Helping understand nutritional gaps in the elderly (HUNGER) : a prospective study of patient factors associated with inadequate nutritional intake in older medical inpatients

BACKGROUND: Malnutrition, and poor intake during hospitalisation, are common in older medical patients. Better understanding of patient-specific factors associated with poor intake may inform nutritional interventions. AIMS: To measure the proportion of older medical patients with inadequate nutritional intake, and identify patient-related factors associated with this outcome. METHODS: Prospective cohort study enrolling consecutive consenting medical inpatients aged 65 years or older. Primary outcome was energy intake less than resting energy expenditure estimated using weight-based equations. Energy intake was calculated for a single day using direct observation of plate waste. Explanatory variables included age, gender, number of co-morbidities, number of medications, diagnosis, usual residence, nutritional status, functional and cognitive impairment, depressive symptoms, poor appetite, poor dentition, and dysphagia. RESULTS: Of 134 participants (mean age 80 years, 51% female), only 41% met estimated resting energy requirements. Mean energy intake was 1220 kcal/day (SD 440), or 18.1 kcal/kg/day. Factors associated with inadequate energy intake in multivariate analysis were poor appetite, higher BMI, diagnosis of infection or cancer, delirium and need for assistance with feeding. CONCLUSIONS: Inadequate nutritional intake is common, and patient factors contributing to poor intake need to be considered in nutritional interventions.

Front page schools, back page schools : a case study of factors perceived to affect academic performance in five Papua New Guinea secondary schools

Papua New Guinea has reformed its colonial established education system and made huge investments with the help of donors to achieve equal access and quality education for all its citizens. Despite this national aspiration and these policy reforms and investments, secondary schools that enrol grade 9 students who are relatively equal in education ability show huge disparities in their grade 10 academic performances. This study examined perceptions of students, teachers and principals regarding factors affecting the disparity in academic performance in the context of a developing country. The central question for the study is: What are the perceptions of students and teachers of the factors that affect disparities in secondary schools' academic performance? This qualitative case study involved two high and three low academic performing secondary schools in Western Highlands Province of Papua New Guinea. Primary data were collected through focus groups and semi-structured interviews involving 112 participants. Students and teachers are key participants in this study, as it intends to find out the realities of schools, yet they are an under-researched group. A postcolonial and sense of community conceptual framework was developed for the analysis of the participants. perceptions. In addition, scholarship on school effectiveness and equity in education informed the interpretation of the findings. Three themes were evident in participants. views. First, participants expressed their view that differences in academic performance were related to the adequacy and equitability of resources. The inequities in resource inputs led some of them to coin the metaphor of .back page and front page. schools. Second, many expressed the view that deficiencies in implementing bilingual education, given the difficulty of catering for 800 vernacular languages, contribute to poor English proficiency and subsequent poor academic performance. Finally, participants believed that, in order to have a positive school culture, it is necessary for educators to recognise and respect contemporary students. identities, communal/tribal membership and needs. This study has implications for national education policy on resource allocation to address equality and equity, bilingual education and teacher education. Moreover, as the study found that high academic performance in this context is also influenced by intra-school social relationships, these relationships need to be nurtured. When appropriately nurtured, they become an important factor in sustaining quality education for all secondary school students. This thesis has laid the foundations for further research and invites further investigations into policy and implementation of school reforms aimed at improving academic achievement.

Critical Factors of Promoting Market Demand of Sustainable Housing in Australia

Strong regulatory pressure on environmental issues and the improved public awareness will continue to influence the market demand for sustainable housing in the coming years. Despite this potential, the voluntary up-take rate of sustainable practices is not as high as expected within the new built housing industry. This is in contrast to the influx of emerging building technologies, new materials and innovative designs as seen in office buildings and exemplar homes built worldwide. One possible reason for this is that key stakeholders such as developers, builders and consumers do not fully understand and appreciate the tangible and mutual benefits of sustainability in their professional and business activities. This situation warrants the study of a multifaceted strategy that integrates the needs of multiple stakeholders. This research investigates multiple factors that affect key stakeholder’s benefits in sustainable housing implementation. Drawing insights from a quantitative study on a questionnaire survey and a qualitative study of in-depth interviews with key stakeholders in the Australian housing industry, 11 critical factors of driving market demand for sustainable housing were unearthed. Their inter-relationships were identified with the aid of Interpretive Structural Modelling. The study concludes with a hierarchical model that amalgamates the strategies for the decision making of key stakeholders.

Quantity of documentation of maltreatment risk factors in injury-related paediatric hospitalisations

Background While child maltreatment is recognised as a global problem, solid epidemiological data on the prevalence of child maltreatment and risk factors associated with child maltreatment is lacking in Australia and internationally. There have been recent calls for action to improve the evidence-base capturing and describing child abuse, particularly those data captured within the health sector. This paper describes the quantity of documentation of maltreatment risk factors in injury-related paediatric hospitalisations in Queensland, Australia. Methods This study involved a retrospective medical record review, text extraction and coding methodology to assess the quantity of documentation of risk factors and the subsequent utility of data in hospital records for describing child maltreatment and data linkage to Child Protection Service (CPS). Results There were 433 children in the maltreatment group and 462 in the unintentional injury group for whom medical records could be reviewed. Almost 93% of the any maltreatment code sample, but only 11% of the unintentional injury sample had documentation identified indicating the presence of any of 20 risk factors. In the maltreatment group the most commonly documented risk factor was history of abuse (41%). In those with an unintentional injury, the most commonly documented risk factor was alcohol abuse of the child or family (3%). More than 93% of the maltreatment sample also linked to a child protection record. Of concern are the 16% of those children who linked to child protection who did not have documented risk factors in the medical record. Conclusion Given the importance of the medical record as a source of information about children presenting to hospital for treatment and as a potential source of evidence for legal action the lack of documentation is of concern. The details surrounding the injury admission and consideration of any maltreatment related risk factors, both identifying their presence and ruling them out are required for each and every case. This highlights the need for additional training for clinicians to understand the importance of their documentation in child injury cases.

Critical sustainability factors in industrialised building systems

Purpose – This paper presents findings of a research study aimed at identifying critical sustainability factors for improved implementation of Industrialised Building Systems (IBS). It also highlights the importance of decision support, through the establishment of decision making guidelines, for sustainability deliverables in IBS development. Design/methodology/approach – A broad range of sustainability factors, as perceived by researchers and practitioners, are identified through a comprehensive literature study. A study of the survey and statistical data analysis is conducted to examine the criticality of these sustainability factors in IBS implementation. Findings – 18 sustainability factors are identified as critical to IBS implementation. Their interrelationships and driving forces are explored, which leads to the development of a conceptual model to map these factors for actions or potential solutions. The work provides a sound basis towards a set of decision making guidelines for sustainable IBS implementation. Originality/value – Compared with previous studies that focus on technical or economical aspects, this study extends existing knowledge on construction prefabrication by linking all aspects of sustainability issues with the design process. It also covers industry characteristics of developing countries, as represented by Malaysia’s scenarios.

Factors facilitating or constraining the fieldwork practicum experience for culturally and linguistically diverse student teachers in Queensland schools

Increasing numbers of Culturally And Linguistically Diverse (CALD) students, both from the international and domestic sectors are undertaking teacher education programs at Australian universities. While many have positive practicum experiences, there are a significant number who experience difficulties. Little work has been done on viewing this situation from a sociocultural perspective where learning is seen as a form of socialisation into the different beliefs, values and practices of the new community, the placement school. This study argues that all student teachers, particularly pre-service CALD teachers, require active learning communities to become successful. Using perspectives derived from situated learning (Lave & Wenger, 1991) and community of practice theory (Wenger, 1998) this study illustrates the processes of learning and identity development and the factors that facilitate or constrain the practicum experience for CALD pre-service teachers. This study adopts a methodology that is grounded in narrative inquiry, with in-depth interview techniques used to explore CALD teachers’ experiences of their fieldwork practicum and their attempts to participate and practice successfully. The data derived from fourteen in-depth narratives of pre-service CALD teachers is analysed from a sociocultural perspective. The practicum for these students is an experience of legitimate peripheral participation in a community of practice (the practicum school), and the complex nature of the social experience as they engaged in building their professional identity as a teacher is discussed. This analysis is used to propose recommendations and strategies at the faculty and school levels to support positive learning and practicum experiences for this group of student teachers.

Reinvigorating the domestic violence sector : systemically addressing conflict, power and practitioner turnover

The purpose of this exploratory Australian study was to consider methods of retaining skilled and experienced staff within the domestic violence sector. The antecedents that might influence turnover of practitioners were investigated and analysed. Antecedents broadly included the work-related factors, organisational factors and professional factors. The changing nature of the domestic violence sector was also examined, in particular, feminist identity and feminist practice frameworks. It became evident, however, that the primary reasons for the turnover of study participants can be described as parallel power processes. The concept of parallel power processes as developed through this research aims to capture how workplace behaviours can strongly mirror, or parallel, behaviours used by domestic violence perpetrators. As such, it appears that some domestic violence practitioners are experiencing their own abusive relationship, not within the confines of their home, but within their workplace. Additionally, parallel power processes are compounded by ineffective conflict management processes within the workplace. These concepts directly contribute to practitioners leaving their workplace and, sometimes, the sector. This qualitative study utilised a feminist research epistemology and focused strongly on practitioners' stories. Interviews were undertaken with fifteen domestic violence practitioners from three services within South-East Queensland, Australia. Two sets of semi-structured interviews provided in-depth information based on practitioners‘ experiences of working within this specialised sector. Analysis was conducted using a thematic analytical frame, drawing attention to the key themes as mentioned above. From these findings, it is suggested that in order to retain practitioners, domestic violence services must identify and address parallel power processes through effective conflict management processes. In an operational sense, it is recommended that education and training be undertaken within all staffing levels, in particular management committees. Lastly, it is recommended that the sector itself places greater attention on the re-invigoration of the feminist principles and philosophy that has traditionally guided the sector.

Spatial inequalities in colorectal and breast cancer survival : premature deaths and associated factors

This study examines the influence of cancer stage, distance to treatment facilities and area disadvantage on breast and colorectal cancer spatial survival inequalities. We also estimate the number of premature deaths after adjusting for cancer stage to quantify the impact of spatial survival inequalities. Population-based descriptive study of residents aged <90 years in Queensland, Australia diagnosed with primary invasive breast (25,202 females) or colorectal (14,690 males, 11,700 females) cancers during 1996-2007. Bayesian hierarchical models explored relative survival inequalities across 478 regions. Cancer stage and disadvantage explained the spatial inequalities in breast cancer survival, however spatial inequalities in colorectal cancer survival persisted after adjustment. Of the 6,019 colorectal cancer deaths within 5 years of diagnosis, 470 (8%) were associated with spatial inequalities in non-diagnostic factors, i.e. factors beyond cancer stage at diagnosis. For breast cancers, of 2,412 deaths, 170 (7%) were related to spatial inequalities in non-diagnostic factors. Quantifying premature deaths can increase incentive for action to reduce these spatial inequalities.

Educational stress among Chinese adolescents : measurement, risk factors and associations with mental health

Academic pressure among adolescents is a major risk factor for poor mental health and suicide and other harmful behaviours. While this is a worldwide phenomenon, it appears to be especially pronounced in China and other East Asian countries. Despite a growing body of research into adolescent mental health in recent years, the multiple constructs within the ‘educational stress’ phenomenon have not been clearly articulated in Chinese contexts. Further, the individual, family, school and peer influencing factors for educational stress and its associations with adolescent mental health are not well understood. An in-depth investigation may provide important information for the ongoing educational reform in Mainland China with a special focus on students’ mental health and wellbeing. The primary goal of this study was to examine the relative contribution of educational stress to poor mental health, in comparison to other well-known individual, family, school and peer factors. Another important task was to identify significant risk factors for educational stress. In addition, due to the lack of a culturally suitable instrument for educational stress in this population, a new tool – the Educational Stress Scale for Adolescents (ESSA) was initially developed in this study and tested for reliability and validity. A self-administered questionnaire was used to collect information from convenient samples of secondary school students in Shandong, China. The pilot survey was conducted with 347 students (grades 8 and 11) to test the psychometric properties of the ESSA and other scales or questions in the questionnaire. Based on factor analysis and reliability and validity testing, the 16-item scale (the ESSA) with five factors showed adequate to good internal consistency, 2-week test-retest reliability, and satisfactory concurrent and predictive validity. Its factor structure was further demonstrated in the main survey with a confirmatory factor analysis illustrating a good fit of the proposed model based on a confirmatory factor analysis. The reliabilities of other scales and questions were also adequate to be used in this study. The main survey was subsequently conducted with a sample of 1627 secondary school (grades 7-12) students to examine the influencing factors of educational stress and its associations with mental health outcomes, including depression, happiness and suicidal behaviours. A wide range of individual, family, school and peer factors were found to have a significant association with the total ESSA and subscale scores. Most of the strong factors for academic stress were school or study-related, including rural school location, low school connectedness, perceived poor academic grades and frequent emotional conflicts with teachers and peers. Unexpectedly, family and parental factors, such as parental bonding, family connectedness and conflicts with parents were found to have little or no association with educational stress. Educational stress was the most predictive variable for depression, but was not strongly associated with happiness. It had a strong association with suicide ideation but not with suicide attempts. Among five subscales of the ESSA, ‘Study despondency’ score had the strongest associations with these mental health measures. Surprising, two subscales, ‘Self-expectation’ and ‘Worry about grades’ showed a protective effect on suicidal behaviours. An additional analysis revealed that although academic pressure was the most commonly reported reason for suicidal thinking, the occurrence of problems in peer relationships such as peer teasing and bullying, and romantic problems had a much stronger relationship with actual attempts. This study provides some insights into the nature and health implications of educational stress among Chinese adolescents. Findings in this study suggest that interventions on educational stress should focus on school environment and academic factors. Intervention programs focused on educational stress may have a high impact on the prevalence of common mental disorders such as depression. Efforts to increase perceived happiness however should cover a wider range of individual, family and school factors. The importance of healthy peer relationships should be adequately emphasised in suicide prevention. In addition, the newly developed scale (the ESSA) demonstrates sound psychometric properties and is expected to be used in future research into academic-related stress among secondary school adolescents.

Seasonal variation in cardiovascular disease risk factors in a subarctic population : the Tromso Study 1979-2008

Background Seasonal changes in cardiovascular disease (CVD) risk factors may be due to exposure to seasonal environmental variables like temperature and acute infections or seasonal behavioural patterns in physical activity and diet. Investigating the seasonal pattern of risk factors should help determine the causes of the seasonal pattern in CVD. Few studies have investigated the seasonal variation in risk factors using repeated measurements from the same individual, which is important as individual and population seasonal patterns may differ. Methods The authors investigated the seasonal pattern in systolic and diastolic blood pressure, heart rate, body weight, total cholesterol, triglycerides, high-density lipoprotein cholesterol, C reactive protein and fibrinogen. Measurements came from 38 037 participants in the population-based cohort, the Tromsø Study, examined up to eight times from 1979 to 2008. Individual and population seasonal patterns were estimated using a cosinor in a mixed model. Results All risk factors had a highly statistically significant seasonal pattern with a peak time in winter, except for triglycerides (peak in autumn), C reactive protein and fibrinogen (peak in spring). The sizes of the seasonal variations were clinically modest. Conclusions Although the authors found highly statistically significant individual seasonal patterns for all risk factors, the sizes of the changes were modest, probably because this subarctic population is well adapted to a harsh climate. Better protection against seasonal risk factors like cold weather could help reduce the winter excess in CVD observed in milder climates.

Age of blood and recipient factors determine the severity of transfusion-related acute lung injury (TRALI)

Introduction Critical care patients frequently receive blood transfusions. Some reports show an association between aged or stored blood and increased morbidity and mortality, including the development of transfusion-related acute lung injury (TRALI). However, the existence of conflicting data endorses the need for research to either reject this association, or to confirm it and elucidate the underlying mechanisms. Methods Twenty-eight sheep were randomised into two groups, receiving saline or lipopolysaccharide (LPS). Sheep were further randomised to also receive transfusion of pooled and heat-inactivated supernatant from fresh (Day 1) or stored (Day 42) non-leucoreduced human packed red blood cells (PRBC) or an infusion of saline. TRALI was defined by hypoxaemia during or within two hours of transfusion and histological evidence of pulmonary oedema. Regression modelling compared physiology between groups, and to a previous study, using stored platelet concentrates (PLT). Samples of the transfused blood products also underwent cytokine array and biochemical analyses, and their neutrophil priming ability was measured in vitro. Results TRALI did not develop in sheep that first received saline-infusion. In contrast, 80% of sheep that first received LPS-infusion developed TRALI following transfusion with "stored PRBC." The decreased mean arterial pressure and cardiac output as well as increased central venous pressure and body temperature were more severe for TRALI induced by "stored PRBC" than by "stored PLT." Storage-related accumulation of several factors was demonstrated in both "stored PRBC" and "stored PLT", and was associated with increased in vitro neutrophil priming. Concentrations of several factors were higher in the "stored PRBC" than in the "stored PLT," however, there was no difference to neutrophil priming in vitro. Conclusions In this in vivo ovine model, both recipient and blood product factors contributed to the development of TRALI. Sick (LPS infused) sheep rather than healthy (saline infused) sheep predominantly developed TRALI when transfused with supernatant from stored but not fresh PRBC. "Stored PRBC" induced a more severe injury than "stored PLT" and had a different storage lesion profile, suggesting that these outcomes may be associated with storage lesion factors unique to each blood product type. Therefore, the transfusion of fresh rather than stored PRBC may minimise the risk of TRALI.

Building community resilience – learning from the 2011 floods in Southeast Queensland, Australia

The year 2010 was the wettest year on record for Queensland, Australia and the wettest year since 1974 for Southeast Queensland. The extremely heavy rain in early January 2011 fell on the catchments of heavily saturated Brisbane and Stanley Rivers systems resulting in significant runoff which rapidly produced a widespread and devastating flood event. The area of inundation was equivalent to the total land area of France and Germany combined. Over 200,000 people were affected leaving 35 people dead and 9 missing. The damage bill was estimated at over $1B and cost to the economy at over $10B with over 30,000 homes and 6,000 business flooded and 86 towns and regional centres affected. The need to disburse disaster funding in a prompt manner to the affected population was paramount to facilitate individuals getting their lives back to some normality. However, the payout of insurance claims has proved to be a major area of community anger. The ongoing impasse in payment of insurance compensation is attributed to the nature and number of claims, confusing definition of flooding and the lack or accuracy of information needed to determine individually the properties affected and legitimacy of claims. Information was not readily available at the micro-level including, extent and type of inundation, flood heights at property level and cause of damage. Events during the aftermath highlighted widespread community misconceptions concerning the technical factors associated with the flood event and the impact of such on access to legitimate compensation and assistance. Individual and community wide concerns and frustration, anger and depression, have arisen resulting from delays in the timely settlement of insurance claims. Lessons learnt during the aftermath are presented in the context of their importance as a basis for inculcating communities impacted by the flood event with resilience for the future.

Antibiotics overuse in children with upper respiratory tract infections in Saudi Arabia : risk factors and potential interventions

Background: Antibiotics misuse is currently one of the major public health issues worldwide. This misuse can lead to the development of bacterial resistance, increasing the burden of chronic diseases, rising costs of health services, and the development of side effects. Several factors may influence this pattern of overuse. Objectives:This article will review the pertinent factors contributing to the overuse of antibiotics worldwide, and to assess the intervention strategies to limit this overuse. Methods: studies about antibiotics use in children were reviewed from several electronic databases, such as MEDLINE and Pubmed. Results: Factors contributing to the overuse of antibiotics could include psychosocial factors, such as behaviors and attitudes (e.g. self-medication, over-the-counter medication, or patients/parents pressure), and demographic factors, such as socio-economic status and education level. Several intervention strategies were reported to be effective in reducing the overuse of antibiotics, such as health education, doctor-patient communication, and policies change. Multifaceted interventions were found to be the most effective in reducing the antibiotics overuse.

Factors influencing health behaviours of younger women after menopause-inducing cancer treatment

Objective To investigate the health promotion and risk reduction behaviors of younger women previously treated for cancer. Design and Sample Guided by the Precede-Proceed framework, a mixed-method descriptive investigation of the health behaviors of younger women with cancer treatment-induced menopause in one health jurisdiction in Australia was undertaken. Measures This article reports the results of the qualitative interview component of the study. Results Of the 85 women who responded to surveys that quantified their health behaviors, 22 consented to interviews that explored how and why these behaviors might occur. Conclusions Several predisposing, enabling and reinforcing factors that influenced participants will or ability to engage with health-promoting behaviors after cancer treatment were identified in the interviews. These include entrenched precancer diagnosis health behaviors, the disabilities resulting from cancer treatments, perceptions of risk, focused intervention by health professionals and the nature of participants social support. The results indicate a need for flexibility when planning public health initiatives to prepare this cohort for a healthy life after cancer, which accounts for their developmental, knowledge and posttreatment needs.

Numerical solution of stress intensity factors of multiple cracks in great number with eigen COD boundary integral equations

Based on the eigen crack opening displacement (COD) boundary integral equations, a newly developed computational approach is proposed for the analysis of multiple crack problems. The eigen COD particularly refers to a crack in an infinite domain under fictitious traction acting on the crack surface. With the concept of eigen COD, the multiple cracks in great number can be solved by using the conventional displacement discontinuity boundary integral equations in an iterative fashion with a small size of system matrix. The interactions among cracks are dealt with by two parts according to the distances of cracks to the current crack. The strong effects of cracks in adjacent group are treated with the aid of the local Eshelby matrix derived from the traction BIEs in discrete form. While the relatively week effects of cracks in far-field group are treated in the iteration procedures. Numerical examples are provided for the stress intensity factors of multiple cracks, up to several thousands in number, with the proposed approach. By comparing with the analytical solutions in the literature as well as solutions of the dual boundary integral equations, the effectiveness and the efficiencies of the proposed approach are verified.