The relevance of the Heart Foundation of Australia's dietary recommendations for adult Australians : a comparison of views of general practitioners, cardiologists and dietitians

PURPOSE: To compare the views of general practitioners, cardiologists and dietitians about the relevance of the Heart Foundation of Australia's dietary recommendations for adult cardiac patients.

BASIC PROCEDURES: Quantitative-cross sectional study. Postal questionnaires were self-completed by 248 Victorian general practitioners (30% response), 189 Australia-wide cardiologists (47% response) and 180 Victorian dietitians (45% response). Responses were represented as percentages and analyses of variance were conducted to explore the impact of the independent variables: age, work status and gender on the dependent variable: dietary recommendation.

MAIN FINDINGS: Approximately half of the recommendations were viewed as strongly important to implement; these related to lean meats, limiting takeaways and cakes/biscuits, and adjusting energy intake. Others of importance were eating fruits, vegetables and fish. However, most of these goals were seen as difficult to achieve. Dietitians appeared to share responses of doctors, except for greater importance of eating fruit and vegetables and a greater difficulty in limiting cakes and biscuits. There was a high level of agreement among the three groups (mean 87%) about patients having difficulty implementing adjusting energy intake.

CONCLUSIONS: There is agreement amongst these professionals that many of the recommendations lack importance, specifically those pertaining to unsaturated oils, low fat dairy products, cholesterol rich foods, intake of legumes and grains and the restriction of salt. This may reflect a need for further nutrition education.

A depth of data : research messages on the state of social work education in England

In the light of extensive media coverage of social work education, this article uses information from the Department of Health funded three-years multi-method evaluation of the social work degree qualification in England to discuss areas in which qualifying education might be improved. It argues that too great a concern with the 'A' level performance of social work applicants risks not paying enough attention to the non-academic qualities that they will need to work in the changing world of children's and adult services. Better partnership working between employers and universities will help students make the transition into the workplace. This includes greater opportunities for employers and practitioners to be involved in candidate selection and teaching on qualifying programmes.

Accounting for the multidimensional nature of the relationship between adult obesity and socio-economic status : the French second National Individual Survey on Food Consumption (INCA 2) dietary survey (2006–07)

The objective was to study the multidimensional nature of the relationship between adult obesity (OB) and socio-economic status (SES),
using comprehensive indices of SES taken separately or synthesised in an overall index. A nationally representative sample of adults aged
18–79 years was taken from the French second National Individual Survey on Food Consumption (INCA 2) dietary survey (2006–07).
Weight and height were measured and OB defined as BMI $ 30 kg/m². SES variables were reported in questionnaires and included
occupation, education and characteristics of household wealth. Composite indices of SES (household wealth and overall SES indices)
were computed by correspondence analysis, and relationships with OB were investigated with logistic regression analysis. In total, 11·8
(95% CI 10·1, 13·4) % of French adults were obese, without significant difference by sex. While no significant relationship was observed
in men, all SES indicators were inversely correlated to OB in women. Both education and the household wealth index were retained in the
stepwise multivariate model, confirming that different socio-economic variables are not necessarily proxies of each other regarding the OB
issue. On the other hand, ‘controlling for SES’ while including several measures of SES in multivariate models may lead to collinearity, and
thus over-adjustment. A more integrative approach may be to derive a synthetic index by including the SES factors available in a given
study. Beyond this methodological perspective, understanding how OB is related to the different dimensions of SES should help to
target the more vulnerable groups and increase the effectiveness of prevention.

Five-year change in cardiovascular risk factors according to education level : the Australian diabetes, obesity and lifestyle (AusDiab) study

Background: Lower socioeconomic status (SES) is strongly associated with a higher prevalence of major cardiovascular risk factors, but few studies have examined changes in these risk factors over time according to SES. We aimed to determine whether SES is a predictor of the change in cardiovascular risk factor levels in a contemporary Australian adult cohort

Methods: Participants in the population-based AusDiab study aged 25+ years who attended both baseline and 5-year follow-up examinations (n=5 954) were categorised according to their level of education at baseline. Cardiovascular risk factor data at both time points were ascertained through questionnaire and physical measurement. Analysis was stratified by gender.

Results: The mean levels of systolic blood pressure, total cholesterol and the prevalence of smoking decreased between the two time points across all educational categories. Increases were also seen in mean BMI and the prevalence of diabetes. For blood pressure, the smallest decrease was seen among men with lower education (age-adjusted difference from higher education 2.8 mmHg, 95% CI 1.0 to 4.6). For total cholesterol, the decrease was greatest among women with lower education (age-adjusted difference from higher education 0.11 mmol/l, 95% CI 0.19 to 0.02). Among those "not at risk" at baseline for each risk factor, women with lower education were more likely than those with higher education to progress to being "at risk" for BMI (age-adjusted odds ratio 1.60, 95% CI 1.09 to 2.35).

Conclusion: Educational gradients narrowed for total cholesterol in women, but widened for systolic blood pressure in men and remained static for other risk factors. Lower education was also associated with an earlier onset of overweight or obesity in women. Given current socioeconomic gradients in risk factors levels, these findings suggest that social inequalities in CVD will persist and may even widen in the future.

Incidence of cardiovascular risk factors by education level 2000-2005 : the Australian diabetes, obesity and lifestyle (AusDiab) cohort study

Lower socioeconomic status (SES) is associated with a higher prevalence of major risk factors for cardiovascular disease (CVD). However, few longitudinal studies have examined the association between SES and CVD risk factors over time. We aimed to determine whether SES, using education as a proxy, is associated with the onset of CVD risk factors over 5 years in an Australian adult cohort study.

Participants in the Australian Diabetes, Obesity and Lifestyle study (AusDiab) study aged 25 years and over who attended both baseline and 5-year follow-up examinations (n=5 967) were categorised according to educational attainment. Cardiovascular risk factor data at both time points were ascertained through questionnaire and physical measurement.

Women with lower education had a greater risk of progressing from normal weight to overweight or obesity than those with higher education (age-adjusted OR 1.57, 95% CI 1.06-2.31). Both men and women with lower education were more likely to develop diabetes (age-adjusted OR from higher education 1.75, 95% CI 1.14-2.71 and 3.01, 95% CI 1.26-7.20, respectively). A lower level of education was associated with a greater number of risk factors accumulated over time in women (OR of progressing from having two or less risk factors at baseline to three or more at follow up, 2.04, 95% 1.32-3.14).

In this Australian population-based study, lower educational attainment was associated with an increased risk of developing both individual and total CVD risk factors over a 5-year period. These findings suggest that SES inequalities in CVD will persist into the future.

Chronic disease and impairment among Alaska native elders : the Alaska Education and Research Towards Health (EARTH) study

Background: Chronic diseases and impairments are prevalent among older Americans. However, prevalence data for Alaska Native (AN) elders are limited, with estimates usually extrapolated from national studies in which AN elders may not be well-represented. The aim of this study was to describe the prevalence of selected chronic diseases, impairments, and measured medical risk factors among a large community sample of AN elders.

Methods: Design, setting, and participants. A community-based cross-sectional study of baseline information from 656 AN elders aged 55 years or over who participated in the Alaska Education and Research Towards Health (EARTH) Study, March 2004 to August 2006. Measurements. Self-reported lifetime prevalence of 17 doctor-diagnosed chronic diseases, and point prevalence of vision, hearing, oral, and general health impairment were estimated from data collected using audio computer-assisted self-administered questionnaires. In addition, height, weight, blood pressure, fasting blood lipids, and fasting blood glucose levels were measured.

Results: The four most prevalent chronic diseases among AN elders were high blood pressure (55%), arthritis (49%), high cholesterol (42%), and adult bone fracture/break (35%). The median number of chronic diseases reported was three (inter-quartile range, 2 to 5). The prevalence of self-reported vision impairment was 15%, hearing impairment 18%, and having had all natural teeth removed 25%. Almost 50% were obese. High blood pressure (systolic ≥ 140 mm Hg and/or diastolic ≥ 90 mm Hg) was measured in 23%, high low density lipoprotein (LDL) cholesterol (≥ 130 mg/dL) in 39%, and high fasting plasma glucose (> 125 mg/dL) in 9%. Obesity was more prevalent among women than men. There were also significant regional differences in rates of obesity and high LDL cholesterol.

Conclusion: These data may be useful in public health programs and health services planning.

The impact of smoking in adolescence on early adult anxiety symptoms and the relationship between infant vulnerability factors for anxiety and early adult anxiety symptoms : The TOPP Study

Cigarette smoking is increased in people with trait anxiety and anxiety disorders, however no longitudinal data exist illuminating whether smoking in adolescence can influence the developmental trajectory of anxiety symptoms from early vulnerability in infancy to adult anxiety expression. Using The Tracing Opportunities and Problems in Childhood and Adolescence (TOPP) Study, a community-based cohort of children and adolescents from Norway who were observed from the age of 18months to age 18–19years, we explored the relationship between adolescent smoking, early vulnerability for anxiety in infancy (e.g. shyness, internalizing behaviors, emotional temperaments) and reported early adult anxiety.

Structural equation modeling demonstrated that adolescent active smoking was positively associated with increased early adulthood anxiety (β = 0.17, p<0.05), after controlling for maternal education (proxy for socioeconomic status). Adolescent anxiety did not predict early adult smoking. Adolescent active smoking was a significant effect modifier in the relationship between some infant vulnerability factors and later anxiety; smoking during adolescence moderated the relationship between infant internalizing behaviors (total sample: active smokers: β = 0.85,p<0.01, non-active smokers: ns) and highly emotional temperament (total sample: active smokers: β = 0.55,p<0.01,non-active smokers: ns), but not shyness, and anxiety in early adulthood. The results support a model where smoking acts as an exogenous risk factor in the development of anxiety, and smoking may alter the developmental trajectory of anxiety from infant vulnerability to early adult anxiety symptom expression. Although alternative non-mutually exclusive models may explain these findings, the results suggest that adolescent smoking may be a risk factor for adult anxiety, potentially by influencing anxiety developmental trajectories. Given the known adverse health effects of cigarette smoking and significant health burden imposed by anxiety disorders, this study supports the importance of smoking prevention and cessation programs targeting children and adolescence.

International vocational education and training - the migration and learning mix

International VET students have divergent, shifting and in some cases multiple purposes for undertaking their VET courses. Students' motives may be instrumental and/or intrinsic and can include obtaining permanent residency, accumulating skills that can secure good employment, gaining a foothold that leads to higher education, and/or personal transformation. Moreover, students' study purposes and imagining of acquired values are neither fixed nor unitary. They can be shaped and reshaped by their families and personal aspirations and by the social world and the learning environment with which they interact. We argue that, whatever a student's study purpose, s/he needs to engage in a learning practice and should be provided with a high quality education. Indeed, we insist this remains the case even if students enroll only in order to gain the qualifications needed to migrate. The paper details the association between migration and learning, and argues that the four variations emerging from the empirical data of this study that centre on migration and skills' accumulation better explain this association than does the 'international VET students simply want to migrate' perspective. We conclude with a discussion of why the stereotype that holds VET international students are mere 'PR hunters' is unjust and constitutes a threat to the international VET sector.

Trauma-related symptoms in Sri Lankan adult survivors after the tsunami: pretraumatic and peritraumatic factors

Limited research has addressed factors associated with psychological distress following disasters among non-Western populations. The 2004 tsunami affected 1.7 million people across South Asia and Africa, with considerable variations in trauma-related outcomes. Pretraumatic and peritraumatic conditions associated with trauma-related symptoms in 305 Sri Lankan adult survivors (28% male, aged 18-83 years; mean = 39.9 years; standard deviation = 15.3), clinically assessed 1 month posttsunami, were evaluated retrospectively. Outcome measures were total scores on 11 trauma-related symptoms. Multivariate linear regression analyses tested for associations between pretraumatic and peritraumatic conditions and symptom scores, with peritraumatic conditions adjusted for pretraumatic variables. Pretraumatic conditions of female gender, employment, prior health and social issues, and substance use and peritraumatic conditions of loss of family, witnessing the tsunami, or suffering an injury were associated with trauma-related symptoms. The findings facilitate understanding cultural contexts that define risk factors associated with trauma-related symptoms in Sri Lankans, which are critical for developing culturally appropriate interventions.

Developing teacher-researchers: a practice-based Masters of Education

Teachers’ work can increasingly be described as knowledge work conducted in a rapidly changing globalised, digital environment. In order to support contemporary teachers’ work, professional learning needs to be grounded in the contexts and identities of teachers, while engaging them in theoretical discourse. Such an approach challenges traditional approaches to the offering of a Masters in Education by distance learning. This presentation reports on a university-educational authority partnership designed to enable practising teachers to gain Masters qualifications through practice-based ethnographic data collection and research. The context of this partnership is a new professional learning program being offered by Deakin University, Australia and the Catholic Education Office Melbourne. Teachers plan and conduct projects in which they identify an issue to be addressed at their school; research the issue identified; develop and implement an intervention to address the issue; and report on the intervention. Teachers have the option of gaining credit towards a Masters of Education by submitting their work for formal assessment. The participants in this mixed methods study are teachers who are undertaking the post-graduate units embedded in a professional learning program. Teachers are invited to undertake anonymous online pre- and post- surveys with both qualitative and quantitative data collected. Data is also collected through teacher interviews and collection of classroom artefacts including planning documents and work samples. Initial findings illustrate that a practice-based approach to Masters studies engages teachers as creators rather than reproducers of knowledge. The use of a range of print and new digital media both within the design and operation of an online learning environment and pedagogies for effective adult professional learning enable flexible and creative pedagogical responses and knowledge creation by teachers.

Erasure, exclusion by inclusion, and the absence of intersectionality: introducing bisexuality in education

Even though many schools and educational systems, from elementary to tertiary, state that they endorse antihomophobic policies, pedagogies, and programs, there appears to be an absence of education about, and affirmation of, bisexuality, and minimal specific attention to bi-phobia in curriculum, policy, and student welfare. Bisexuality continues to fall into the gap between the binary of heterosexuality and homosexuality across all educational sectors. These absences and erasures leave bisexual students, family members, and educators feeling silenced and invisibilized within school communities. Indeed, these absences and erasures have been considered a major factor in bisexual young people, family members, and educators in school communities experiencing worse mental, emotional, sexual, and social health than their homosexual or heterosexual counterparts. Also of interest is the persistence of bisexual erasure in adult-developed resources and programs, even though there is increasing evidence of sexual identities and practices in youth subcultures that are adopting shifting discursive and societal constructs of sexuality, characterized by notions of fluidity, ambisexuality, and a reluctance to label their sexuality according to the heterosexual/homosexual binary. The articles in this issue profoundly engage with and problematize the three impediments to education systems when those systems engage with sexual diversity instead of sexual duality, namely, erasure, exclusion by inclusion into gay and lesbian categories, and the absence of intersectionality (wherein other facets of identity and experience that interweave with sexuality are not taken into account, such as class, gender, Indigeneity/Aboriginality, ethnicity, geographical location, and religion). 

Facilitating learning in continuing education: some important sources

If higher education institutions are to respond effectively to the demands for continuing education, they will need to change their assumptions about the design of courses and the facilitation of learning. Despite many decades of development of new approaches to teaching and learning, courses in universities and polytechnics are normally still organised around the structures of the academic disciplines and the interests of the teaching staff. Learning-centred and problem-based courses, which can be especially appropriate in continuing education are rare particularly in those professional subjects where the potential for continuing education provision may be the greatest. The aim of the paper is to consider briefly the contributions ofthree groups of people to the ways in which learning can be facilitated in continuing education courses. These are Malcolm Knowles and his associates on teaching and learning strategies, John Heron and his associates on facilitation skills and the needs of adult learners, and the Sydney group based on the Australian Consortium on Experiential Education on fostering learning from experience and problem-based learning.

Adult cardiothoracic transplant nursing: an ISHLT consensus document on the current adult nursing practice in heart and lung transplantation.

The role of nurses in cardiothoracic transplantation has evolved over the last 25 years. Transplant nurses work in a variety of roles in collaboration with multidisciplinary teams to manage complex pre- and post-transplantation issues. There is lack of clarity and consistency regarding required qualifications to practice transplant nursing, delineation of roles and adequate levels of staffing.

"I tell ya who needs educatin’”: non-Indigenous cultural self-awareness and prisoner education.

Glen says, “current education is colonial; it ain’t ours. I tell ya who needs educatin’, wadjellas”. Glen is a Noongar man who, along with several other Aboriginal adults living in Western Australia, teaches me in a PhD research project about prisoner education from their perspective. His words pose a question for wadjellas like myself who are raised, taught and work in a white neo-colonial society. We have been raised in, taught in and work in a colonial system. As non-Aboriginal people we have unearned privileges which are often invisible and unacknowledged. How then to address the outcomes of this in a way that might lead to working co-operatively alongside Aboriginal people? What kind of ‘educatin’ could teach us about our own unacknowledged privilege and the disadvantage this can lead to for others? Is the standard cross-cultural awareness training enough?This paper shares some of the teachings of Glen and other participants in this research. It expresses the view that, ultimately, the usually unacknowledged legacy of colonisation and associated issue of denied Aboriginal sovereignty lies at the heart of much of the disadvantage experienced by Aboriginal people today when considering education and the prison system. Addressing gaps in non-Indigenous cultural self-awareness by learning from Aboriginal people is an important factor in improving their experiences of education.

School based education programme to reduce salt intake in children and their families (School-EduSalt): cluster randomised controlled trial

Objective To determine whether an education programme targeted at schoolchildren could lower salt intake in children and their families. Design Cluster randomised controlled trial, with schools randomly assigned to either the intervention or control group. Setting 28 primary schools in urban Changzhi, northern China. Participants 279 children in grade 5 of primary school, with mean age of 10.1; 553 adult family members (mean age 43.8). Intervention Children in the intervention group were educated on the harmful effects of salt and how to reduce salt intake within the schools' usual health education lessons. Children then delivered the salt reduction message to their families. The intervention lasted for one school term (about 3.5 months). Main outcome measures The primary outcome was the difference between the groups in the change in salt intake (as measured by 24 hour urinary sodium excretion) from baseline to the end of the trial. The secondary outcome was the difference between the two groups in the change in blood pressure. Results At baseline, the mean salt intake in children was 7.3 (SE 0.3) g/day in the intervention group and 6.8 (SE 0.3) g/day in the control group. In adult family members the salt intakes were 12.6 (SE 0.4) and 11.3 (SE 0.4) g/day, respectively. During the study there was a reduction in salt intake in the intervention group, whereas in the control group salt intake increased. The mean effect on salt intake for intervention versus control group was -1.9 g/day (95% confidence interval -2.6 to -1.3 g/day; P<0.001) in children and -2.9 g/day (-3.7 to -2.2 g/ day; P<0.001) in adults. The mean effect on systolic blood pressure was -0.8 mm Hg (-3.0 to 1.5 mm Hg; P=0.51) in children and -2.3 mm Hg (-4.5 to -0.04 mm Hg; P<0.05) in adults. Conclusions An education programme delivered to primary school children as part of the usual curriculum is effective in lowering salt intake in children and their families. This offers a novel and important approach to reducing salt intake in a population in which most of the salt in the diet is added by consumers.