Genetic technologies and the regulation of reproductive decision-making in Australia

This article provides a critical analysis of the current Australian regulatory landscape at the interface between genetics and reproductive decision- making. The authors argue that a comparative analysis with other countries and international law and a contextual examination of the way law regulates concepts such as disease and health, abnormality and normality is necessary before we can develop appropriate policy and legislative responses in this area. Specific genetic testing technologies are considered including prenatal genetic testing, preimplantation genetic diagnosis and inheritable genetic modification. An increasing number of members of the Australian community are using genetic testing technologies when they decide to have a baby. The authors argue that as concepts of disease and health vary among members of the community and the potential to test for traits other than illness increases, a new tension arises between an ethic of individual choice and a role for government in regulating reproductive decision-making.

Young and Well CRC: Engaging young people as research partners

This paper presents the outcomes of an international collaboration between researchers and young people in Australia and the United States, using participatory design to engage young people as research partners in the collaborative development of a conceptual framework for the Online WellBeing Center (OWBC), a repository of evidence-based mental health tools focused on mental health promotion and the prevention of mental illness developed as part of Young and Well Cooperative Research Centre. Eighteen participants (nine in Australia and nine in USA) were involved as key partners through a series of participatory design workshops to develop the framework for the OWBC. Key objectives of the collaboration included an increased understanding of: how to recruit young people to be part of an international project team collaborating remotely; how to use new technologies to manage communication and maintain engagement; how to apply principles of participatory research to create a youth informed research project; how to develop an international stakeholder partnership to ensure relevancy in value systems, cultural orientation and project outcomes. Recommendations included guidelines for how others can establish international collaborations that integrate young people as active project participants.

An integrative framework of supervisor responses to workgroup conflict

It is well-established that prolonged exposure to workplace conflict, as a work stressor, is linked to physical illness and psychological dysfunction in employees (see Spector and Jex, 1998; Romanov, Appelberg, Honkasalo, and Koskenvuo, 1996; Skogstad, Einarsen, Torsheim, Aasland, and Hetland, 2007). In addition to the negative implications for physiological and psychological health, workplace conflict has been shown to influence employee behaviors that have consequences for organizational effectiveness (e.g., turnover and impaired performance; see Bowling and Beehr, 2006; De Dreu and Weingart, 2003). Further, research suggests that managers spend approximately 20 percent of their time managing conflict (Thomas, 1992; Baron, 1989). There also are substantial financial implications associated with workplace conflict. For example, in the United Kingdom, costs at the national level for sickness absence and replacement costs has been estimated to be close to £2 billion per annum (Hoel, Sparks, and Cooper, 2001).

Considering research enquiry into biophilic urbanism and office worker productivity

In cities, people spend a significant portion of their time indoors, much of which is in office buildings. The quality and nature of these spaces have the potential to be a strong determinant of people’s health and wellbeing. There is a body of evidence that suggests experiences of nature increase the rate of attention recovery, reduce stress, depression and anxiety, and increase cognitive abilities. Further, the presence of nature inside buildings (such as pot plants and internal green walls) can improve indoor air quality, potentially reducing illness and increasing cognitive function. Urban design that integrates nature into the built environment to provide these benefits, among others, is called ‘biophilic urbanism’ and is the subject of growing international interest and research. The potential for these benefits to increase worker productivity in office buildings is of particular interest, as this could significantly increase the financial performance of office building-based organisations. However, productivity is a complex concept that is difficult to define, and affected by a multitude of factors, which make it difficult to measure. This inability to quantify productivity increases from investments in nature- experiences in office buildings is currently a significant barrier to such investments. Within this context, this paper considers opportunities for research to explore the relationship between office-based nature experiences and productivity, by reviewing existing research in this field and reflecting on the authors’ own experiences. This review has a particular focus on the importance of quantifying this link in order to encourage private property owners to voluntarily integrate nature into buildings to provide city-wide ecosystem service benefits. The paper begins with a contextual overview of how biophilic urbanism can potentially increase worker productivity. Existing methods of measuring and evaluating the performance of biophilic urbanism within the context of office buildings are then explored, along with a discussion of issues with such methods that are currently limiting investment in biophilic urbanism to increase worker productivity and wellbeing. This includes a summary of a survey within a Perth office building to explore the impact of views of nature through a window. Drawing on these insights, the paper makes recommendations regarding opportunities for focusing future investigations to enhance understanding of how biophilic urbanism can contribute to increased wellbeing and productivity in office buildings. This paper builds on work conducted as part of the Sustainable Built Environment National Research Centre Project 1.5, Harnessing the Potential of Biophilic Urbanism in Australia, which considered the role of nature integrated into the built environment in responding to emerging challenges of climate change, resource shortages and population pressures, while providing a host of co- benefits to a range of stakeholders.

Considering research enquiry into biophilic urbanism and office worker productivity

In cities, people spend a significant portion of their time indoors, much of which is in office buildings. The quality and nature of these spaces have the potential to be a strong determinant of people’s health and wellbeing. There is a body of evidence that suggests experiences of nature increase the rate of attention recovery, reduce stress, depression and anxiety, and increase cognitive abilities. Further, the presence of nature inside buildings (such as pot plants and internal green walls) can improve indoor air quality, potentially reducing illness and increasing cognitive function. Urban design that integrates nature into the built environment to provide these benefits, among others, is called ‘biophilic urbanism’ and is the subject of growing international interest and research. The potential for these benefits to increase worker productivity in office buildings is of particular interest, as this could significantly increase the financial performance of office building-based organisations. However, productivity is a complex concept that is difficult to define, and affected by a multitude of factors, which make it difficult to measure. This inability to quantify productivity increases from investments in nature- experiences in office buildings is currently a significant barrier to such investments. Within this context, this paper considers opportunities for research to explore the relationship between office-based nature experiences and productivity, by reviewing existing research in this field and reflecting on the authors’ own experiences. This review has a particular focus on the importance of quantifying this link in order to encourage private property owners to voluntarily integrate nature into buildings to provide city-wide ecosystem service benefits. The paper begins with a contextual overview of how biophilic urbanism can potentially increase worker productivity. Existing methods of measuring and evaluating the performance of biophilic urbanism within the context of office buildings are then explored, along with a discussion of issues with such methods that are currently limiting investment in biophilic urbanism to increase worker productivity and wellbeing. This includes a summary of a survey within a Perth office building to explore the impact of views of nature through a window. Drawing on these insights, the paper makes recommendations regarding opportunities for focusing future investigations to enhance understanding of how biophilic urbanism can contribute to increased wellbeing and productivity in office buildings. This paper builds on work conducted as part of the Sustainable Built Environment National Research Centre Project 1.5, Harnessing the Potential of Biophilic Urbanism in Australia, which considered the role of nature integrated into the built environment in responding to emerging challenges of climate change, resource shortages and population pressures, while providing a host of co- benefits to a range of stakeholders.

Factors that influence young people's mental health help‐seeking behaviour : a study based on the Health Belief Model

Aim To identify key predictors and moderators of mental health ‘help-seeking behavior’ in adolescents. Background Mental illness is highly prevalent in adolescents and young adults; however, individuals in this demographic group are among the least likely to seek help for such illnesses. Very little quantitative research has examined predictors of help-seeking behaviour in this demographic group. Design A cross-sectional design was used. Methods A group of 180 volunteers between the ages of 17–25 completed a survey designed to measure hypothesized predictors and moderators of help-seeking behaviour. Predictors included a range of health beliefs, personality traits and attitudes. Data were collected in August 2010 and were analysed using two standard and three hierarchical multiple regression analyses. Findings The standard multiple regression analyses revealed that extraversion, perceived benefits of seeking help, perceived barriers to seeking help and social support were direct predictors of help-seeking behaviour. Tests of moderated relationships (using hierarchical multiple regression analyses) indicated that perceived benefits were more important than barriers in predicting help-seeking behaviour. In addition, perceived susceptibility did not predict help-seeking behaviour unless individuals were health conscious to begin with or they believed that they would benefit from help. Conclusion A range of personality traits, attitudes and health beliefs can predict help-seeking behaviour for mental health problems in adolescents. The variable ‘Perceived Benefits’ is of particular importance as it is: (1) a strong and robust predictor of help-seeking behaviour, and; (2) a factor that can theoretically be modified based on health promotion programmes.

Promoting resilience in children with intellectual disability : a randomized controlled trial in Australian schools

Children with intellectual disability are more vulnerable to adverse developmental outcomes because of the lifelong risks associated with cognitive impairment. Difficulties with learning and adaptive behaviour inevitably produce considerable personal, social and economic disadvantage. Of concern is consistent evidence that psychiatric disorders affect a substantial proportion of people with intellectual disability. The estimated prevalence rate of between 35 and 49 % is three times that found in the general population (Wallander, Dekker, & Koot, 2006). Until recently, mental illness has been relatively neglected for people with intellectual disability, especially in relation to prevention or early detection (Kolaitis, 2008) and most research to date has been descriptive rather than focused on intervention (Bouras, 2013). Yet a considerable body of evidence demonstrates that efficacious interventions do exist for preventing psychopathology and enhancing resilience in typically developing children and adolescents (see Mallin, Walker, & Levin, 2013 for a review). In order to prevent the high comorbidity of intellectual disability and psychopathology, there is a compelling need for evidence-based practices that promote the resilience of individuals with intellectual disability (Matson, Terlonge, & Minshawi, 2008). In this chapter, we describe a randomized controlled trial of an intervention that was designed to enhance the resilience of a group of children with mild intellectual disability as they prepared to make the transition to high school. We report results from our evaluation of this intervention, and reflect on the difficulties of providing successful interventions for children whose lives are complicated not only by intellectual disability, but also by a range of contextual disadvantages.

Pharmacist prescribing of venous thromboembolism prophylaxis in a surgical pre-admission clinic

Venous thromboembolism (VTE) is the term used to describe the disease process which presents as either deep vein thrombosis or pulmonary embolism. It is a major cause of death and disability worldwide and places a large financial burden on healthcare systems. Multiple risk factors have been identified for the development of VTE, including hospitalisation for acute medical illness and surgery. Documentation of VTE risk assessment is a critical part of any patient admission, driven by evidence that a risk assessment is a trigger for VTE prophylaxis to be considered. In the United Kingdom, healthcare services have set targets for VTE risk assessment documentation and financial incentives are linked to targets being met...

Food safety : maximising impact by understanding the food business context

In Australia there are 5.4 million cases of food-borne illness annually which costs the community $1.2 billion per annum (Department of Health and Ageing 2006). As a co-regulator in food safety, local government has a significant interest in ensuring adherence to good food safety practices. This research project involved focus groups or interviews with food business operators and young food handlers to explore their food safety understanding, attitudes, practices and the organisational culture in which they participated. By its nature qualitative research is not intended to provide definitive generalizable findings. Rather the advantage of a small sample size qualitative study is to provide depth rather than breadth. Thus the findings here provide insight into the complexities and nuances of food safety regulation in a manner which a large scale quantitative study could not.

The validity and reliability of the Parent Fever Management Scale: A study from Palestine

Background Parental fever phobia and overuse of antipyretics to control fever is increasing. Little is known about childhood fever management among Arab parents. No scales to measure parents’ fever management practices in Palestine are available. Aims The aims of this study were to translate and examine the psychometric properties of the Arabic version of the Parent Fever Management Scale (PFMS). Methods A standard “forward–backward” procedure was used to translate PFMS into Arabic language. It was then validated on a convenience sample of 402 parents between July and October 2012. Descriptive statistics were used, and instrument reliability was assessed for internal consistency using Cronbach's alpha coefficient. Validity was confirmed using convergent and known group validation. Results Applying the recommended scoring method, the median (interquartile range) score of the PFMS was 26 (23-30). Acceptable internal consistency was found (Cronbach’s alpha = 0.733) and the test–retest reliability value was 0.92 (P < 0.001). The chi-squared (χ2) test showed a significant relationship between PFMS groups and frequent daily administration of antipyretic groups (χ2 = 52.86; P < 0.001). The PFMS sensitivity and specificity were 77.67% and 57.75%, respectively. The positive and negative predictive values were 67.89% and 32.11%, respectively. Conclusions The findings of this validation study indicate that the Arabic version of the PFMS is a reliable and valid measure which can be used as a useful tool for health professionals to identify parents’ fever management practices and thus provide targeted education to reduce the unnecessary burden of care they place on themselves when concerned for a febrile child.

A large proportion of asymptomatic Plasmodium infections with low and sub-microscopic parasite densities in the low transmission setting of Temotu Province, Solomon Islands : challenges for malaria diagnostics in an elimination setting

Background Many countries are scaling up malaria interventions towards elimination. This transition changes demands on malaria diagnostics from diagnosing ill patients to detecting parasites in all carriers including asymptomatic infections and infections with low parasite densities. Detection methods suitable to local malaria epidemiology must be selected prior to transitioning a malaria control programme to elimination. A baseline malaria survey conducted in Temotu Province, Solomon Islands in late 2008, as the first step in a provincial malaria elimination programme, provided malaria epidemiology data and an opportunity to assess how well different diagnostic methods performed in this setting. Methods During the survey, 9,491 blood samples were collected and examined by microscopy for Plasmodium species and density, with a subset also examined by polymerase chain reaction (PCR) and rapid diagnostic tests (RDTs). The performances of these diagnostic methods were compared. Results A total of 256 samples were positive by microscopy, giving a point prevalence of 2.7%. The species distribution was 17.5% Plasmodium falciparum and 82.4% Plasmodium vivax. In this low transmission setting, only 17.8% of the P. falciparum and 2.9% of P. vivax infected subjects were febrile (≥38°C) at the time of the survey. A significant proportion of infections detected by microscopy, 40% and 65.6% for P. falciparum and P. vivax respectively, had parasite density below 100/μL. There was an age correlation for the proportion of parasite density below 100/μL for P. vivax infections, but not for P. falciparum infections. PCR detected substantially more infections than microscopy (point prevalence of 8.71%), indicating a large number of subjects had sub-microscopic parasitemia. The concordance between PCR and microscopy in detecting single species was greater for P. vivax (135/162) compared to P. falciparum (36/118). The malaria RDT detected the 12 microscopy and PCR positive P. falciparum, but failed to detect 12/13 microscopy and PCR positive P. vivax infections. Conclusion Asymptomatic malaria infections and infections with low and sub-microscopic parasite densities are highly prevalent in Temotu province where malaria transmission is low. This presents a challenge for elimination since the large proportion of the parasite reservoir will not be detected by standard active and passive case detection. Therefore effective mass screening and treatment campaigns will most likely need more sensitive assays such as a field deployable molecular based assay.

Predictors of mental health in midlife and older women : results from the Australian Healthy Aging of Women Study

Purpose: To examine the extent to which socio-demographic characteristics, modifiable lifestyle factors and health status influence the mental health of midlife and older Australian women from the Australian Healthy Aging of Women (HOW) study. Methods: Data on health status, chronic disease and modifiable lifestyle factors were collected from a random sample of 340 women aged 40-65 years, residing in Queensland, Australia in 2011. Structural equation modelling (SEM) was used to measure the effect of a range of socio-demographic characteristics (marital status, age, income), modifiable lifestyle factors (caffeine intake, alcohol consumption, exercise, physical activity, sleep), and health markers (self-reported physical health, history of chronic illness) on the latent construct, mental health. Mental health was evaluated using the Medical Outcomes Study Short Form 12 (SF-12®) and the Center for Epidemiologic Studies Depression Scale (CES-D). Results: The model was a good fit for the data (χ2 = 40.166, df =312, p 0.125, CFI = 0.976, TLI = 0.950, RMSEA = 0.030, 90% CI = 0.000-0.053); the model suggested mental health was negatively influenced by sleep disturbance (β = -0.628), sedentary lifestyle (β = -0.137), having been diagnosed with one or more chronic illnesses (β = -0.203), and poor self-reported physical health (β = - 0.161). While mental health was associated with sleep, it was not correlated with many other lifestyle factors (BMI (β = -0.050), alcohol consumption (β = 0.079), or cigarette smoking (β = 0.008)) or background socio-demographic characteristics (age (β = 0.078), or income (β = -0.039)). Conclusion: While research suggests that it is important to engage in a range health promoting behaviours to preserve good health, we found that only sleep disturbance, physical health, chronic illness and level of physical activity predicted current mental health. However, while socio-demographic characteristics and modifiable lifestyle factors seemed to have little direct impact on mental health, they probably had an indirect effect.

What predicts mental health in midlife and older women? Results from the Australian Healthy Aging of Women Study

Objectives: Previous research has linked unhealthy lifestyle with a range of negative health outcomes in women. As women age however, they may have fewer performance expectations, but may view their health more positively. Clearly, the experiences of midlife and older women in relation to health and wellbeing need further exploration. The purpose of this study is to examine the factors associated with poor health-related quality of life in midlife (HRQoL) and older Australian women. Methods: The Australian longitudinal Healthy Aging of Women (HOW) study prospectively examines HRQoL, chronic disease and modifiable lifestyle factors midlife and older women as they age. Random sampling was used to select rural and urban based women from South-East Queensland, Australia. Data were collected from 386 women at three time points over the last decade (2001, 2004 and 2011). Results: The average age of women in this study was 65 years (SD = 2.82). Almost three-quarters (73%, n = 248) of the sample were married or living as though married, nine per cent (n = 30) were separated or divorced and a small proportion were had never married (n = 13). Most (86%, n = 291) of the women sample reported being Australian born, around one quarter (34%, n = 114) had completed additional study since leaving school (university degree or diploma). Over half (55%, n = 186) of participants were retired, one quarter (25%, n = 85) were in paid employment and the remained were unemployed (1%, n = 4), unable to work because of illness (2%, n = 6) or worked within the home (17%, n = 56). Using data collected over time we examined the relationship between a range of modifiable lifestyle factors and mental health using structural equation modelling. The overall model exhibited a good fit with the data. Poor sleep quality was associated with reduced mental health while better mental health was reported in women who exercised regularly and satisfied with their currently weight. As hypothesized, past mental health was a significant mediator of current mental health. Conclusions: These findings demonstrate that the mental health of women is complex and needs to be understood not only in terms of current lifestyle but also in relation to previously reported health status.

Breathe easier online : evaluation of a randomized controlled pilot trial of an internet-based intervention to improve well-being in children and adolescents with a chronic respiratory condition

Background Chronic respiratory illnesses are the most common group of childhood chronic health conditions and are overrepresented in socially isolated groups. Objective To conduct a randomized controlled pilot trial to evaluate the efficacy of Breathe Easier Online (BEO), an Internet-based problem-solving program with minimal facilitator involvement to improve psychosocial well-being in children and adolescents with a chronic respiratory condition. Methods We randomly assigned 42 socially isolated children and adolescents (18 males), aged between 10 and 17 years to either a BEO (final n = 19) or a wait-list control (final n = 20) condition. In total, 3 participants (2 from BEO and 1 from control) did not complete the intervention. Psychosocial well-being was operationalized through self-reported scores on depression symptoms and social problem solving. Secondary outcome measures included self-reported attitudes toward their illness and spirometry results. Paper-and-pencil questionnaires were completed at the hospital when participants attended a briefing session at baseline (time 1) and in their homes after the intervention for the BEO group or a matched 9-week time period for the wait-list group (time 2). Results The two groups were comparable at baseline across all demographic measures (all F < 1). For the primary outcome measures, there were no significant group differences on depression (P = .17) or social problem solving (P = .61). However, following the online intervention, those in the BEO group reported significantly lower depression (P = .04), less impulsive/careless problem solving (P = .01), and an improvement in positive attitude toward their illness (P = .04) compared with baseline. The wait-list group did not show these differences. Children in the BEO group and their parents rated the online modules very favorably. Conclusions Although there were no significant group differences on primary outcome measures, our pilot data provide tentative support for the feasibility (acceptability and user satisfaction) and initial efficacy of an Internet-based intervention for improving well-being in children and adolescents with a chronic respiratory condition. Trial registration Australian New Zealand Clinical Trials Registry number: ACTRN12610000214033;

Heat-related morbidity in Brisbane, Australia : spatial variation and area-level predictors

Background: Extreme heat is a leading weather-related cause of illness and death in many locations across the globe, including subtropical Australia. The possibility of increasingly frequent and severe heat waves warrants continued efforts to reduce this health burden, which could be accomplished by targeting intervention measures toward the most vulnerable communities. Objectives: We sought to quantify spatial variability in heat-related morbidity in Brisbane, Australia, to highlight regions of the city with the greatest risk. We also aimed to find area-level social and environmental determinants of high risk within Brisbane. Methods: We used a series of hierarchical Bayesian models to examine city-wide and intracity associations between temperature and morbidity using a 2007–2011 time series of geographically referenced hospital admissions data. The models accounted for long-term time trends, seasonality, and day of week and holiday effects. Results: On average, a 10°C increase in daily maximum temperature during the summer was associated with a 7.2% increase in hospital admissions (95% CI: 4.7, 9.8%) on the following day. Positive statistically significant relationships between admissions and temperature were found for 16 of the city’s 158 areas; negative relationships were found for 5 areas. High-risk areas were associated with a lack of high income earners and higher population density. Conclusions: Geographically targeted public health strategies for extreme heat may be effective in Brisbane, because morbidity risk was found to be spatially variable. Emergency responders, health officials, and city planners could focus on short- and long-term intervention measures that reach communities in the city with lower incomes and higher population densities, including reduction of urban heat island effects.