Relationships between preventive activities, psychosocial factors and recurrence of venous leg ulcers : a prospective study

Aim To identify relationships between preventive activities, psychosocial factors and leg ulcer recurrence in patients with chronic venous leg ulcers. Background Chronic venous leg ulcers are slow to heal and frequently recur, resulting in years of suffering and intensive use of health care resources. Methods A prospective longitudinal study was undertaken with a sample of 80 patients with a venous leg ulcer recruited when their ulcer healed. Data were collected from 2006–2009 from medical records on demographics, medical history and ulcer history; and from self-report questionnaires on physical activity, nutrition, preventive activities and psychosocial measures. Follow-up data were collected via questionnaires every three months for 12 months after healing. Median time to recurrence was calculated using the Kaplan-Meier method. A Cox proportional-hazards regression model was used to adjust for potential confounders and determine effects of preventive strategies and psychosocial factors on recurrence. Results: There were 35 recurrences in a sample of 80 participants. Median time to recurrence was 27 weeks. After adjustment for potential confounders, a Cox proportional hazards regression model found that at least an hour/day of leg elevation, six or more days/week in Class 2 (20–25mmHg) or 3 (30–40mmHg) compression hosiery, higher social support scale scores and higher General Self-Efficacy scores remained significantly associated (p<0.05) with a lower risk of recurrence, while male gender and a history of DVT remained significant risk factors for recurrence. Conclusion Results indicate that leg elevation, compression hosiery, high levels of self-efficacy and strong social support will help prevent recurrence.

Local and global : cultural globalization, consumerism, and children's fiction

According to Zygmunt Bauman in Liquid Modernity (2000), the formerly solid and stable institutions of social life that characterised earlier stages of modernity have become fluid. He sees this as an outcome of the modernist project of progress itself, which in seeking to dismantle oppressive structures failed to reconstruct new roles for society, community and the individual. The un-tethering of social life from tradition in the latter stages of the twentieth century has produced unprecedented freedoms and unparalleled uncertainties, at least in the West. Although Bauman’s elaboration of some of the features and drivers of liquid modernity – increased mobility, rapid communications technologies, individualism – suggests it to be a neologism for globalisation, it is arguably also the context which has allowed this phenomenon to flourish. The qualities of fluidity, leakage, and flow that distinguish uncontained liquids also characterise globalisation, which encompasses a range of global trends and processes no longer confined to, or controlled by, the ‘container’ of the nation or state. The concept of liquid modernity helps to explain the conditions under which globalisation discourses have found a purchase and, by extension, the world in which contemporary children’s literature, media, and culture are produced. Perhaps more significantly, it points to the fluid conceptions of self and other that inform the ‘liquid’ worldview of the current generation of consumers of texts for children and young adults. This generation is growing up under the phase of globalisation we describe in this chapter.

Re-Presenting/Representing Melbourne: A literary and cultural analysis of Melbourne’s inner city and outer suburbs in contemporary fiction

This article provides an overview of a research project investigating contemporary literary representations of Melbourne’s inner and outer suburban spaces. It will argue that the city represented by local writers is an often more complex way of envisioning the city than the one presented in public policy and cultural discourses. In this view, the writer’s vision of a city does not necessarily override or provide a “truer’ account but it is in the fictional city where the complexity of the everyday life of a city is most accurately portrayed. The article will also provide an overview of the theoretical framework for reading the fictional texts in this way, examining how Soja’s concept of Thirdspace (2006) provides a place to engage “critically with theoretical issues, while simultaneously being that space where the debate occurs” (Mole 2008: 3).

Keeping House : a novel and novel companion

The creative work of this study is a novel-length work of literary fiction called Keeping House (published as Grace's Table, by University of Queensland Press, April 2014). Grace has not had twelve people at her table for a long time. Hers isn't the kind of family who share regular Sunday meals. As Grace prepares the feast, she reflects on her life, her marriage and her friendships. When the three generations of her family come together, simmering tensions from the past threaten to boil over. The one thing that no one can talk about is the one thing that no one can forget. Grace's Table is a moving and often funny novel using food as a language to explore the power of memory and the family rituals that define us. The exegetical component of this study does not adhere to traditional research pedagogies. Instead, it follows the model of what the literature describes as fictocriticism. It is the intention that the exegesis be read as a hybrid genre; one that combines creative practice and theory and blurs the boundaries between philosophy and fiction. In offering itself as an alternative to the exegetical canon it provides a model for the multiplicity of knowledge production suited to the discipline of practice-led research. The exegesis mirrors structural elements of the creative work by inviting twelve guests into the domestic space of the novel to share a meal. The guests, chosen for their diverse thinking, enable examination of the various agents of power involved in the delivery of food. Their ideas cross genders, ages and time periods; their motivations and opinions often collide. Some are more concerned with the spatial politics of where food is consumed, others with its actual preparation and consumption. Each, however, provides a series of creative reflective conversations throughout the meal which help to answer the research question: How can disempowered women take authority within their domestic space? Michel de Certeau must defend his "operational tactics" or "art of the weak" 1 as a means by which women can subvert the colonisation of their domestic space against Michel Foucault's ideas about the functions of a "disciplinary apparatus". 2 Erving Goffman argues that the success of de Certeau's "tactics" depends upon his theories of "performance" and "masquerade" 3; a claim de Certeau refutes. Doreen Massey and the author combine forces in arguing for space, time and politics to be seen as interconnected, non-static and often contested. The author calls for identity, or sense of self, to be considered a further dimension which impacts on the function of spatial models. Yu-Fi Tuan speaks of the intimacy of kitchens; Gaston Bachelard the power of daydreams; and Jean Anthelme Brillat-Savarin gives the reader a taste of the nourishing arts. Roland Barthes forces the author to reconsider her function as a writer and her understanding of the reader's relationship with a text. Fictional characters from two texts have a place at the table – Marian from The Edible Woman by Margaret Atwood 4 and Lilian from Lilian's Story by Kate Grenville. 5 Each explores how they successfully subverted expectations of their gender. The author interprets and applies elements of the conversations to support Grace's tactics in the novel as well as those related to her own creative research practice. Grace serves her guests, reflecting on what is said and how it relates to her story. Over coffee, the two come together to examine what each has learned.

Being Grateful : Does it Bring Us Closer? Gratitude, Attachment and Intimacy in Romantic Relationships

To date, little is known about the function of gratitude in romantic relationships. Being grateful has been demonstrated to provide a number of positive benefits for individuals; however, few studies have explored how grateful experiences may be beneficial in enhancing romantic relationships. This study explored the extent to which adult attachment moderates the relationship between dispositional gratitude and the experience of intimacy within romantic relationships. A greater disposition toward gratitude was expected to result in more frequent experiences of gratitude. It was also anticipated that experiences of gratitude would be associated with feelings of closeness. Participants (n = 156) were required to be currently in a relationship of at least six months duration and completed a series of questionnaires assessing dispositional gratitude, attachment and emotional intimacy. Moderation analysis revealed that although a positive, weak correlation existed between dispositional gratitude and intimacy, attachment did not moderate this association. It was concluded that further investigation of the experience of gratitude is necessary to understand the function of gratitude in romantic relationships. Methods focusing on specific experiences of gratitude in romantic relationships, and the associated feelings of closeness experienced by each partner, may yield more conclusive findings and may provide support for therapeutic approaches focused on enhancing closeness between couples by increasing experiences of gratitude.

Being grateful : does it bring us closer? Gratitude, attachment and intimacy in romantic relationships

This study proposed that levels of dispositional gratitude influence experiences of intimacy within romantic relationships and that this influence is moderated by relationship attachment. Gratitude, in this study, was described as feelings of appreciation associated with the perception that one had been the focus of another’s intentionally beneficial actions. A greater disposition toward gratitude was expected to result in more frequent experiences of gratitude. It was also anticipated that experiences of gratitude would be associated with feelings of closeness toward the one responsible for the beneficial act. Participants (n=156) ranged in age from 18 – 70 and, although required to be currently in a relationship of at least six months’ duration, each was studied as an individual. Participants included both males and females, in same-sex or other-sex relationships, and completed a series of questionnaires assessing dispositional gratitude, attachment and emotional intimacy. Moderation analysis was conducted using hierarchical regression and revealed that although a positive, weak correlation exists between gratitude and intimacy, attachment did not moderate that association. However, the measures used did not elicit sufficiently divergent responses. Thus neither complete exploration of the proposed association between gratitude and intimacy, nor of the moderation of that association by attachment were possible. In conclusion, further investigation of experiences of gratitude, particularly in relation to enhancing feelings of closeness, is necessary to understand the function of gratitude in romantic relationships. Methods focusing on specific experiences of gratitude in romantic relationships and the associated feelings of closeness experienced by each partner may yield more conclusive findings. In addition, such findings may provide support for therapeutic approaches focused on enhancing closeness between couples by increasing experiences of gratitude.

The accidental mentor : Australian rural nurses developing supportive relationships in the workplace

improved rural nurse retention as an outcome of recognising and developing such supportive relationships in the workplace. Strategies include: performance review and development processes that account for all forms of supportive relationships conducted in the workplace; recognising the importance of developing supportive relationships and allocating time for these; and continuing professional development designed to meet local needs for developing a culture of support in the workplace.

An examination of the relationships between lifestyle factors and mental health among Australian midlife and older women

Background It is well known that lifestyle factors including overweight/obesity, physical inactivity, smoking and alcohol use are largely related with morbidity and mortality of chronic diseases including diabetes and cardiovascular diseases. The effect of lifestyle factors on people’s mental health who have a chronic disease is less defined in the research. The World Health Organisation has defined health as “a state of complete physical, mental and social well-being”. It is important, therefore to develop an understanding of the relationships between lifestyle and mental health as this may have implications for maximising the efficacy of health promotion in people with chronic diseases. Objectives The overall aim of the research was to examine the relationships between lifestyle factors and mental health among Australian midlife and older women. Methodology The current research measured four lifestyle factors including weight status, physical activity, smoking and alcohol use. Three interconnecting studies were undertaken to develop a comprehensive understanding of the relationships between lifestyle factors and mental health. Study 1 investigated the longitudinal effect of lifestyle factors on mental health by using midlife and older women randomly selected from the community. Study 2 adopted a cross-sectional design, and compared the effect of lifestyle factors on mental health between midlife and older women with and without diabetes. Study 3 examined the mediating effect of self-efficacy in the relationships between lifestyle factors and mental health among midlife and older women with diabetes. A questionnaire survey was chosen as the means to gather information, and multiple linear regression analysis was conducted as the primary statistical approach. Results The research showed that the four lifestyle factors including weight status, physical activity, smoking and alcohol use did impact on mental health among Australian midlife and older women. First, women with a higher BMI had lower levels of mental health than women with normal weight, but as women age, the mental health of women who were overweight and obese becomes better than that of women with normal weight. Second, women who were physically active had higher levels of mental health than those who were not. Third, smoking adversely impacted on women’s mental health. Finally, those who were past-drinkers had less anxiety symptoms than women who were non-drinkers as they age. Women with diabetes appeared to have lower levels of mental health compared to women without. However, the disparities of mental health between two groups were confounded by low levels of physical activity and co-morbidities. This finding underlines the effect of physical activity on women’s mental health, and highlights the potential of reducing the gap of mental health by promoting physical activity. In addition, self-efficacy was shown to be the mediator of the relationships between BMI, physical activity and depression, suggesting that enhancing people’s self-efficacy may be useful for mental health improvement. Conclusions In conclusion, Australian midlife and older women who live with a healthier lifestyle have higher levels of mental health. It is suggested that strategies aiming to improve people’s mental health may be more effective if they focus on enhancing people’s self-efficacy levels. This study has implications to both health education and policy development. It indicates that health professionals may need to consider clients’ mental health as an integrated part of lifestyle changing process. Furthermore, given that lifestyle factors impact on both physical and mental health, lifestyle modification should continue to be the focus of policy development.

Relationships between rainfall intensity, duration and suspended particle washoff from an urban road surface

A basic understanding of the relationships between rainfall intensity, duration of rainfall and the amount of suspended particles in stormwater runoff generated from road surfaces has been gained mainly from past washoff experiments using rainfall simulators. Simulated rainfall was generally applied at constant intensities, whereas rainfall temporal patterns during actual storms are typically highly variable. This paper discusses a rationale for the application of the constant-intensity washoff concepts to actual storm event runoff. The rationale is tested using suspended particle load data collected at a road site located in Toowoomba, Australia. Agreement between the washoff concepts and measured data is most consistent for intermediate-duration storms (duration <5 h and >1 h). Particle loads resulting from these storm events increase linearly with average rainfall intensity. Above a threshold intensity, there is evidence to suggest a constant or plateau particle load is reached. The inclusion of a peak discharge factor (maximum 6 min rainfall intensity) enhances the ability to predict particle loads.

The impact of nonlinear exposure risk relationships on seasonal time series data: modelling danish neonatal birth anthropometric data

Background Birth weight and length have seasonal fluctuations. Previous analyses of birth weight by latitude effects identified seemingly contradictory results, showing both 6 and 12 monthly periodicities in weight. The aims of this paper are twofold: (a) to explore seasonal patterns in a large, Danish Medical Birth Register, and (b) to explore models based on seasonal exposures and a non-linear exposure-risk relationship. Methods Birth weight and birth lengths on over 1.5 million Danish singleton, live births were examined for seasonality. We modelled seasonal patterns based on linear, U- and J-shaped exposure-risk relationships. We then added an extra layer of complexity by modelling weighted population-based exposure patterns. Results The Danish data showed clear seasonal fluctuations for both birth weight and birth length. A bimodal model best fits the data, however the amplitude of the 6 and 12 month peaks changed over time. In the modelling exercises, U- and J-shaped exposure-risk relationships generate time series with both 6 and 12 month periodicities. Changing the weightings of the population exposure risks result in unexpected properties. A J-shaped exposure-risk relationship with a diminishing population exposure over time fitted the observed seasonal pattern in the Danish birth weight data. Conclusion In keeping with many other studies, Danish birth anthropometric data show complex and shifting seasonal patterns. We speculate that annual periodicities with non-linear exposure-risk models may underlie these findings. Understanding the nature of seasonal fluctuations can help generate candidate exposures.