A survey to evaluate the implementation of a national clinical assessment form

Purpose: The Australian Universities Radiation Therapy Student Clinical Assessment Form (AURTSCAF) was designed to assess the clinical skills of radiation therapy (RT) students from the six universities that offer entry level RT programs. Given the AURTSCAF has now been in use for over two years, the Radiation Therapy Program Coordinators (RTPC) group initiated a post implementation evaluation survey. This formed the final phase of the AURTSCAF project and was funded by the Radiation Oncology Division of the Department of Health and Ageing. Methods: A cross-sectional designed survey using purposive sampling was distributed via email to all RT clinical sites. The survey asked questions about the requirements of a pass grade for students at different stages of their program, and the addition of a new category of assessment related to fitness to practise. Response types included both forced choice closed ended responses and open ended responses. There was also a section for open comments about the AURTSCAF. Results: There were 100 responses (55%) from clinicians who had utilised the assessment form over the previous 12 month period. Responses highlighted several positives with regard to the utility and implementation of the form. Comments regarding areas for improvement with the standardisation of the grading of students and consensus for the addition of a new domain in fitness for practise have informed the recommended changes proposed for 2012. Conclusion: This evaluation has provided a representative sample of the views of clinicians involved in assessing students on clinical placement. Recommendations include the addition of the sixth domain of assessment: Fitness for practise, the addition of descriptors and prompts for this domain in the user guide, the addition of a consensus statement about the use of the rating scale and dissemination of the proposed changes nationally.

Teaching planning beyond the national context : pedagogic analyses of international fieldtrip experiences

Urban and regional planners, in the era of globalization, require being equipped with skill sets to better deal with complex and rapidly changing economic, socio-cultural, political and environmental fabrics of cities and their regions. In order to provide such skill sets, urban and regional planning curriculum of Queensland University of Technology (Brisbane, Australia) offers regional planning practice in the international context. This paper reports the findings of the pedagogic analyses from the regional planning practice fieldtrips to Malaysia, Korea, Turkey, Taiwan, and discusses the opportunities and constraints of exposure of students to regional planning practice beyond the national context.

Urban, suburban, and rural variations in separation/divorce rape/sexual assault : results from the National Crime Victimization Survey

To date, no large study has looked at whether separation/divorce sexual assault varies across urban, suburban, and rural areas. The authors use 1992-2009 NCVS (National Crime Victimization Survey) data to estimate the percentage of separation/divorce sexual assault against women in urban, suburban, and rural communities. In addition, the authors identify and compare the relative risk of sexual assault victimization for women across areas. Findings indicate that a higher percentage of rural divorced/separated women were victims of rape/sexual assault than were urban divorced/separated women. In addition, rural separated women are victims of intimate rape/sexual assault at significantly higher rates than their suburban and urban counterparts.

Exeter short stems compared with standard length Exeter stems : experience from the Australian Orthopaedic Association National Joint Replacement Registry

The standard Exeter stem has a length of 150mm with offsets 37.5mm to 56mm. Shorter stems of lengths 95mm, 115mm and 125mm with offsets 35.5mm or less are available for patients with smaller femurs. Concern has been raised regarding the behaviour of the smaller implants. This paper analysed data from the Australian Orthopaedic Association National Joint Replacement Registry comparing survivorship of stems of offset 35.5mm or less with the standard stems of 37.5mm offset or greater. At seven years there was no significant difference in the Cumulative Percent Revision Rate in the short stems (3.4%, 95% CI 2.4-4.8%) compared with the standard length stems (3.5%, 95% CI 3.3-3.8%) despite its use in a greater proportion of potentially more difficult developmental dysplasia of the hip cases.

National Institute for Clinical Studies Report for Phase 1, Evidence Uptake Network : Best Practice Community Care for Clients with Chronic Venous Leg Ulcers

Chronic leg ulcers cause significant pain, cost, decreased quality of life and morbidity for a considerable segment of the older population (Graham et al., 2003a). At any given time the prevalence of patients with open leg ulcers receiving treatment is between 0.11% - 0.18% (Briggs & Closs 2003). Chronic leg ulcers occur in approximately 1 - 2% of the over 60 population in the US, UK, Europe and Australia (Baker & Stacey 1994; Johnson 1995; Lees & Lambert 1992; Margolis et al. 2002). Considerable research has been undertaken to determine the best treatment practices that will aid in the management and the healing of these ulcers, and practical and effective strategies and techniques for healing venous leg ulcers have been trialled to demonstrate their beneficial effects (Nelson et al. 2004; Cullum et al. 2001)...

The WTO, the national security exception and climate change

Article XX has been a valuable instrument to justify exceptions from the anti-discrimination provisions of the GATT 1994. In general, this Article is considered by experts to be the most likely defence for any climate change mitigation measure in breach GATT 1994 obligations. That assumption is not in dispute here; rather, this article considers the requirements of the Article XX exceptions, but also explores the conditions of the National Security exception contained in Article XXI. Although it is possible that this exception could be used for climate change mitigation measures, this paper argues that it is unlikely that the National Security exception could be legitimately applied in these circumstances without member agreement to the contrary.

Health complaint commissions in Australia : time for a national approach to data collection

Health complaint statistics are important for identifying problems and bringing about improvements to health care provided by health service providers and to the wider health care system. This paper overviews complaints handling by the eight Australian state and territory health complaint entities, based on an analysis of data from their annual reports. The analysis shows considerable variation between jurisdictions in the ways complaint data are defined, collected and recorded. Complaints from the public are an important accountability mechanism and open a window on service quality. The lack of a national approach leads to fragmentation of complaint data and a lost opportunity to use national data to assist policy development and identify the main areas causing consumers to complain. We need a national approach to complaints data collection in order to better respond to patients’ concerns.

Forging the heteroglossic citizen : articulating local, national, regional and global horizons in the Australian Curriculum

This article offers a discourse analysis comparing selected articles in the national press over the consultative period for Phase 1 subjects in the new Australian Curriculum, with rationales prefacing official Australian Curriculum Assessment and Reporting Authority documents. It traces how various versions of Australia, its ‘nation-ness’ and its future citizens have been taken up in the final product. The analysis uses Lemke's analytic elaboration of Bakhtin's concept of heteroglossia and its derivative, intertextuality. It identifies a range of intertextual thematic formations around ‘nation’, ‘history’, ‘citizen’ and ‘curriculum’ circulating in the public debates, then traces their presence in official curriculum documents. Rather than concluding that these themes are contradictory and incoherent, the conclusion asks how these multiple dialogic facets of Australian nation-ness potentially offer a better response to complex times than any coherent monologic orthodoxy might.

Does food insecurity contribute to socioeconomic inequalities in BMI?

Introduction: Food insecurity is a social determinant of health and is defined as limited ability to access sufficient amounts of nutritionally adequate or safe food for a healthy and active life. Food insecurity is associated with poor health status and the exacerbation of other health inequalities. This study examined whether an association existed between 1) socioeconomic position (SEP) and food insecurity and 2) food insecurity and weight status. Methods: Data from the 1995 National Nutrition Survey was analysed. A random sample of households (n = 13 858) were asked about dietary habits and food choices. Information about gender, age, BMI, waist circumference, household income and whether the household had run out of money to purchase food in the previous 12 months was obtained and analysed using chi-square and logistic regression. Results: Income was significantly associated with food insecurity; households with lower income were at higher risk of food insecurity. Lower income males were nine times more likely to experience food insecurity and lower income females were three times more likely to experience food insecurity than their higher income counterparts. Food insecurity was significantly associated with body mass index (BMI) among women but not men. Women experiencing food insecurity were at higher risk of overweight/obesity according to BMI and waist circumference measures. Conclusion: Evidence suggests that low income households are at higher risk of food insecurity and women who are food insecure are at higher risk of being overweight or obese. Food insecurity may mediate the association between SEP and BMI.

Smoking status as a moderator of the association between food insecurity and decreased fruit and vegetable consumption

Food insecurity is the inadequate access to, or availability of, sufficient amounts of nutritious, culturally-appropriate and safe foods, or the inability to acquire such foods by socially acceptable means. Food insecurity has been shown to be associated with poor dietary intakes and poor health status. Recently, evidence has emerged suggesting increased rates of food insecurity among those with substance abuse problems, including those who smoke. This cross-sectional study investigates the potential moderating effect of smoking on the association between food insecurity and fruit and vegetable intakes among the Australian population, using regression analyses. Participants were adults 18 years and older participating in the 2004/05 National Health Survey (n = 19,500). Those from food insecure households were up to two-times more likely to report inadequate fruit and vegetable intakes compared to those who were food secure. Those who smoked were nearly six times more likely to report being food insecure, and up to three-times more likely to report inadequate fruit and vegetable intakes, compared to their non-smoking counterparts. Further analyses revealed a marked decline in the strength of the association between food insecurity and fruit consumption with the addition of smoking status into a regression model. These findings have important implications for the development of policy and interventions to address food insecurity, suggesting that those from food insecure households are less likely to comply with national dietary recommendations, and that this may in part be moderated by smoking status.

Associations exist between food insecurity, poor diet, chronic illness and obesity among an Australian population

Food insecurity is the limited availability of, or access to, sufficient amounts of nutritious, culturally-appropriate and safe foods, or the inability to access such foods by socially-acceptable means. Evidence from the United States and Canada suggests that food insecurity may be associated with poor dietary intakes, obesity, and chronic disease including depression and diabetes, thus constituting a significant public health issue. Currently, no existing studies have investigated the dietary and health factors associated with food insecurity among the general Australian population. The current study investigated the potential associations between food insecurity, diet and health among Australian adults (18 years and over) participating in the cross-sectional National Health Survey (n = 19,500). Data were analysed by logistic regression adjusting for sociodemographic covariates. Those from food insecure households were 50% less likely to consume the recommended number of servings of fruit, 60% more likely to report poor health and experienced a 6-fold increase in the risk of severe depressive disorders, compared to their food secure counterparts. Furthermore, food insecurity was associated with a 50% increase in the risk of being diagnosed with ‘high sugar levels’. Finally, women from food insecure households were 30% more likely to be obese compared to their food secure counterparts. These findings suggest that food insecurity may play an important role in preventing adherence with national dietary recommendations, and may increase the risk of obesity and chronic illness. This has important implications for both clinical practice, and the development of interventions and policy to address food insecurity.

Assessing food insecurity : current underestimations in Australia, alternative measures and reflections on their use

Food insecurity is the limited access to, or availability of, nutritious, culturally-appropriate and safe foods, or the inability to access these foods by socially acceptable means. In Australia, the monitoring of food insecurity is limited to the use of a single item, included in the three-yearly National Health Survey (NHS). The current research comprised a) a review of the literature and available tools to measure food security, b) piloting and adaptation of the more comprehensive 16-item United States Department of Agriculture (USDA) Food Security Survey Module (FSSM), and c) a cross-sectional study comparing this more comprehensive tool, and it’s 10- and 6- item short forms, with the current single-item used in the NHS, among a sample of households in disadvantaged urban-areas of Brisbane, Australia. Findings have shown that internationally the 16-item USDA-FSSM is the most widely used tool for the measurement of food insecurity. Furthermore, of the validated tools that exist to measure food insecurity, sensitivity and reliability decline as the number of questions in a tool decreases. Among an Australian sample, the current single-measure utilised in the NHS yielded a significantly lower prevalence for food insecurity compared to the 16-item USDA-FSSM and it’s two shorter forms respectively (four and two percentage points lower respectively). These findings suggest that the current prevalence of food insecurity (estimated at 6% in the most recent NHS) may have been underestimated, and have important implications for the development of an effective means of monitoring food security within the context of a developed country.

Current measure of food insecurity used in the National Health Survey may be underestimating its prevalence

Objective: Food insecurity may be associated with a number of adverse health and social outcomes however our knowledge of its public health significance in Australia has been limited by use of a single-item measure in the Australian National Health Surveys (NHS) and, more recently, the exclusion of food security items from these surveys. The current study compares prevalence estimates of food insecurity in disadvantaged urban areas of Brisbane using the one-item NHS measure with three adaptations of the United States Department of Agriculture Food Security Survey Module (USDA-FSSM). Design: Data were collected by postal survey (n= 505, 53% response). Food security status was ascertained by the measure used in the NHS, and the 6-, 10- and 18-item versions of the USDA-FSSM. Demographic characteristics of the sample, prevalence estimates of food insecurity and different levels of food insecurity estimated by each tool were determined. Setting: Disadvantaged suburbs of Brisbane city, Australia, 2009. Subjects: Individuals aged ≥ 18 years. Results: Food insecurity was prevalent in socioeconomically-disadvantaged urban areas, estimated as 19.5% using the single-item NHS measure. This was significantly less than the 24.6% (P <0.01), 22.0% (P = 0.01) and 21.3% (P = 0.03) identified using the 18-item, 10-item and 6-item versions of the USDA-FSSM, respectively. The proportion of the sample reporting more severe levels of food insecurity were 10.7%, 10% and 8.6% for the 18-, 10- and 6-item USDA measures respectively, however this degree of food insecurity could not be ascertained using the NHS measure. Conclusions: The measure of food insecurity employed in the NHS may underestimate its prevalence and public health significance. Future monitoring and surveillance efforts should seek to employ a more accurate measure.

Educational accountability tests, social and legal inclusion approaches to discrimination for students with disability : a national case study from Australia

The UN Convention on the Rights of Persons with Disability (CRPD) promotes equal and full participation by children in education. Equity of educational access for all students, including students with disability, free from discrimination, is the first stated national goal of Australian education (MCEETYA 2008). Australian federal disability discrimination law, the Disability Discrimination Act 1992 (DDA), follows the Convention, with the federal Disability Standards for Education 2005 (DSE) enacting specific requirements for education. This article discusses equity of processes for inclusion of students with disability in Australian educational accountability testing, including international tests in which many countries participate. The conclusion drawn is that equitable inclusion of students with disability in current Australian educational accountability testing in not occurring from a social perspective and is not in principle compliant with law. However, given the reluctance of courts to intervene in education matters and the uncertainty of an outcome in any court consideration, the discussion shows that equitable inclusion in accountability systems is available through policy change rather than expensive, and possibly unsuccessful, legal challenges.