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.

Development and testing of an iPad application for teaching self-management to heart failure patients. (Nursing/Allied Health Professional Investigator Award)- Abstract

Purpose: Heart failure (HF) is the leading cause of hospitalization and significant burden to the health care system in Australia. To reduce hospitalizations, multidisciplinary approaches and enhance self-management programs have been strongly advocated for HF patients globally. HF patients who can effectively manage their symptoms and adhere to complex medicine regimes will experience fewer hospitalizations. Research indicates that information technologies (IT) have a significant role in providing support to promote patients' self-management skills. The iPad utilizes user-friendly interfaces and to date an application for HF patient education has not been developed. This project aimed to develop the HF iPad teaching application in the way that would be engaging, interactive and simple to follow and usable for patients' carers and health care workers within both the hospital and community setting. Methods: The design for the development and evaluation of the application consisted of two action research cycles. Each cycle included 3 phases of testing and feedback from three groups comprising IT team, HF experts and patients. All patient education materials of the application were derived from national and international evidence based practice guidelines and patient self-care recommendations. Results: The iPad application has animated anatomy and physiology that simply and clearly teaches the concepts of the normal heart and the heart in failure. Patient Avatars throughout the application can be changed to reflect the sex and culture of the patient. There is voice-over presenting a script developed by the heart failure expert panel. Additional engagement processes included points of interaction throughout the application with touch screen responses and the ability of the patient to enter their weight and this data is secured and transferred to the clinic nurse and/or research data set. The application has been used independently, for instance, at home or using headphones in a clinic waiting room or most commonly to aid a nurse-led HF consultation. Conclusion: This project utilized iPad as an educational tool to standardize HF education from nurses who are not always heart failure specialists. Furthermore, study is currently ongoing to evaluate of the effectiveness of this tool on patient outcomes and to develop several specifically designed cultural adaptations [Hispanic (USA), Aboriginal (Australia), and Maori (New Zealand)].

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.

Shifting the Airline Business Model - Current Struggles of National Carriers to Become Profitable Passenger Experience Companies

National flag carriers are struggling for survival, not only due to classical reasons such as increase in fuel and tax or natural disasters, but largely due to the inability to quickly adapt to its competitive environment – the emergence of budget and Persian Gulf airlines. In this research, we investigate how airlines can transform their business models via technological and strategic capabilities to become profitable and sustainable passenger experience companies. To formulate recommendations, we analyze customer sentiments via social media to understand what people are saying about the airlines.

A home-based progressive resistance exercise programme for patients with venous leg ulcers : a feasibility study

This study aimed to assess the feasibility of a home-based exercise program and examine the effects on the healing rates of venous leg ulcers. A 12 –week randomised controlled trial was conducted investigating the effects of an exercise intervention compared to a usual care group. Participants in both groups (n = 13) had active venous ulceration and were treated in a metropolitan hospital outpatients clinic in Australia. Data were collected on recruitment from medical records, clinical assessment and questionnaires. Follow-up data on progress in healing and treatments were collected fortnightly for 12 weeks. Calf muscle pump function data were collected at baseline and 12 weeks from recruitment. Range of ankle motion data were collected at baseline, 6 and 12 weeks from recruitment. This pilot study indicated that the intervention was feasible. Clinical significance was observed in the intervention group with a 32% greater decrease in ulcer size (p=0.34) than the control group, and a 10% (p=0.74) improvement in the number of participants healed in the intervention group compared to the control group. Significant differences between groups over time were observed in calf muscle pump function parameters; (ejection fraction [p = 0.05]; residual volume fraction [p = 0.04]) and range of ankle motion (p = 0.01). This pilot study is one of the first studies to examine and measure clinical healing rates for participants involved in a home-based progressive resistance exercise program. Further research is warranted with a larger multi-site study.

Speed enforcement in China : national, provincial and city initiatives and their success

China is motorizing rapidly, with associated urban road development and extensive construction of motorways. Speeding accounts for about 10% of fatalities, which represents a large decrease from a peak of 17.2% in 2004. Speeding has been addressed at a national level through the introduction of laws and procedural requirements in 2004, in provinces either across all road types or on motorways, and at city level. Typically, documentation of speed enforcement programmes has taken place when new technology (i.e. speed cameras) is introduced, and it is likely that many programmes have not been documented or widely reported. In particular, the national legislation of 2004 and its implementation was associated with a large reduction in fatalities attributed to speeding. In Guangdong Province, after using speed detection equipment, motorway fatalities due to speeding in 2005 decreased by 32.5% comparing with 2004. In Beijing, the number of traffic monitoring units which were used to photograph illegal traffic activities such as traffic light violations, speeding and using bus lanes illegally increased to 1958 by April 1, 2009, and in the future such automated enforcement will become the main means of enforcement, expected to account for 60% of all traffic enforcement in Beijing. This paper provides a brief overview of the speeding enforcement programmes in China which have been documented and their successes.

A national survey : transporting patients within Australian hospitals

A telephone survey was conducted to describe current practices and policies of patient transport in Australian hospitals.The survey had a 94% response rate. Results showed considerable variability and ambiguity throughout the samplein both practice and policy. Findings also indicated that criteria used for transport practices were predominantlyshaped by physiological and technological considerations. Factors related to human and financial resources, as well aspsychological and emotional aspects of the patient's condition, received little attention.

Hospital and home : strange bedfellows or new partners?

This paper addresses the hospital/community interface as an emerging context of health care practice. As a consequence of industry reforms health service managers are looking to the community space as a location for delivery of acute health care. This focus on the community is sharpened by the promise of cost savings and enhanced by the seemingly limitless potential of biomedical technology. The paper argues that the interface of hospital and community is a conceptual space where two different types of health services meet, bringing with them different cultural practices and expectations. The ‘hospital in the home’ programs that structure health care at this interface provide the delivery of acute nursing and medical care and the accoutrements of this care in the community, the neighbourhood, the home. Consequently, the home is becoming the new site for high technology ‘hospital’ care. This domestication of illness technology is contrasted with the notion of home as a place of sanctuary, familiarity and belonging.

Incident investigation : on a collision course towards a national standardised approach

The investigation of rail incidents is a highly specialised and important area within the rail industry. Historically training for investigators has been disjointed, with no standard approach being applied consistently. Currently in Australia, rail incidents are investigated by the various rail operators and regulators of each State, with the more serious incidents investigated by the Australian Transport Safety Bureau (ATSB). However, it is hoped with the introduction of a National Safety Regulator for the industry, a standardised competency framework for rail incident investigators can be developed. Consequently, this will also lead to more standardised training across the industry for these specialised career paths. A previous scoping report published by the CRC for Rail Innovation highlighted a need within the industry for a standardised competency framework and training package. Based on the results of the scoping report, a comprehensive Training Needs Analysis for the rail industry was undertaken. This paper will examine potential barriers and facilitators that the industry may face when implementing this national training. Furthermore, based on the results of the Training Needs Analysis, differences and similarities in the needs of rail organisations as well as between operators and regulators will be examined.