Self-reported access to and quality of healthcare for diabetes : Do the severely obese experience equal access?

Background: Given reported pejorative views that health professionals have about patients who are severely obese, we examined the self-reported views of the quality and availability of diabetes care from the perspective of adults with type 2 diabetes (T2DM), stratified by body mass index (BMI). Methods: 1795 respondents to the Diabetes MILES - Australia national survey had T2DM. Of these, 530 (30%) were severely obese (BMI ≥35 kg/m2) and these participants were matched with 530 controls (BMI <35 kg/m2). Data regarding participants' self-reported interactions with health practitioners and services were compared. Results: Over 70% of participants reported that their general practitioner was the professional they relied on most for diabetes care. There were no betweengroup differences in patient-reported availability of health services, quality of interaction with health practitioners, resources and support for selfmanagement, or access to almost all diabetes services. Discussion: Participants who were severely obese did not generally report greater difficulty in accessing diabetes care.

An RCT to evaluate the utility of a clinical protocol for staff in the management of behavioral and psychological symptoms of dementia in residential aged-care settings

Objectives: Behavioral and psychological symptoms of dementia (BPSD) cause significant stress and distress to both aged-care residents and staff. This study evaluated a training program to assist staff to manage BPSD in residential care. Method: A randomised controlled trial (RCT) was employed. The study was included in the Australian and New Zealand Clinical Trial Register residential care facilities. Staff (n = 204) and residents (n = 187) were from 16 residential care facilities. Facilities were recruited and randomly assigned to four staff training conditions: (1) training in the use of a BPSD-structured clinical protocol, plus external clinical support, (2) a workshop on BPSD, plus external clinical support, (3) training in the use of the structured clinical protocol alone, and (4) care as usual. Staff and resident outcome measures were obtained pre-intervention, three months and six months post-intervention. The primary outcome was changes in BPSD, measured using the Cohen-Mansfield Agitation Inventory (CMAI) as well as frequency and duration of challenging behaviors. Secondary outcomes were changes in staff adjustment. Results: There were improvements in challenging behaviors for both intervention conditions that included training in the BPSD instrument, but these were not maintained in the condition without clinical support. The training/support condition resulted in sustained improvements in both staff and resident variables, whereas the other conditions only led to improvement in some of the measured variables. Conclusion: These results demonstrate the effectiveness of the BPSD protocol in reducing BPSD and improving staff self-efficacy and stress.

Leadership self-development in China and Vietnam

The transition towards a socialist market-oriented economy has presented many challenges to both China and Vietnam. One of the key human resource challenges has been to develop business leadership skills in a flexible, timely and cost-effective manner. This paper focuses on the self-initiated approach to professional development that has been introduced by managers at a grassroot level to improve business leadership (referred to as self-development). Given the limited research on self-development in China and Vietnam, the intention of this paper is to enrich understanding of why managers in a complex and dynamic transitional environment undertake self-development activities. The findings of this study suggest that there is no ‘one-size-fits-all’ paradigm to understand self-development across contexts. First, the western model of leadership competencies at the different management levels do not necessarily fit the needs that managers are targeting in their self-development activities in China and Vietnam. Second, despite some similarities between China and Vietnam, the Chinese managers were more interested in technical leadership skills than the Vietnamese managers whose self-development foci were centred on improving their moral standards. Such differences highlight each country's stage of economic and social development while reinforcing the influence of contextual factors. It also suggests that self-development is best understood as a process within a specific context.

Reflections on being a first generation self-advocate: belonging, social connections, and doing things that matter

Background Despite good policy intentions, people with intellectual disability continue to be socially excluded. Social geographers suggest the potential of self-authored spaces as catalysts for social inclusion. One such space, self-advocacy, is commonly perceived as part of a political movement for social change rather than a vehicle for social inclusion of its members. This paper investigated what involvement in self-advocacy has meant to long-term members of a self-advocacy group in Victoria, Australia. Methods In-depth interviews were conducted with 12 self-advocates about their reflections on involvement in the group. These data together with the commentary of 5 self-advocates during interviews with 18 self-advocacy supporters about their recollections of involvement in the group were transcribed and analysed thematically. Findings Through their involvement in self-advocacy, members of the group had gained a sense of belonging, social connections, and purposeful occupation, which included paid project work, lobbying, and organisational leadership and management. Conclusions This study suggests that self-advocacy groups can be places that foster social inclusion, potentially offering “membership” of an exclusive group, a wider social movement and of mainstream society.

Self-monitoring of blood glucose versus self-monitoring of urine glucose in adults with newly diagnosed Type 2 diabetes receiving structured education: a cluster randomized controlled trial.

AIMS: To compare the effectiveness and acceptability of self-monitoring of blood glucose with self-monitoring of urine glucose in adults with newly diagnosed Type 2 diabetes. METHODS: We conducted a multi-site cluster randomized controlled trial with practice-level randomization. Participants attended a structured group education programme, which included a module on self-monitoring using blood glucose or urine glucose monitoring. HbA1c and other biomedical measures as well as psychosocial data were collected at 6, 12 and 18 months. A total of 292 participants with Type 2 diabetes were recruited from 75 practices. RESULTS: HbA1c levels were significantly lower at 18 months than at baseline in both the blood monitoring group [mean (se) -12 (2) mmol/mol; -1.1 (0.2) %] and the urine monitoring group [mean (se) -13 (2) mmol/mol; -1.2 (0.2)%], with no difference between groups [mean difference adjusted for cluster effect and baseline value = -1 mmol/mol (95% CI -3, 2); -0.1% (95% CI -0.3, 0.2)]. Similar improvements were observed for the other biomedical outcomes, with no differences between groups. Both groups showed improvements in total treatment satisfaction, generic well-being, and diabetes-specific well-being, and had a less threatening view of diabetes, with no differences between groups at 18 months. Approximately one in five participants in the urine monitoring arm switched to blood monitoring, while those in the blood monitoring arm rarely switched (18 vs 1% at 18 months; P < 0.001). CONCLUSIONS: Participants with newly diagnosed Type 2 diabetes who attended structured education showed similar improvements in HbA1c levels at 18 months, regardless of whether they were assigned to blood or urine self-monitoring.

A new perspective on competency management: Implemented through effective human-computer interaction

Making an informed decision on whether an individual is suited to undertake an educational course or industry training programme can be very frustrating. When dealing with young adults at different cognitive skill levels, it is important to be able to identify and distinguish between their knowledge/competency levels, mostly on the basis of the evidence gathered from test-items. The current absence of appropriate measurement tools to determine skill/competency/knowledge levels remains a practical issue. The main aim of this paper is to discuss the management of this important differentiation in cognitive skill performance. One of the dilemmas surrounding this type of competency evaluation is the time it takes to test an individual. Insisting for instance, that a novice undergoes a long and arduous test, including many difficult testing items, results in lowered self-esteem, reduced motivation for learning something new, may induce stress related disorders. Similarly, expecting a more competent individual to undergo numerous simple test-items can generate the same negative result. A Competency Management System (CMS) is presented to initiate effective human-computer interaction (HCI) for cognitive skills assessment. © 2009 Springer-Verlag US.

Self-regulated learning strategies & academic achievement in online higher education learning environments: a systematic review

© 2015 Elsevier Inc. All rights reserved. As enrolments in online courses continue to increase, there is a need to understand how students can best apply self-regulated learning strategies to achieve academic success within the online environment. A search of relevant databases was conducted in December 2014 for studies published from 2004 to Dec 2014 examining SRL strategies as correlates of academic achievement in online higher education settings. From 12 studies, the strategies of time management, metacognition, effort regulation, and critical thinking were positively correlated with academic outcomes, whereas rehearsal, elaboration, and organisation had the least empirical support. Peer learning had a moderate positive effect, however its confidence intervals crossed zero. Although the contributors to achievement in traditional face-to-face settings appear to generalise to on-line context, these effects appear weaker and suggest that (1) they may be less effective, and (2) that other, currently unexplored factors may be more important in on-line contexts.

Hard times and the "fact" and "fancy" of modern labour management

Dickens believed that, played out in practical terms, the pursuit of a totally rationalised society devoid of ‘Fancy’ only served to benefit those in power to the impoverishment of those in their charge. He was appalled by a selfish and self-interested philosophy that combined with laissez-faire capitalism to reduce human effort to mere numbers for the sole purpose of determining its monetary worth. His story thus provides a rebuke to the dehumanising effects of utilitarianism and the way it is used to calculate workers in the manner of machines; reducing them to little more than a resource that is no more or less important any other resource used in industrial enterprise. Their modern-day counterparts live in similar Hard Times in being in the grip of laissez-fair economics of global proportions, which visits upon them similar conceptions of their worth, as evidenced by the current precariousness of their employment and their present exposure to the vicissitudes of arbitrary power exercised by managements still wedded to utilitarian principles. As a result, the ‘light of Fancy’ that at one time would periodically burst through in earnest storms of protest, is now refracted into cynical asides directed at rational systems that continue to standardise and homogenise all that ‘counts’ in working life.