personal determinants – affecting workers’ turnover intention. The substantive grounded theory was developed from an identified core category and basic social process.
Results: The turnover intention theory provides a whole-of-person explanation of turnover intention. It was developed based on an identified core category of professional and personal expectations being met and an identified basic social process of adjusting to change. The theory posits that an individual’s decision to stay or leave their job is determined by the meeting of life aspirations, and this relates to the extent of the gap between individuals’ professional and personal expectations and the reality of their current employment and rural-living experience. The extent of individuals’ professional and personal expectations can be measured by their satisfaction levels. A major finding from the identification of the basic social process was that, in the adjustment stages (initial and continuing), turnover intention was most strongly affected by professional experiences, in particular those relating to the job role, workplace relationships and level of access to continuing professional development. In this stage, personal satisfaction mostly concerned those with limited social connections in the town (ie non-local – newcomers). Having reached the ‘having adapted’ stage, the major influence on turnover intention shifted to personal satisfaction, and this was strongly impacted by individuals’ life stage. By drawing on the turnover intention theory and the basic social process, it is possible to make a risk assessment of individuals’ turnover intention. Three levels of risk were identified: highly vulnerable, moderately vulnerable and not very vulnerable.
Conclusions: The study offers a holistic explanation of life factors influencing the turnover intention of early-career health professionals working in public health services in rural NSW. These findings and the turnover intention risk matrix are thought to be suitable for use by Australian public health services and governments, as well as in other highly industrialised countries, to assist in the development of policies and strategies tailored for individual health professionals’ work-experience level and life stage. By adopting such a whole-of-person approach, health services and governments will be better positioned to address the life aspirations of rural-based, early-career health professionals and this is likely to assist in the reduction of avoidable turnover.

The purpose of this qualitative research is to explore the perception of Iranian-American women about their sexual-selves and gender role formations. Additionally, the research discusses issues which contributed to the formation of their sexual-selves, gender roles, and gender identity, as well as the role culture plays in the lives of these women. The snowball sampling technique was used to identify the 24 participants, aged 18 years and older, among the first generation Iranian-American women living in Southern California, United States. A feminist perspective was selected to provide the theoretical framework to understand each woman's unique experience with respect to her sexual-self and life circumstances. Narrative analysis was utilized to explore the sexual life stories via individual in-depth interview. These stories included childhood to marriage in Iran, the undoing and unlearning process underpinning the development of their sexual-selves, and the influences of the socio-cultural factors that framed the experiences of the participants in both their home and host cultures. ... The thesis argues that the concept of the sexual rights of women has to be equated with human rights for significant advances to be made in the equality of women with men. The findings have policy and practice implications of Iranian-American women benefiting from educational programs and community discussion groups. Health professionals will see greater therapeutic gain in their patients by having adequate sensitivity to and familiarity with their patients' culture and language. Researchers will have an information base from which to pursue further research, not only with Iranian women, but also with women of similar cultural backgrounds.

There is paucity of research studies from Saudi Arabia on 'end-of-life' (EOL) care regarding hospitalised patients after a 'do-not-resuscitate' (DNR) decision has been made. The aim of this research study was to describe the lived experiences and explore the meaning of these experiences and the extent of nurses' involvement as team members in EOL care, in the context of a physician-led health care team. The research site was a large tertiary-level teaching hospital in Riyadh, Saudi Arabia and the research location was the general medical units that are frequent sites of death in EOL care after a DNR decision had been made. The research problem focused on involvement of nurses, who were largely non-Muslim, multinational and non-Arabic speaking, and local patients who were mainly Muslim and speak Arabic as their primary language. The research study design embraced qualitative, exploratory and descriptive approaches utilising aspects of phenomenology. Congruent with qualitative inquiry, the literature review commenced at the beginning of the research study and continued in an iterative manner after data collection, throughout data analysis, and during the thesis generation. Purposive sampling was used to recruit registered nurse participants who met the participation criteria in relation to direct experiences in EOL care after the DNR decision on general medical units. A total of twenty-six (26) registered nurses participated in this study by informed consent. Reflective journalling technique was selected as the most appropriate data collection method owing to its congruency with the professional nursing practice context of the hospital setting. Ethical research principles were upheld to maintain the rights of the participants, and in keeping with organisational permission to conduct the study.

Objective: The life expectancy of both the mainstream population and of people with intellectual disabilities has increased significantly in the past 100 years. However, there are research gaps regarding the comparative experience of ageing with and without a lifelong intellectual disability, and differences that are evident between metropolitan and rural localities. Methods: The current study examined the main factors that supported or hindered successful ageing for both people with and without lifelong intellectual disability across both metropolitan and rural regions of NSW and Queensland. The project utilised a qualitative design in which 40 semi-structured interviews were undertaken with individuals ageing both with and without an intellectual disability and their carers. The sample was comprised of participants who were still living in their local community and those who had transitioned into a permanent residential aged care placement. The purpose of the interviews was to gauge what different factors were enablers or impediments to the successful ageing process. Key Findings: The paper will present the findings, with a focus upon the social, environmental, political and personal health factors that underpin successful ageing. The key similarities and any differences for individuals both with and without lifelong intellectual disabilities residing in rural and metropolitan areas will be discussed. Conclusions: There is an increasing need for support structures that meet the often complex individual needs of people ageing with an intellectual disability. These models need to be based upon information gained from inclusive research to ensure that the disparate needs of people with intellectual disabilities are met in both rural and metropolitan localities. Learnings from the mainstream ageing communities can further assist in the development of appropriate systems of support. The results have also informed ways in which bridges can be built between disability and aged care policies and practices.