Criteria for the systematic review of health promotion and public health interventions

Systematic reviews of public health interventions are fraught with challenges. Complexity is inherent; this may be due to multi-component interventions, diverse study populations, multiple outcomes measured, mixed study designs utilized and the effect of context on intervention design, implementation and effectiveness. For policy makers and practitioners to use systematic reviews to implement effective public health programmes, systematic reviews must include this information, which seeks to answer the questions posed by decision makers, including recipients of programmes. This necessitates expanding the traditional evaluation of evidence to incorporate the assessment of theory, integrity of interventions, context and sustainability of the interventions and outcomes. Unfortunately however, the critical information required for judging both the quality of a public health intervention and whether or not an intervention is worthwhile or replicable is missing from most public health intervention studies. When the raw material is not available in primary studies the systematic review process becomes even more challenging. Systematic reviews, which highlight these critical gaps, may act to encourage better reporting in primary studies. This paper provides recommendations to reviewers on the issues to address within a public health systematic review and, indirectly, provides advice to researchers on the reporting requirements of primary studies for the production of high quality systematic reviews.

Effect of dietary arachidonic acid and n-3 polyunsaturated fatty acids on the production of eicosanoids

The major polyunsaturated fatty acid (PUFA) in the western diet is linoleic acid (LA), which is considered to be the major source of tissue arachidonic acid (AA), the principal precursor for the vaso-active eicosanoids via the cyclooxygenase enzymatic pathway. However, dietary AA may contribute significantly to tissue levels of AA in humans, leading to an increase in the production of eicosanoids, particularly the platelet aggregating, vasoconstricting, thromboxane (TXA2), hence increasing thrombosis risk. The aims of this study were to determine the extent to which dietary AA contributed to prostacyclin (PGI2) and TXA2 production in vivo and whether dietary long chain (LC) n-3 PUFA have a modulating influence on the metabolism of AA to these vaso-active eicosanoids. A gas chromatography -mass spectrometry (GCMS) method for urinary PGI2-M determination and a tandem GCMS/MS method for urinary TXA2-M determination were perfected for use within our laboratory (with the assistance of Dr Howard Knapp, University of Iowa and Professor Reinhard Lorenz, Ludwig Maximilian's University, Munich, respectively). An initial animal study compared the in vitro production of PGI2 by aorta segments with the whole body in vivo production of PGI2 in rats fed ethyl arachidonate or the ethyl ester of eicosapentaenoic acid (EPA), at levels many times higher than encountered in human diets. During AA feeding both measures of PGI2 increased, although in vitro TXA2 production was not affected. EPA feeding lowered in vitro TXA2 and in vivo PGI2. Prior to determining the effects of AA and LC n-3 PUFA in humans, a study was carried out to determine the AA and LC n-3 PUFA content of foods and from these, an estimate of the mean daily intake of AA and other LC PUFA. Eggs, organ meats and paté were found to be the richest sources of AA. Of the meat and fish analysed, white meat was found to be relatively rich in AA but poor in LC n-3 PUFA. Lean red meat, particularly kangaroo had similar LC n-3 PUFA and AA content. Fish, although rich in AA, had extremely high levels of LC n-3 PUFA. The calculated mean daily intakes of AA in Australian adults was 130mg (males) and 96mg (females). For total LC n-3 PUFA intake, the mean daily values were 247mg (males) and 197mg (females). Two human pilot studies involving dietary intervention trials examined the effects of dietary AA and AA plus long chain n-3 PUFA on thrombosis risk, gauged by the change in the ratio of PGI2 / TXA2 as well as alterations to other recognised risk factors, such as lipoprotein lipids and platelet aggregation. The desired dietary amounts of AA and LC n-3 PUFA were achieved in the first study by combining food items with known levels of each fatty acid. In the second study, where a diet with approximately equal quantities of AA and LC n-3 PUFA was being examined, kangaroo meat was consumed, following a low-fat vegetarian diet used as a baseline. Diets rich in AA alone (~500mg/day) increased plasma phospholipid (PL) AA levels, PGIi and TXA2 production. When foods containing equal quantities of AA and EPA (∼500mg/day of each) were fed to subjects PGI2 increased, with no change in TXAs production. Low fat vegetarian diets lowered PGI2 production, the level of which was reestablished by an AA rich diet (∼300mg AA/day + ∼260mg/day LC n-3 PUFA) of kangaroo meat. However, TXA2 production was not altered. A final, larger human dietary intervention trial then examined the effects of diets relatively rich in AA alone, AA plus LC n-3 PUFA and LC n-3 PUFA, on the ratio of PGI2/TXA2- The dietary sources of these fatty acids were white meat, red meat and fish, respectively. Each contained a mean level of AA of ∼140mg/day, with varying LC n-3 PUFA levels (59, 161 and 3380mg/day, respectively). Neither meat diet altered PGI2 or TXA2 production significantly, despite increasing serum PL AA levels. The fish diet resulted in a decrease in the serum and platelet PL AA/EPA ratio and TXA2 production, thus increasing the PGI2 / TXA2 ratio. These results would indicate that stores of AA in the body are sufficiently high to have effectively saturated the cyclooxygenase pathway for production of both PGI2 and TXA2, thus making any small change in the plasma level of AA due to 'normal' dietary levels, inconsequential. However, as seen in the rat study and the two pilot studies higher dietary levels of AA can increase both PGI2 and TXA2 production. Increases in platelet levels of EPA and DHA were associated with a decrease in TXA2 production, or the maintenance of a constant TXA2 level, while AA tissue levels and PGI2 production increased. This suggests a possible inhibitory effect of LC n-3 PUFA on the metabolism of AA to TXA2, particularly in platelets. From these short term studies, conducted over 2-3 week periods, it can be concluded that diets rich in lean meats can raise plasma AA levels but do not affect TXA2 or PGI2 production, hence are not pro-thrombotic. Diets rich in long chain n-3 PUFA from fish, raise plasma EPA and DHA levels, lower TXA2 production and are anti-thrombotic. Diets which combine equal quantities of AA and LC n-3 PUFA appear to increase PGI2 production while keeping TXA2 production constant. In order for these LC PUFA to have a significant effect on eicosanoid production the dietary intake of these fatty acids through foods such as red meat or white meat would have to be higher than average current Australian consumption levels.

Industrial biotechnology for the production of proteins/enzymes for a sustainable future

Worldwide emergence of Industrial biotechnology (IB) is providing opportunities to produce enzymes/proteins with variety of industrial/therapeutic applications. In transitioning the Australian economy towards a sustainable future, Federal government identified the development of IB pathway which would ensure increased productivity, enhanced sustainability, health, safety and reduced environmental footprint. The presentation will revolve around specific stories that drives Deakin University newest technology platform which applies biology and fermentation in an integrated way to play a crucial role in developing cost-effective technologies for the development of molecules that can benefit pharmaceutical and food industry in regional Victoria and Australia in general. The talk will also highlight specific examples where new products like recombinant rhamnosidase (an enzyme used for the production of flavonoids with health benefits) and ribosome inactivating proteins (detected in medicinal plants which possess RNA N- glycosidase activity that depurinates the major rRNA, thus damaging ribosome in an irreversible manner and arresting protein synthesis) would be made available through bioprocessing.

Co-production and health system reform - from re-imagining to re-making

There is growing interest in the application of citizen participation within all areas of public sector service development, where it is increasingly promoted as a significant strand of post-neoliberal policy concerned with re-imagining citizenship and more participatory forms of citizen/consumer engagement. The application of such a perspective within health services, via co-production, has both beneficial, but also problematic implications for the organisation of such services, for professional practice and education. Given the disappointing results in increasing consumer involvement in health services via ‘choice’ and ‘voice’ participation strategies, the question of how the more challenging approach of co-production will fare needs to be addressed. The article discusses the possibilities and challenges of system-wide co-production for health. It identifies the discourse and practice contours of co-production, differentiating co-production from other health consumer-led approaches. Finally, it identifies issues critically related to the successful implementation of co-production where additional theorisation and research are required.

A review on the assessment of stress conditions for simultaneous production of microalgal lipids and carotenoids

Microalgal species are potential resource of both biofuels and high-value metabolites, and their production is growth dependent. Growth parameters can be screened for the selection of novel microalgal species that produce molecules of interest. In this context our review confirms that, autotrophic and heterotrophic organisms have demonstrated a dual potential, namely the ability to produce lipids as well as value-added products (particularly carotenoids) under influence of various physico-chemical stresses on microalgae. Some species of microalgae can synthesize, besides some pigments, very-long-chain polyunsaturated fatty acids (VL-PUFA,>20C) such as docosahexaenoic acid and eicosapentaenoic acid, those have significant applications in food and health. Producing value-added by-products in addition to biofuels, fatty acid methyl esters (FAME), and lipids has the potential to improve microalgae-based biorefineries by employing either the autotrophic or the heterotrophic mode, which could be an offshoot of biotechnology. The review considers the potential of microalgae to produce a range of products and indicates future directions for developing suitable criteria for choosing novel isolates through bioprospecting large gene pool of microalga obtained from various habitats and climatic conditions.

Amalgamation of health services in South-West Victoria: reinvention or survival?

In Australia 'the hospital' has long been considered the cornerstone of small, rural health services. However, this premise has been altered significantly by the introduction of casemix loading and diagnostic-related groups that promote a rationalised output-based model of management. In the light of these changes, many rural health services have struggled to reinvent themselves by establishing a range of service models such as Multi-purpose Service (MPS) and Health Streams, while maintaining traditional models (i.e. bush nursing centres, nursing homes and aged-care facilities). These changes are about survival. This paper analyses one such case in south-west Victoria, the Macarthur and District Community Outreach Service, and compares the outcomes with other similar Victorian rural health research projects. Particular attention is paid to the nature of the health services, the management of change and the proposed health outcomes for the local rural communities. In conclusion, it is argued that this study adds to the body of knowledge surrounding the construction of models of community health and development programming, These models impact upon future rural and remote area initiatives throughout Australia.

Production of Australian freshwater crayfish in earthen-based systems using pelleted diets and forage crops as food

Juvenile Cherax destructor (commonly called theyabby) were cultured in earthen-based ponds and tanks for 70–105d, and were fed pellets and/or a forage crop of the perennialwhiteclover, Trifolium repens. Three supplementary feedingstrategies were evaluated. Yabby growth on pellets consistently exceeded (by67–159%) that obtained on clover. Base-line yields for extensiveproduction systems are around 400 kg ha^–1. Thesupplementary addition of T. repens produced yields of 635kg ha^–1 (in ponds) to 1086 kgha^–1 (in tanks). The sequential addition of cut-cloverto tanks stimulated growth to levels approaching those achieved on pellets.Yabbies stocked into ponds at 17 m^–2 and fed 33%protein pellets for 100 d, resulted in a yield of 1117 kgha^–1.Pellet inputs at a rate of 129–249 g m^–2(dry matter) and 38–83 g m^–2 (protein) over70–100 d resulted in acceptable growth and feed utilisationindices. Clover inputs of 534–682 g m–2 (asdry matter) or 84–177 g m^–2 (as protein)produced reasonable growth rates but poor feed utilisation indices. Aconsiderable quantity of the dry matter and protein content of clover waseitherinefficiently utilised or directed into other production pathways. In tanks,clover inputs from 113–296 g m^–2 (drymatter) and 24–54 g m^–2 (protein) weresufficient to maintain high growth rates for 4 weeks, while in ponds, inputs of21 g m^–2 (dry matter) and 4.3 gm^–2 (protein) were sufficient for 3 weeks. During theearly weeks of production no growth advantage was gained by providing pelletstoanimals cultured in forage-based systems. Forage depletion occurred after3–4 weeks and was probably a major growth limiting factor.

Preliminary study on the use of synthetic substrate for juvenile stage production of the yabby, Cherax destructor (Clark) (Decapoda: Parastacidae)

Juvenile Cherax destructor (commonly called the yabby) (mean weight 48.3 mg) were cultured intensively (stocking density 360/m²) under controlled conditions for 48 days. The animals were provided with a combination of food (high protein pellets and/or natural feed organisms attached to a conditioned synthetic substrate) and refuge. Fastest growth and highest yield was recorded when both pellets and the conditioned synthetic material were provided. Although the yabbies sheltered in the synthetic substrate, it did not increase survival. Juvenile yabbies (< 200 mg) were able to graze on small organisms attached to the synthetic material but this ability appeared to decline as the yabbies grew to a larger size. The use of artificial substrates in the intensive nursery phase production of juvenile freshwater crayfish is discussed.

Clinical nurses` response to an environment of health care reform and organizational restructuring

The aim of this paper is to provide an explanation for clinicians' undisputed acceptance of change. This will be performed by examining the process of organizational restructuring across three analytical levels – the macro, meso and micro; identifying the consequences of restructuring for clinical nurses' performance; and evaluating organizational restructuring using a micro-political theoretical framework.

Social factors and obesity: an investigation of the role of health behaviours

OBJECTIVES: This study evaluated a behavioural model of the relation between social factors and obesity, in which differences in body mass index (BMI) across sociodemographic groups were hypothesized to be attributable to social group differences in health behaviours affecting energy expenditure (physical activity, diet and alcohol consumption and weight control).

METHODS: A total of 8667 adults who participated in the 1995 Australian National Health and Nutrition Surveys provided data on a range of health factors including objectively measured height and weight, health behaviours, and social factors including family status, employment status, housing situation and migration status.

RESULTS: Social factors remained significant predictors of BMI after controlling for all health behaviours. Neither social factors alone, nor health behaviours alone, adequately explained the variance in BMI. Gender-specific interactions were found between social factors and individual health behaviours.

CONCLUSIONS: These results suggest that social factors moderate the relation between BMI and weight-related behaviours, and that the mechanisms underlying sociodemographic group differences in obesity may vary among men and women. Additional factors are likely to act in conjunction with current health behaviours to explain variation in obesity prevalence across sociodemographic groups.

Multiple sclerosis and economic well being: role of health, age, and duration of illness

This study used quantitative and qualitative techniques to examine the role of health, age, and duration of illness among people with multiple sclerosis (MS) in their economic well-being. Participants were 113 adults (31 males and 82 females) with MS who lived in urban and rural regions of Australia. The results demonstrated that health and age had a significant impact on both the economic well-being and psychological adjustment of people who contract this disorder. Different health variables predicted different aspects of economic well-being. Fatigue was the major health variable that predicted costs of MS and economic pressure, with age also predicting economic pressure, whereas income levels were predicted by cognitive confusion and mobility problems. Duration of illness, gender, and urban/rural location were not significant predictors of the economic variables. These results demonstrate the importance of obtaining multiple measures of economic well-being, as well as a broad range of health-related measures, in determining the impact of MS on the economic well-being of people with this disorder.