Ambulance call triage outcomes for patients reporting pain : a retrospective cross-sectional analysis of pain score versus traige level

Objective: To identify any association between the response priority code generated during calls to the ambulance communication centre and patient reports of pain severity.

Methods: A retrospective analysis of patient care records was undertaken for all patients transported by paramedics over a 7-day period. The primary research interest was the association between the response code allocated at the time of telephone triage and the initial pain severity score recorded using a numeric rating scale (NRS). Univariate and multivariate logistic regression methods were used to analyse the association between the response priority variable and explanatory variables.

Results: There were 1246 cases in which both an initial pain score using the NRS and a response code were recorded. Of these cases, 716/1246 (57.5%) were associated with a code 1 ("time-critical") response. After adjusting for gender, age, cause of pain and duration of pain, a multivariate logistic regression analysis found no significant change in the odds of a patient in pain receiving a time-critical response compared with patients who had no pain, regardless of their initial pain score (NRS 1–3, odds ratio (OR) 1.11, 95% CI 0.7 to 1.8; NRS 4–7, OR 1.12, 95% CI 0.7 to 1.8; NRS 8–10, OR 0.84, 95% CI 0.5 to 1.4).

Conclusion: The severity of pain experienced by the patient appeared to have no influence on the priority (urgency) of the dispatch response. Triage systems used to prioritise ambulance calls and decide the urgency of response or type of referral options should consider pain severity to facilitate timely and humane care.

Community center-based resistance training for the maintenance of glycemic control in adults with type 2 diabetes

OBJECTIVE--The purpose of this study Was to determine whether beneficial effects on glycemic control of an initial laboratory-supervised resistance training program could be sustained through a community center-based maintenance program.

RESEARCH DESIGN AND METHODS--We studied 57 overweight (BMI [greater than or equal to] 27 kg/[m.sup.2]) sedentary men and women aged 40-80 years with established (>6 months) type 2 diabetes. Initially, all participants attended a twice-weekly 2-month supervised resistance training program conducted in the exercise laboratory. Thereafter, participants undertook a resistance training maintenance program (2 times/week) for 12 months and were randomly assigned to carry this out either in a community fitness and recreation center (center) or in their domestic environment (home). Glycemic control ([HbA.sub.1c] [A1C]) was assessed at 0, 2, and 14 months.

RESULTS--Pooling data from the two groups for the 2-month supervised resistance training program showed that compared with baseline, mean A1C fell by -0.4% [95% CI -0.6 to -0.2]. Within-group comparisons showed that A1C remained lower than baseline values at 14 months in the center group (-0.4% [-0.7 to -0.03]) but not in the home group (-0.1% [-0.4 to 0.3]). However, no between-group differences were observed at each time point. Changes in A1C during the maintenance period were positively associated with exercise adherence in the center group only.

CONCLUSIONS--Center-based but not home-based resistance training was associated with the maintenance of modestly improved glycemic control from baseline, which was proportional to program adherence. Our findings emphasize the need to develop and test behavioral methods to promote healthy lifestyles including increased physical activity in adults with type 2 diabetes.

Resisting the call to arms : men who did not enlist in World War 1

Historian Dr Bart Ziino has researched thousands of records that give an insight into an often overlooked aspect of World War I – men who chose not to enlist for service.

Enlistment and non-enlistment in wartime Australia : responses to the 1916 call to arms appeal

This article examines men’s responses to the 1916 ‘Call to Arms’ appeal, in which Australia’s federal government questioned military-aged male citizens on their willingness to enlist voluntarily in the armed forces for service at the front. It argues that the appeal illuminated men’s difficult negotiation of choice, in which they weighed their personal sense of obligation to the state at war, to their families, and to themselves. It shows how men not only confronted their decision, but measured their responsibilities against others’, producing a subjective order of sacrifice that paralysed recruiting. In the absence of conscription, that private decision-making was critical to the nature of Australia’s commitment to the war, as men assessed and re-assessed the limits of obligation for themselves.

Why has the rising economic tide failed to float the disability employment boat? A call to action : business,community, government and people power

It is well established that people with disabilities are under-represented in the workforce. Disability labour market scholars agree that there is a significant gap between labour market participation of people with disabilities and people without disabilities, with on-going labour market disadvantage widely reported. All indicate that notwithstanding the recent economic growth of Western economies, the employment rate for people with disabilities has not improved. This paper draws on the findings of three recent research projects on disability employment in Australia and on data from contemporary literature on workplace discrimination and proposes that a combination of more robust social inclusion policies and legislation, revitalised supported employment models, intensive social marketing, and radical disability advocacy is required.

Call for research – the consuming child-in-context in unhealthy and unsustainable times

Childhood obesity is a highly complex issue with serious health and environmental implications. It has been postulated that young children (preschool-aged in particular) are able to internalise positive environmental beliefs. Applying a socioecological theoretical perspective, in this discussion paper we argue that although children may internalise such beliefs, they commonly behave in ways that contradict these beliefs as demonstrated by their consumer choices. The media directly influences these consumer choices and growing evidence suggests that media exposure (particularly commercial television viewing) may be a significant “player” in the prediction of childhood obesity. However, there is still debate as to whether childhood obesity is caused by digital media use per se or whether other factors mediate this relationship. Growing evidence suggests that researchers should examine whether different types of content have conflicting influences on a child’s consumer choices and, by extension, obesity. The extent to which young children connect their consumer choices and the sustainability of the product/s they consume with their overall health and wellbeing has not previously been researched. To these ends, we call for further research on this socioecological phenomenon among young children, particularly with respect to the influence of digital media use on a child’s consumer behaviours.