The First Steps Program : a case study of a new model of community child health service

Community Child Health Nursing Services provide support for new mothers; however, the focus has often been on individual consultations, complemented by a series of group sessions soon after birth. We describe a new model of community care for first-time mothers that centres on group sessions throughout the whole contact period. The model was developed by practicing child health nurses for a large health service district in south-east Queensland, which offers a comprehensive community child health service. Issues identified by clinicians working within existing services, feedback from clients and the need for more resource-efficient methods of service provision underpinned the development of the model. The pilot program was implemented in two community child health centres in Brisbane. An early individual consultation to engage the family with the service was added in response to feedback from clinicians and clients. The modified model has since been implemented service-wide as the ‘First Steps Program’. The introduction of this model has ensured that the service has been able to retain a comprehensive service for first-time parents from a universal population, while responding to the challenges of population growth and the increasing number of complex clients placing demands on resources.

Physical function and health-related quality of life of older adults undergoing hospital rehabilitation : how strong is the association?

The purpose of this research is to report preliminary empirical evidence regarding the association between common physical performance measures and health-related quality of life (HRQoL) of hospitalized older adults recovering from illness and injury. Frequently, these patients do not return to premorbid levels of independence and physical ability. Rehabilitation for this population often focuses on improving physical functioning and mobility with the intention of maximizing their HRQoL for discharge and thereafter. For this reason, longitudinal use of physical performance measures as an indicator of improvement in physical functioning (and thus HRQoL) is common. Although this is a logical approach, there have been mixed results from previous investigations into the association between common measures of physical function and HRQoL amongst other adult patient populations.1,2 There has been no previous investigation reporting the association between HRQoL and a variety of common physical performance measures in hospitalized older adults.

Supervisory safety practices in the work-related driving context

Work-related driving crashes are the most common cause of work-related injury, death, and absence from work in Australia and overseas. Surprisingly however, limited attention has been given to initiatives designed to improve safety outcomes in the work-related driving setting. This research paper will present preliminary findings from a research project designed to examine the effects of increasing work-related driving safety discussions on the relationship between drivers and their supervisors and motivations to drive safely. The research project was conducted within a community nursing population, where 112 drivers were matched with 23 supervisors. To establish discussions between supervisors and drivers, safety sessions were conducted on a monthly basis with supervisors of the drivers. At these sessions, the researcher presented context specific, audio-based anti-speeding messages. Throughout the course of the intervention and following each of these safety sessions, supervisors were instructed to ensure that all drivers within their workgroup listened to each particular anti-speeding message at least once a fortnight. In addition to the message, supervisors were also encouraged to frequently promote the anti-speeding message through any contact they had with their drivers (i.e., face to face, email, SMS text, and/or paper based contact). Fortnightly discussions were subsequently held with drivers, whereby the researchers ascertained the number and type of discussions supervisors engaged in with their drivers. These discussions also assessed drivers’ perceptions of the group safety climate. In addition to the fortnightly discussion, drivers completed a daily speed reporting form which assessed the proportion of their driving day spent knowingly over the speed limit. As predicted, the results found that if supervisors reported a good safety climate prior to the intervention, increasing the number of safety discussions resulted in drivers reporting a high quality relationship (i.e., leader-member exchange) with their supervisor post intervention. In addition, if drivers reported a good safety climate, increasing the number of discussions resulted in increased motivation to drive safely post intervention. Motivations to drive safely prior to the intervention also predicted self-reported speeding over the subsequent three months of reporting. These results suggest safety discussions play an important role in improving the exchange between supervisors and their drivers and drivers’ subsequent motivation to drive safely and, in turn, self reported speeding.

Engaging energy saving through motivation-specific social comparison

Comparison is widely used in research projects and commercial products whose goal is to motivate energy saving at home. This research builds on fundamental theories from social psychology in an attempt to shed light on how to motivate consumers to conserve energy by providing relevant people for social comparison depending on consumer’s motivation to compare. To support the research process, the mobile application EnergyWiz was developed through a theory-driven design approach. Along with other features EnergyWiz provides users with three types of social comparison – normative, one-on-one and ranking. The results of interviews with prospective users are used to derive design suggestions for relevant people for comparison (comparison subjects).

Asset health prediction using condition indicators and operating environment indicators : a case study

Prognostics and asset life prediction is one of research potentials in engineering asset health management. We previously developed the Explicit Hazard Model (EHM) to effectively and explicitly predict asset life using three types of information: population characteristics; condition indicators; and operating environment indicators. We have formerly studied the application of both the semi-parametric EHM and non-parametric EHM to the survival probability estimation in the reliability field. The survival time in these models is dependent not only upon the age of the asset monitored, but also upon the condition and operating environment information obtained. This paper is a further study of the semi-parametric and non-parametric EHMs to the hazard and residual life prediction of a set of resistance elements. The resistance elements were used as corrosion sensors for measuring the atmospheric corrosion rate in a laboratory experiment. In this paper, the estimated hazard of the resistance element using the semi-parametric EHM and the non-parametric EHM is compared to the traditional Weibull model and the Aalen Linear Regression Model (ALRM), respectively. Due to assuming a Weibull distribution in the baseline hazard of the semi-parametric EHM, the estimated hazard using this model is compared to the traditional Weibull model. The estimated hazard using the non-parametric EHM is compared to ALRM which is a well-known non-parametric covariate-based hazard model. At last, the predicted residual life of the resistance element using both EHMs is compared to the actual life data.

Mental health of newly arrived Burmese refugees in Australia : contributions of pre-migration and post-migration experience

Objective: This study documents the mental health status of people from Burmese refugee backgrounds, recently arrived in Australia; then examines the contributions of gender, premigration and postmigration factors in predicting mental health. Method: Structured interviews, including a demographic questionnaire, the Harvard Trauma Questionnaire, Postmigration Living Difficulties Checklist and Hopkins Symptom Checklist assessed premigration trauma, postmigration living difficulties, depression, anxiety, somatisation and traumatisation symptoms in a sample of 70 adults across five Burmese ethnic groups. Results: Substantial proportions of participants reported psychological distress in symptomatic ranges including: posttraumatic stress disorder (9%); anxiety (20%), and; depression (36%), as well as significant symptoms of somatisation (37%). Participants reported multiple and severe premigration traumas. Postmigration living difficulties of greatest concern included communication problems and worry about family not in Australia. Gender did not predict mental health. Level of exposure to traumatic events and postmigration living difficulties each made unique and relatively equal contributions to traumatisation symptoms. Postmigration living difficulties made unique contributions to depression, anxiety and somatisation symptoms. Conclusions: While exposure to traumatic events impacted on participants’ mental wellbeing, postmigration living difficulties had greater salience in predicting mental health outcomes of people from Burmese refugee backgrounds. Reported rates of posttraumatic stress disorder symptoms were consistent with a large review of adults across seven western countries. High levels of somatisation pointed to a nuanced expression of distress. Findings have implications for service provision in terms of implementing appropriate interventions to effectively meet the needs of this newly arrived group in Australia.

Children of substance-using mothers : child health engagement and child protection outcomes

Aim: Maternal substance use has been associated with a range of child risk factors. The study investigated the relationship between engagement with child health services and child protection outcomes for children of substance using mothers. ----- ----- Methods: A sample of 119 children of mothers who disclosed opiate, amphetamine or methadone use during a maternity admission between 2000 and 2003, as included in a previous matched co-hort study1, were included in the current study. Statutory child protection agency and child health engagement information for the first two years of life, was obtained. The relationship between type of maternal substance use, child health engagement and child protection outcomes was examined. ----- ----- Results: Seventy two percent of study group infants were engaged with child health services during the first two years of life. Chi square analysis showed no significant relationship between child health engagement and child protection reports. Child health engagement was associated with decreased substantiated child protection notifications for children of methadone using mothers, but not for children of illicit substance users. ----- ----- Conclusions: Almost a quarter of identified children of substance using mothers are not accessing standard child health services in their first two years of life. This study provides support for increased attention to the provision of child health services for children of methadone using mothers. Further research into effective intervention strategies for children of illicit substance using mothers is indicated.

Use of acoustic emission technique for structural health monitoring of bridges

Bridges are valuable assets of every nation. They deteriorate with age and often are subjected to additional loads or different load patterns than originally designed for. These changes in loads can cause localized distress and may result in bridge failure if not corrected in time. Early detection of damage and appropriate retrofitting will aid in preventing bridge failures. Large amounts of money are spent in bridge maintenance all around the world. A need exists for a reliable technology capable of monitoring the structural health of bridges, thereby ensuring they operate safely and efficiently during the whole intended lives. Monitoring of bridges has been traditionally done by means of visual inspection. Visual inspection alone is not capable of locating and identifying all signs of damage, hence a variety of structural health monitoring (SHM) techniques is used regularly nowadays to monitor performance and to assess condition of bridges for early damage detection. Acoustic emission (AE) is one technique that is finding an increasing use in SHM applications of bridges all around the world. The chapter starts with a brief introduction to structural health monitoring and techniques commonly used for monitoring purposes. Acoustic emission technique, wave nature of AE phenomenon, previous applications and limitations and challenges in the use as a SHM technique are also discussed. Scope of the project and work carried out will be explained, followed by some recommendations of work planned in future.

Exploiting system fluctuations. Differential training in physical prevention and rehabilitation programs for health and exercise

Background: Traditional causal modeling of health interventions tends to be linear in nature and lacks multidisciplinarity. Consequently, strategies for exercise prescription in health maintenance are typically group based and focused on the role of a common optimal health status template toward which all individuals should aspire. ----- ----- Materials and methods: In this paper, we discuss inherent weaknesses of traditional methods and introduce an approach exercise training based on neurobiological system variability. The significance of neurobiological system variability in differential learning and training was highlighted.----- ----- Results: Our theoretical analysis revealed differential training as a method by which neurobiological system variability could be harnessed to facilitate health benefits of exercise training. It was observed that this approach emphasizes the importance of using individualized programs in rehabilitation and exercise, rather than group-based strategies to exercise prescription.----- ----- Conclusion: Research is needed on potential benefits of differential training as an approach to physical rehabilitation and exercise prescription that could counteract psychological and physical effects of disease and illness in subelite populations. For example, enhancing the complexity and variability of movement patterns in exercise prescription programs might alleviate effects of depression in nonathletic populations and physical effects of repetitive strain injuries experienced by athletes in elite and developing sport programs.

Wellness in higher education : a transformative framework for health related disciplines

The perceived benefits of Wellness Education in University environments are substantiated by a number of studies in relation to the place, impact and purpose of Wellness curricula. Many authors recommend that Wellness curriculum design must include personal experiences, reflective practice and active self-managed learning approaches in order to legitimise the adoption of Wellness as a personal lifestyle approach. Wellness Education provides opportunities to engage in learning self-regulation skills both within and beyond the context of the Wellness construct. Learner success is optimised by creating authentic opportunities to develop and practice self regulation strategies that facilitate making meaning of life's experiences. Such opportunities include provision of options for self determined outcomes and are scaffolded according to learner needs; thus, configuring a learner-centred curriculum in Wellness Education would potentially benefit by overlaying principles from the domains of Self Determination Theory, Self Regulated Learning and Transformative Education Theory to highlight authentic, transformative learning as a lifelong approach to Wellness.

Design and implementation of the Exercise for Health trial – a pragmatic exercise intervention for women with breast cancer

Background Exercise for Health was a pragmatic, randomised, controlled trial comparing the effect of an eight-month exercise intervention on function, treatment-related side effects and quality of life following breast cancer, compared with usual care. The intervention commenced six weeks post-surgery, and two modes of delivering the same intervention was compared with usual care. The purpose of this paper is to describe the study design, along with outcomes related to recruitment, retention and representativeness, and intervention participation. Methods: Women newly diagnosed with breast cancer and residing in a major metropolitan city of Queensland, Australia, were eligible to participate. Consenting women were randomised to a face-to-face-delivered exercise group (FtF, n=67), telephone-delivered exercise group (Tel, n=67) or usual care group (UC, n=60) and were assessed pre-intervention (5-weeks post-surgery), mid-intervention (6 months post-surgery) and 10 weeks post-intervention (12 months post-surgery). Each intervention arm entailed 16 sessions with an Exercise Physiologist. Results: Of 318 potentially eligible women, 63% (n=200) agreed to participate, with a 12-month retention rate of 93%. Participants were similar to the Queensland breast cancer population with respect to disease characteristics, and the randomisation procedure was mostly successful at attaining group balance, with the few minor imbalances observed unlikely to influence intervention effects given balance in other related characteristics. Median participation was 14 (min, max: 0, 16) and 13 (min, max: 3, 16) intervention sessions for the FtF and Tel, respectively, with 68% of those in Tel and 82% in FtF participating in at least 75% of sessions. Discussion: Participation in both intervention arms during and following treatment for breast cancer was feasible and acceptable to women. Future work, designed to inform translation into practice, will evaluate the quality of life, clinical, psychosocial and behavioural outcomes associated with each mode of delivery.

Establishing Aboriginal health research priorities in Victoria

Short overview of the VACCHO Social Determinants Research Forum (2010).

Non-invasive assessment of tear film surface quality

The tear film plays an important role preserving the health of the ocular surface and maintaining the optimal refractive power of the cornea. Moreover dry eye syndrome is one of the most commonly reported eye health problems. This syndrome is caused by abnormalities in the properties of the tear film. Current clinical tools to assess the tear film properties have shown certain limitations. The traditional invasive methods for the assessment of tear film quality, which are used by most clinicians, have been criticized for the lack of reliability and/or repeatability. A range of non-invasive methods of tear assessment have been investigated, but also present limitations. Hence no “gold standard” test is currently available to assess the tear film integrity. Therefore, improving techniques for the assessment of the tear film quality is of clinical significance and the main motivation for the work described in this thesis. In this study the tear film surface quality (TFSQ) changes were investigated by means of high-speed videokeratoscopy (HSV). In this technique, a set of concentric rings formed in an illuminated cone or a bowl is projected on the anterior cornea and their reflection from the ocular surface imaged on a charge-coupled device (CCD). The reflection of the light is produced in the outer most layer of the cornea, the tear film. Hence, when the tear film is smooth the reflected image presents a well structure pattern. In contrast, when the tear film surface presents irregularities, the pattern also becomes irregular due to the light scatter and deviation of the reflected light. The videokeratoscope provides an estimate of the corneal topography associated with each Placido disk image. Topographical estimates, which have been used in the past to quantify tear film changes, may not always be suitable for the evaluation of all the dynamic phases of the tear film. However the Placido disk image itself, which contains the reflected pattern, may be more appropriate to assess the tear film dynamics. A set of novel routines have been purposely developed to quantify the changes of the reflected pattern and to extract a time series estimate of the TFSQ from the video recording. The routine extracts from each frame of the video recording a maximized area of analysis. In this area a metric of the TFSQ is calculated. Initially two metrics based on the Gabor filter and Gaussian gradient-based techniques, were used to quantify the consistency of the pattern’s local orientation as a metric of TFSQ. These metrics have helped to demonstrate the applicability of HSV to assess the tear film, and the influence of contact lens wear on TFSQ. The results suggest that the dynamic-area analysis method of HSV was able to distinguish and quantify the subtle, but systematic degradation of tear film surface quality in the inter-blink interval in contact lens wear. It was also able to clearly show a difference between bare eye and contact lens wearing conditions. Thus, the HSV method appears to be a useful technique for quantitatively investigating the effects of contact lens wear on the TFSQ. Subsequently a larger clinical study was conducted to perform a comparison between HSV and two other non-invasive techniques, lateral shearing interferometry (LSI) and dynamic wavefront sensing (DWS). Of these non-invasive techniques, the HSV appeared to be the most precise method for measuring TFSQ, by virtue of its lower coefficient of variation. While the LSI appears to be the most sensitive method for analyzing the tear build-up time (TBUT). The capability of each of the non-invasive methods to discriminate dry eye from normal subjects was also investigated. The receiver operating characteristic (ROC) curves were calculated to assess the ability of each method to predict dry eye syndrome. The LSI technique gave the best results under both natural blinking conditions and in suppressed blinking conditions, which was closely followed by HSV. The DWS did not perform as well as LSI or HSV. The main limitation of the HSV technique, which was identified during the former clinical study, was the lack of the sensitivity to quantify the build-up/formation phase of the tear film cycle. For that reason an extra metric based on image transformation and block processing was proposed. In this metric, the area of analysis was transformed from Cartesian to Polar coordinates, converting the concentric circles pattern into a quasi-straight lines image in which a block statistics value was extracted. This metric has shown better sensitivity under low pattern disturbance as well as has improved the performance of the ROC curves. Additionally a theoretical study, based on ray-tracing techniques and topographical models of the tear film, was proposed to fully comprehend the HSV measurement and the instrument’s potential limitations. Of special interested was the assessment of the instrument’s sensitivity under subtle topographic changes. The theoretical simulations have helped to provide some understanding on the tear film dynamics, for instance the model extracted for the build-up phase has helped to provide some insight into the dynamics during this initial phase. Finally some aspects of the mathematical modeling of TFSQ time series have been reported in this thesis. Over the years, different functions have been used to model the time series as well as to extract the key clinical parameters (i.e., timing). Unfortunately those techniques to model the tear film time series do not simultaneously consider the underlying physiological mechanism and the parameter extraction methods. A set of guidelines are proposed to meet both criteria. Special attention was given to a commonly used fit, the polynomial function, and considerations to select the appropriate model order to ensure the true derivative of the signal is accurately represented. The work described in this thesis has shown the potential of using high-speed videokeratoscopy to assess tear film surface quality. A set of novel image and signal processing techniques have been proposed to quantify different aspects of the tear film assessment, analysis and modeling. The dynamic-area HSV has shown good performance in a broad range of conditions (i.e., contact lens, normal and dry eye subjects). As a result, this technique could be a useful clinical tool to assess tear film surface quality in the future.