Early users of fertility treatment with hormones and IVF : women who live in major cities and have private health insurance

Objective: To identify early users (women aged <34 years) of fertility treatment with hormones and in vitro fertilisation (IVF). Methods: A cross-sectional survey of infertile women from fertility clinics (n=59) and from the community (Australian Longitudinal Study on Women's Health participants) who had (n=121) or had not (n=110) used hormones/IVF as treatment for infertility. Associations between socio-demographic, reproductive and lifestyle factors, medical conditions and recurrent symptoms and using treatment (or not) were analysed using multivariable logistic regression. Results: Among infertile women who had used treatment (community vs clinic), women from clinics had lower odds of living outside major cities, using hormones only, i.e., not IVF, or recurrent headaches/migraines, severe tiredness, or stiff/painful joints; and higher odds of recent diagnoses of urinary tract infection or anxiety disorder. Compared to infertile women who had not used treatment, women from clinics had lower odds of living outside major cities, recurrent allergies or severe tiredness; and higher odds of having private health insurance for hospital or ancillary services, recent diagnosis of polycystic ovary syndrome or recurrent constipation. Conclusions: Compared to infertile women in the community, living in major cities and having private health insurance are associated with early use of treatment for infertility at specialist clinics by women aged <34 years. Implications: These results provided evidence of inequity of services for infertile women.

Sustainable water provision : challenges, alternative strategies and sources in the ERA of climate change

As a result of rapid urbanisation, population growth, changes in lifestyle, pollution and the impacts of climate change, water provision has become a critical challenge for planners and policy-makers. In the wake of increasingly difficult water provision and drought, the notion that freshwater is a finite and vulnerable resource is increasingly being realised. Many city administrations around the world are struggling to provide water security for their residents to maintain lifestyle and economic growth. This chapter reviews the global challenge of providing freshwater to sustain lifestyles and economic growth, and the contributing challenges of climate change, urbanisation, population growth and problems in rainfall distribution. The chapter proceeds to evaluate major alternatives to current water sources such as conservation, recycling and reclamation, and desalination. Integrated water resource management is briefly looked at to explore its role in complementing water provision. A comparative study on alternative resources is undertaken to evaluate their strengths, weaknesses, opportunities and constraints, and the results are discussed.

The interaction between exercise, appetite and food intake : implications for weight control

Exercise could indirectly affect body weight by exerting changes on various components of appetite control, including nutrient and taste preferences, meal size and frequency, and the drive to eat. This review summarizes the evidence on how exercise affects appetite and eating behavior and in particular answers the question, “Does exercise induce an increase in food intake to compensate for the increase in energy expenditure?” Evidence will be presented to demonstrate that there is no automatic increase in food intake in response to acute exercise and that the response to repeated exercise is variable. The review will also identify areas of further study required to explain the variability. One limitation with studies that assess the efficacy of exercise as a method of weight control is that only mean data are presented—the individual variability tends to be overlooked. Recent evidence highlights the importance of characterizing the individual variability by demonstrating exercise-induced changes in appetite. Individuals who experience lower than theoretically predicted reductions in body weight can be characterized by hedonic (eg, pleasure) and homeostatic (eg, hunger) features.

Prevalence and trends of the diabetes epidemic in South Asia : a systematic review and meta-analysis

Background Diabetes mellitus has reached epidemic proportions worldwide. South Asians are known to have an increased predisposition for diabetes which has become an important health concern in the region. We discuss the prevalence of pre-diabetes and diabetes in South Asia and explore the differential risk factors reported. Methods Prevalence data were obtained by searching the Medline® database with; ‘prediabetes’ and ‘diabetes mellitus’ (MeSH major topic) and ‘Epidemology/EP’ (MeSH subheading). Search limits were articles in English, between 01/01/1980–31/12/2011, on human adults (≥19 years). The conjunction of the above results was narrowed down with country names. Results The most recent reported prevalence of pre-diabetes:diabetes in regional countries were; Bangladesh–4.7%:8.5% (2004–2005;Rural), India–4.6%:12.5% (2007;Rural); Maldives–3.0%:3.7% (2004;National), Nepal–19.5%:9.5% (2007;Urban), Pakistan–3.0%:7.2% (2002;Rural), Sri Lanka–11.5%:10.3% (2005–2006;National). Urban populations demonstrated a higher prevalence of diabetes. An increasing trend in prevalence of diabetes was observed in urban/rural India and rural Sri Lanka. The diabetes epidemicity index decreased with the increasing prevalence of diabetes in respective countries. A high epidemicity index was seen in Sri Lanka (2005/2006–52.8%), while for other countries, the epidemicity index was comparatively low (rural India 2007–26.9%; urban India 2002/2005–31.3%, and urban Bangladesh–33.1%). Family history, urban residency, age, higher BMI, sedentary lifestyle, hypertension and waist-hip ratio were associated with an increased risks of diabetes. Conclusion A significant epidemic of diabetes is present in the South Asian region with a rapid increase in prevalence over the last two decades. Hence there is a need for urgent preventive and curative strategies .

Do people gamble with their lives : The relationship between risky driving behaviour and other risky behaviours

General risky behaviour is explored for correlation with risky driving behaviour in light of two theories, self-control and cross-situational consistency. Identification of general risky behaviours associated with risky driving behaviour, and the theory that best predicts the behaviours, will enable better targeting of intervention and education strategies to reduce driving related fatalities and injuries. A correlational study using participants (N=152) drawn from first year university undergraduates and the public surveyed their lifestyle and behaviours. Relationships were found between risky driving behaviours and other risky behaviours such as alcohol consumption, cannabis use and performing unlawful activities. No significant differences were found between genders, with the exception that males were more likely to believe that they were at risk of injury from their employment, χ2 (1, N = 152) = 4.49, p = .03, were more likely to have performed an unlawful offence, χ2 (1, N = 152) = 11.77, p = .001 and were more likely to drink drive, t (55.41) = -3.87, p < .001, mean difference = -0.63, CI 95% (-0.9, -0.37). People engaged in risky driving behaviours were more likely to engage in other risky behaviours. The theories that were explored were unable to accurately predict an association between general risky behaviour and driving without a license or when disqualified. Cross-situational consistency explained 20% (R2adj = .16) of the variance in which people engaged in risky driving with low self-control theory explaining an additional 0.3% variance (R2change = .003), F (8,143) = 6.92, p < .001. Driving while under the influence of alcohol could be predicted by risky behaviours in lifestyle, health, smoking, cannabis use and alcohol consumption, F (8,143) = 6.92, p < .001. The addition of self-control was not significant.

Mental health and well-being in resident mine workers : out of the fly-in fly-out box

Objective: To explore psychosocial issues perceived to impact the mental health and well-being of resident (non-fly-in fly-out) mine workers at a local mine in regional Queensland. Design: A descriptive qualitative study using semistructured interviews. Setting: The research was conducted on-site at an opencut coal mine in regional Queensland. Participants: Ten miners (nine men) currently employed in workshop, production or supervisory roles. Main outcome measures: Self-reported issues affecting psychological well-being. Results: Participants’ occupation and the surrounding context appeared to have both positive and negative influences on their well-being. Overall findings could be grouped into four key themes: (i) the importance of relationships; (ii) the impact of lifestyle; (iii) work characteristics; and (iv) mental health attitudes. While not without strains on mental health, in general, participants reported that their current situation was superior to their previous mining jobs. This was attributed to close relationships among locally recruited workers, respect for management practices and rosters that allowed adequate sleep recovery and family time between shifts. Conclusions: This study is the first to examine mental health and well being in non-fly-in fly-out mining populations. It suggests that while some issues appear inherent in the mining occupation, personal and organisational support can help workers have a more positive workplace experience. Further work looking at more extensive comparisons over various mining contexts will greatly assist in the development of programs and support structures for rural and regional mine workers.

Experience of overseas-trained health professionals in rural and remote areas of destination countries: A literature review

This study aimed to review and synthesise existing literature that investigated the experience of overseastrained health professionals (OTHPs) in rural and remote areas of destination countries. A systematic literature review was conducted using electronic databases and manual search of studies published from January 2004 to February 2011. Data were analysed from the final 17 original report articles that met the inclusion criteria. The reviewed research studies were conducted in Australia, Canada, New Zealand, the UK and the USA. Overseas-trained medical practitioners were the most frequently researched (n = 14); two studies involved nurses and one study included several health professionals. Three main themes emerged from the review and these were: (i) expectations; (ii) cultural diversity; and (iii) orientation and integration to rural and remote health work environment. The OTHPs were expected to possess the appropriate professional and cultural skills while they themselves expected recognition of their previous experiences and adequate organisational orientation and support. A welcoming and accepting community coupled with a relaxed rural lifestyle and the joy of continued patient care resulted in successful integration and contributed to increased staff retention rates. Recognition of expectations and cultural diversity by all parties and comprehensive orientation with sufficient organisational support are important elements in the integration of OTHPs and subsequent delivery of quality health care to people living in rural and remote areas.

Postpartum diet quality in Australian women following a gestational diabetes pregnancy

BACKGROUND/OBJECTIVES: To describe the diet quality of a national sample of Australian women with a recent history of gestational diabetes mellitus (GDM) and determine factors associated with adherence to national dietary recommendations. SUBJECTS/METHODS: A postpartum lifestyle survey with 1499 Australian women diagnosed with GDM p3 years previously. Diet quality was measured using the Australian recommended food score (ARFS) and weighted by demographic and diabetes management characteristics. Multinominal logistic regression analysis was used to determine the association between diet quality and demographic characteristics, health seeking behaviours and diabetes-related risk factors. RESULTS: Mean (±s.d.) ARFS was 30.9±8.1 from a possible maximum score of 74. Subscale component scores demonstrated that the nuts/legumes, grains and fruits were the most poorly scored. Factors associated with being in the highest compared with the lowest ARFS quintile included age (odds ratio (OR) 5-year increase=1.40; 95% (confidence interval) CI:1.16–1.68), tertiary education (OR=2.19; 95% CI:1.52–3.17), speaking only English (OR=1.92; 95% CI:1.19–3.08), being sufficiently physically active (OR=2.11; 95% CI:1.46–3.05), returning for postpartum blood glucose testing (OR=1.75; 95% CI:1.23–2.50) and receiving riskreduction advice from a health professional (OR=1.80; 95% CI:1.24–2.60). CONCLUSIONS: Despite an increased risk of type 2 diabetes, women in this study had an overall poor diet quality as measured by the ARFS. Women with GDM should be targeted for interventions aimed at achieving a postpartum diet consistent with the guidelines for chronic disease prevention. Encouraging women to return for follow-up and providing risk reduction advice may be positive initial steps to improve diet quality, but additional strategies need to be identified.

Realizing 'four comforts' in the urban fringe : the case of White Horse Lake Eco-creative City Project, Hangzhou, China

This article examines a cultural and creative industries park project – the White Horse Lake Ecocreative City on land outside the urban centre of Hangzhou, China, which uses an imaginary rural lifestyle as its key attraction. By analysing government policies and development plans, and through interviews with initiators, managers and creative practitioners, the article first assesses the geographical position, that is, the impact of locality with regard to both hard and soft infrastructure of the project; it then examines the synergies and tensions embedded in the strategic goals, that is, to build the right city for ‘four comforts’ (siyi, 四宜) – for residence, for business, for travel and for culture. The article concludes that Chinese-style cultural conversion remains locked in a top-down ideological framework, one that rural residents and the new ‘creative class’ are expected to respect.

Integrating ICT into the planning process : impacts, opportunities and challenges

Mobile telecommunications have become a key lifestyle and technological trend of the twenty first century. In the context of increased urbanism and pressure on cites for citizen engagement for the purpose of creating good public places the potential of these technologies raises critical questions for planning professionals. Even though technology has become integral to all functions within our urban environment, little is known about perceptions and relationship between urban planners and the ubiquitous, ever-present digital layer of urban data and information. This paper explores this issue, via three focus groups and an additional follow-up interview with planners from local and state government, education and private sector. This paper explores the issues of integrating information and communication technologies into planning practice and the affordances that these technologies offer for community consultation and placemaking.

Assessment bias : physical activity questionnaire assessment inadvertently influences patients’ desire to be ‘more physically active’

Evaluating physical activity is important for public health population research and evaluating lifestyle interventions among targeted groups. Self-reported questionnaires are frequently used to evaluate physical activity in a variety of contexts where resource or pragmatic limitations prohibit the use of more sophisticated approaches. However, prior research in the use of other patient reported outcomes in healthcare settings has highlighted that simply completing a questionnaire may change a patients’ behaviour or responses to subsequent questions. This methodology study aimed to examine whether completing a standard physical activity questionnaire altered patients responses to two related questions a) whether they are ‘sufficiently physically active’ and b) whether they desire ‘to be more physically active.’

Enhancing public transport passenger experience via mobile-mediated applications and services

Despite the rapidly urbanising population, public transport usage in metropolitan areas is not growing at a level that corresponds to the trend. Many people are reluctant to travel using public transport, as it is commonly associated with unpleasant experiences such as limited services, long wait time, and crowded spaces. This study aims to explore the use of mobile spatial interactions and services, and investigate their potential to increase the enjoyment of our everyday commuting experience. The main goal is to develop and evaluate mobile-mediated design interventions to foster interactions for and among passengers, as well as between passengers and public transport infrastructures, with the aim to positively influence the experience of commuting. Ultimately, this study hopes to generate findings and knowledge towards creating a more enjoyable public transport experience, as well as to explore innovative uses of mobile technologies and context-aware services for the urban lifestyle.

Physical activity amongst people with chronic back pain : an investigation of perceived barriers and facilitators to inform intervention development

Previous research has indicated people with non-specific low back pain who are physically inactive face a poorer prognosis than people with back pain who participate in low or moderate intensity physical activity. They also face a greater risk of other lifestyle related health conditions, such as diabetes and heart disease. For these reasons, contemporary non-surgical interventions for low back pain aim to incorporate a return to physical activity. However, there is a lack of empirical evidence supporting physical activity interventions for this purpose. It is likely that people with low back pain face additional challenges when trying to commence (or return to) regular physical activity. This exploratory qualitative research aimed to map out perceived barriers and facilitators to undertaking physical activity among people with non-specific low back pain to inform future intervention development.

Outcomes following inpatient rehabilitation of lower limb amputees

Introduction: Lower-limb amputations are a serious adverse consequence of lifestyle related chronic conditions and a serious concern among the aging population in Australia. Lower limb amputations have severe personal, social and economic impacts on the individual, healthcare system and broader community. This study aimed to address a critical gap in the research literature by investigating the physical functioning and social characteristics of lower limb amputees at discharge from tertiary hospital inpatient rehabilitation. Method: A cohort study was implemented among patients with lower limb amputations admitted to a Geriatric Assessment and Rehabilitation Unit for rehabilitation at a tertiary hospital. Conventional descriptive statistics were used to examine patient demographic, physical functioning and social living outcomes recorded for patients admitted between 2005 and 2011. Results: A total of 423 admissions occurred during the study period, 313 (74%) were male. This sample included admissions for left (n = 189, 45%), right (n = 220, 52%) and bilateral (n = 14, 3%) lower limb amputations, with 15 (3%) patients dying whilst an inpatient. The mean (standard deviation) age was 65 (13.9) years. Amputations attributed to vascular causes accounted for 333 (78%) admissions; 65 (15%) of these had previously had an amputation. The mean (SD) length of stay in the rehabilitation unit was 56 (42) days. Prior to this admission, 123 (29%) patients were living alone, 289 (68%) were living with another and 3 (0.7%) were living in residential care. Following this amputation related admission, 89 (21%) patients did not return to their prior living situation. Of those admitted, 187 (44%) patients were discharged with a lower limb prosthesis. Conclusion: The clinical group is predominately older adults. The ratio of males to females was approximately 3:1. Over half did not return to walking and many were not able to return to their prior accommodation. However, few patients died during their admission.