Prevalence, trends and associated socio-economic factors of obesity in South Asia

Aim Worldwide obesity levels have increased unprecedentedly over the past couple of decades. Although the prevalence, trends and associated socio-economic factors of the condition have been extensively reported in Western populations, less is known regarding South Asian populations. Methods A review of articles using Medline with combinations of the MeSH terms: 'Obesity', 'Overweight' and 'Abdominal Obesity' limiting to epidemiology and South Asian countries. Results Despite methodological heterogeneity and variation according to country, area of residence and gender , the most recent nationally representative and large regional data demonstrates that without any doubt there is a epidemic of obesity, overweight and abdominal obesity in South Asian countries. Prevalence estimates of overweight and obesity (based on Asian cut-offs: overweight ≥ 23 kg/m(2), obesity ≥ 25 kg/m(2)) ranged from 3.5% in rural Bangladesh to over 65% in the Maldives. Abdominal obesity was more prevalent than general obesity in both sexes in this ethnic group. Countries with the lowest prevalence had the highest upward trend of obesity. Socio-economic factors associated with greater obesity in the region included female gender, middle age, urban residence, higher educational and economic status. Conclusion South Asia is significantly affected by the obesity epidemic. Collaborative public health interventions to reverse these trends need to be mindful of many socio-economic constraints in order to provide long-term solutions.

Measurement as legitimacy versus legitimacy of measures : Performance evaluation of social enterprise

Purpose The purpose of this paper is to review the growing emphasis on quantifiable performance measures such as social return on investment (SROI) in third sector organisations – specifically, social enterprise – through a legitimacy theory lens. It then examines what social enterprises value (i.e. consider important) in terms of performance evaluation, using a case study approach. Design/methodology/approach Case studies involving interviews, documentary analysis, and observation, of three social enterprises at different life-cycle stages with different funding structures, were constructed to consider “what measures matter” from a practitioner's perspective. Findings Findings highlight a priority on quality outcomes and impacts in primarily qualitative terms to evaluate performance. Further, there is a noticeable lack of emphasis on financial measures other than basic access to financial resources to continue pursuing social goals. Social implications The practical challenges faced by social enterprises – many of which are small to medium sized – in evaluating performance and by implication organisational legitimacy are contrasted with measures such as SROI which are resource intensive and have inherent methodological limitations. Hence, findings suggest the limited and valuable resources of social enterprises would be better allocated towards documenting the actual outcomes and impacts as a first step, in order to evaluate social and financial performance in terms appropriate to each objective, in order to demonstrate organisational legitimacy. Originality/value Findings distinguish between processes which may hold symbolic legitimacy for select stakeholder groups, and processes which hold substantive, cognitive legitimacy for stakeholders more broadly, in the under-researched context of social enterprise.

Understanding chronic pain complicating disability: Finding meaning through focus group methodology

Over the past few decades a major paradigm shift has occurred in the conceptualisation of chronic pain as a complex multidimensional phenomenon. Yet, pain experienced by individuals with a primary disability continues to be understood largely from a traditional biomedical model, despite its inherent limitations. This is reflected in the body of literature on the topic that is primarily driven by positivist assumptions and the search for etiologic pain mechanisms. Conversely, little is known about the experiences of and meanings attributed to, disability-related pain. Thus the purpose of this paper is to discuss the use of focus group methodology in elucidating the meanings and experiences of this population. Here, a distinction is made between the method of the focus group and focus group research as methodology. Typically, the focus group is presented as a seemingly atheoretical method of research. Drawing on research undertaken on the impact of chronic pain in people with multiple sclerosis, this paper seeks to theorise the focus group in arguing the methodological congruence of focus group research and the study of pain experience. It is argued that the contributions of group interaction and shared experiences in focus group discussions produce data and insights less accessible through more structured research methods. It is concluded that a biopsychosocial perspective of chronic pain may only ever be appreciated when the person-in-context is the unit of investigation.

Risky business : mapping ethical landscapes and negotiating governance tensions when researching female offending

Whilst there is an excellent and growing body of literature around female criminality underpinned by feminist methodologies, the nitty gritty of the methodological journey is nowhere as well detailed as it is in the context of the Higher Degree Research (HDR) thesis. Thus the purpose of this paper is threefold: i) to explore a range of feminist methodologies underpinning 20 Australian HDR theses focussing on female criminality; ii) to identify and map the governance/ethics tensions experienced by these researchers whilst undertaking high risk research in the area of female offending; and iii) to document strategies drawn from negotiations, resolutions and outcomes to a range of gate-keeping issues. By exploring the strategies used by these researchers, this paper aims to: promote discussion on feminist methodologies; highlight pathways that may be created when negotiating the challenging process of accessing data pertinent to this relatively understudied area; contribute to a community of practice; and provide useful insights into what Mason & Stubbs (2010:16) refer to as “the open and honest reflexivity through the research process by describing the assumptions, and hiccups” for future researchers navigating governance landscapes.

Recent developments and research needs in modeling lane changing

This paper comprehensively reviews recent developments in modeling lane-changing behavior. The major lane changing models in the literature are categorized into two groups: models that aim to capture the lane changing decision-making process, and models that aim to quantify the impact of lane changing behavior on surrounding vehicles. The methodologies and important features (including their limitations) of representative models in each category are outlined and discussed. Future research needs are determined.

On the periodicity of traffic oscillations and capacity drop : the role of driver characteristics

This paper shows that traffic hysteresis, a manifestation of driver characteristics, has a profound impact on the development of traffic oscillations and the bottleneck discharge rate. Findings suggest that aggressive driver behavior (with small response times and jammed spacing) leads to spontaneous formations of stop-and-go disturbances. Furthermore, the aggressive behavior, coupled with a late response to adopt less aggressive behavior, generates large hysteresis that leads to oscillations’ transformation from localized to substantial disturbances and growth. The larger the magnitude of hysteresis is, the larger the growth is. Our finding also suggests that the bottleneck discharge rate can diminish by 8-23% when driver adopts a less aggressive reaction to a disturbance (characterized by a larger response time). This finding is particularly notable since lane-changes have been believed to be the major cause of a reduction in bottleneck discharge rate.

Gait parameters associated with hallux valgus : a systematic review

Background Hallux valgus (HV) has been linked to functional disability and increased falls risk in older adults. However, specific gait alterations in individuals with HV are unclear. This systematic review investigated gait parameters associated with HV in otherwise healthy adults. Methods Electronic databases (Medline, Embase, CINAHL) were searched to October 2011, including cross-sectional studies with clearly defined HV and non-HV comparison groups. Two investigators independently rated studies for methodological quality. Effect sizes (95% confidence intervals (CI)) were calculated as standardized mean differences (SMD) for continuous data and risk ratios (RR) for dichotomous data. Results Nine studies included a total of 589 participants. Three plantar pressure studies reported increased hallux loading (SMD 0.56 to 1.78) and medial forefoot loading (SMD 0.62 to 1.21), while one study found reduced first metatarsal loading (SMD −0.61, CI −1.19 to −0.03) in HV participants. HV participants demonstrated less ankle and rearfoot motion during terminal stance (SMD −0.81 to −0.63) and increased intrinsic muscle activity (RR 1.6, 1.1 to 2.2). Most studies reported no differences in spatio-temporal parameters; however, one study found reduced speed (SMD −0.73, -1.25 to −0.20), step length (SMD −0.66 to −0.59) and less stable gait patterns (SMD −0.86 to −0.78) in older adults with HV. Conclusions HV impacts on particular gait parameters, and further understanding of potentially modifiable factors is important for prevention and management of HV. Cause and effect relationships cannot be inferred from cross-sectional studies, thus prospective studies are warranted to elucidate the relationship between HV and functional disability.

InterLACE : a new international collaboration for a Life course approach to women's reproductive health and chronic disease events.

Evidence from population-based studies of women increasingly points to the inter-related nature of reproductive health, lifestyle, and chronic disease risk. This paper describes the recently established International Collaboration for a Life Course Approach to Reproductive Health and Chronic Disease. InterLACE aims to advance the evidence base for women's health policy beyond associations from disparate studies by means of systematic and culturally sensitive synthesis of longitudinal data. Currently InterLACE draws on individual level data for reproductive health and chronic disease among 200,000 women from over thirteen studies of women's health in seven countries. The rationale for this multi-study research programme is set out in terms of a life course perspective to reproductive health. The research programme will build a comprehensive picture of reproductive health through life in relation to chronic disease risk. Although combining multiple international studies poses methodological challenges, InterLACE represents an invaluable opportunity to strength evidence to guide the development of timely and tailored preventive health strategies.

Monitoring the price and affordability of foods and diets globally

Food prices and food affordability are important determinants of food choices, obesity and non-communicable diseases. As governments around the world consider policies to promote the consumption of healthier foods, data on the relative price and affordability of foods, with a particular focus on the difference between ‘less healthy’ and ‘healthy’ foods and diets, are urgently needed. This paper briefly reviews past and current approaches to monitoring food prices, and identifies key issues affecting the development of practical tools and methods for food price data collection, analysis and reporting. A step-wise monitoring framework, including measurement indicators, is proposed. ‘Minimal’ data collection will assess the differential price of ‘healthy’ and ‘less healthy’ foods; ‘expanded’ monitoring will assess the differential price of ‘healthy’ and ‘less healthy’ diets; and the ‘optimal’ approach will also monitor food affordability, by taking into account household income. The monitoring of the price and affordability of ‘healthy’ and ‘less healthy’ foods and diets globally will provide robust data and benchmarks to inform economic and fiscal policy responses. Given the range of methodological, cultural and logistical challenges in this area, it is imperative that all aspects of the proposed monitoring framework are tested rigorously before implementation.

The effectiveness of non-pharmacological interventions in improving psychological outcomes for heart transplant recipients : a systematic review

Background Post-heart transplant psychological distress may both directly hinder physiological health as well as indirectly impact on clinical outcomes by increasing unhealthy behaviours, such as immunosuppression non-adherence. Reducing psychological distress for heart transplant recipients is therefore vitally important, in order to improve patients’ overall health and well-being but also clinical outcomes, such as morbidity and mortality. Evidence from other populations suggests that non-pharmacological interventions may be an effective strategy. Aim To appraise the efficacy of non-pharmacological interventions on psychological outcomes after heart transplant. Method A systematic review was conducted using the Joanna Briggs Institute methodology. Experimental and quasi-experimental studies that involved any non-pharmacological intervention for heart transplant recipients were included, provided that data on psychological outcomes were reported. Multiple electronic databases were searched for published and unpublished studies and reference lists of retrieved studies were scrutinized for further primary research. Data were extracted using a standardised data extraction tool. Included studies were assessed by two independent reviewers using standardised critical appraisal instruments. Results Three studies fulfilled the inclusion and exclusion criteria, which involved only 125 heart transplant recipients. Two studies reported on exercise programs. One study reported a web-based psychosocial intervention. While psychological outcomes significantly improved from baseline to follow-up for the recipients who received the interventions, between-group comparisons were not reported. The methodological quality of the studies was judged to be poor. Conclusions Further research is required, as we found there is insufficient evidence available to draw conclusions for or against the use of non-pharmacological interventions after heart transplant.

Implementation of a better choice healthy food and drink supply strategy for staff and visitors in government owned health facilities in Queensland, Australia

Objective The present paper reports on a quality improvement activity examining implementation of A Better Choice Healthy Food and Drink Supply Strategy for Queensland Health Facilities (A Better Choice). A Better Choice is a policy to increase supply and promotion of healthy foods and drinks and decrease supply and promotion of energy-dense, nutrient-poor choices in all food supply areas including food outlets, staff dining rooms, vending machines, tea trolleys, coffee carts, leased premises, catering, fundraising, promotion and advertising. Design An online survey targeted 278 facility managers to collect self-reported quantitative and qualitative data. Telephone interviews were sought concurrently with the twenty-five A Better Choice district contact officers to gather qualitative information. Setting Public sector-owned and -operated health facilities in Queensland, Australia. Subjects One hundred and thirty-four facility managers and twenty-four district contact officers participated with response rates of 48·2 % and 96·0 %, respectively. Results Of facility managers, 78·4 % reported implementation of more than half of the A Better Choice requirements including 24·6 % who reported full strategy implementation. Reported implementation was highest in food outlets, staff dining rooms, tea trolleys, coffee carts, internal catering and drink vending machines. Reported implementation was more problematic in snack vending machines, external catering, leased premises and fundraising. Conclusions Despite methodological challenges, the study suggests that policy approaches to improve the food and drink supply can be implemented successfully in public-sector health facilities, although results can be limited in some areas. A Better Choice may provide a model for improving food supply in other health and workplace settings.

Heritage language learning for Chinese Australians : the role of habitus

The relationship between Heritage Language and ethnic identity has gained significant research ground in social psychological and poststructural scholarship, with empirical evidence largely emerging from the North American settings. There is little pertinent sociological work conducted outside North America. To fill this gap, this sociological study sets its scene in an Australian context. Drawing on Bourdieu’s notion of habitus, the study examines the contribution of Chinese Australians’ Chineseness to their Chinese Heritage Language proficiency. Two hundred and thirty young Chinese Australians completed the online survey. Results from multiple regression indicate that habitus of Chineseness is one of the significant predictors for the Chinese Heritage Language proficiency of these young people. The study makes a theoretical contribution to investigate ethnic identity – Heritage Language link through the notion of habitus and makes a methodological contribution to quantify this habitus.

Measuring global economic interdependence : a hierarchical network approach

This paper investigates the business cycle co-movement across countries and regions since 1950 as a measure for quantifying the economic interdependence in the ongoing globalisation process. Our methodological approach is based on analysis of a correlation matrix and the networks it contains. Such an approach summarises the interaction and interdependence of all elements, and it represents a more accurate measure of the global interdependence involved in an economic system. Our results show (1) the dynamics of interdependence has been driven more by synchronisation in regional growth patterns than by the synchronisation of the world economy, and (2) world crisis periods dramatically increase the global co-movement in the world economy.

The Effective and The Evocative : A Spectrum of Creative Practice Research

In the expanding literature on creative practice research, art and design are often described as a unified field. They are bracketed together (art-and-design), referred to as interchangeable terms (art/design), and nested together, as if the practices of one domain encompass the other. However it is possible to establish substantial differences in research approaches. In this chapter we argue that core distinctions arise out of the goals of the research, intentions invested in the resulting “artefacts” (creative works, products, events), and the knowledge claims made for the research outcomes. Moreover, these fundamental differences give rise to a number of contingent attributes of the research such as the forming contexts, methodological approaches, and ways of evidencing and reporting new knowledge. We do not strictly ascribe these differences to disciplinary contexts. Rather, we use the terms effective practice research and evocative practice research to describe the spirit of the two distinctive research paradigms we identify. In short, effective practice research (often pursued in design fields) seeks a solution (or resolution) to a problem identified with a particular community, and it produces an artefact that addresses this problem by effecting change (making a situation, product or process more efficient or effective in some way). On the other hand, evocative practice research (often pursued by creative arts fields) is driven by individual pre-occupations, cultural concerns or human experience more broadly. It produces artefacts that evoke affect and resonance, and are poetically irreducible in meaning. We cite recent examples of creative research projects that illustrate the distinctions we identify. We then go on to describe projects that integrate these modes of research. In this way, we map out a creative research spectrum, with distinct poles as well as multiple hybrid possibilities. The hybrid projects we reference are not presented as evidence an undifferentiated field. Instead, we argue that they integrate research modes in deliberate, purposeful and distinctive ways: employing effective practice research methods in the production of evocative artefacts or harnessing evocative (as well as effective) research paradigms to effect change.

Acquiring ‘doctorateness’ in the creative industries : an Australian perspective on professional research doctorates

Over the last two decades, particularly in Australia and the UK, the doctoral landscape has changed considerably with increasingly hybridised approaches to methodologies and research strategies as well as greater choice of examinable outputs. This paper provides an overview of doctoral practices that are emerging in the creative industries context, from a predominantly Australian perspective, with a focus on practice-led approaches within the Doctor of Philosophy and recent developments in professional doctorates. The paper examines some of the diverse theoretical principles which foreground the practitioner/researcher, methodological approaches that incorporate tacit knowledge and reflective practice together with qualitative strategies, blended learning delivery modes, and flexible doctoral outputs;and how these are shaping this shifting environment towards greater research-based industry outputs. The discussion is based around a single extended case study of the Doctor of Creative Industries at Queensland University of Technology (QUT) as one model of an interdisciplinary professional research doctorate.