Best practice for prevention and treatment of cardiovascular disease through an equity lens : a review

Background: Despite declining rates of cardiovascular disease (CVD) mortality in developed countries, lower socioeconomic groups continue to experience a greater burden of the disease. There are now many evidence-based treatments and prevention strategies for the management of CVD and it is essential that their impact on the more disadvantaged group is understood if socioeconomic inequalities in CVD are to be reduced. Aims: To determine whether key interventions for CVD prevention and treatment are effective among lower socioeconomic groups, to describe barriers to their effectiveness and the potential or actual impact of these interventions on the socioeconomic gradient in CVD. Methods: Interventions were selected from four stages of the CVD continuum. These included smoking reduction strategies, absolute risk assessment, cardiac rehabilitation, secondary prevention medications, and heart failure self-management programmes. Electronic searches were conducted using terms for each intervention combined with terms for socioeconomic status (SES). Results: Only limited evidence was found for the effectiveness of the selected interventions among lower SES groups and there was little exploration of socioeconomic-related barriers to their uptake. Some broad themes and key messages were identified. In the majority of findings examined, it was clear that the underlying material, social and environmental factors associated with disadvantage are a significant barrier to the effectiveness of interventions. Conclusion: Opportunities to reduce socioeconomic inequalities occur at all stages of the CVD continuum. Despite this, current treatment and prevention strategies may be contributing to the widening socioeconomic-CVD gradient. Further research into the impact of best-practice interventions for CVD upon lower SES groups is required.

Socioeconomic inequalities in weight status among mid-aged adults : the contribution of perceptions of weight status and weight-control behaviours

Background Socioeconomically-disadvantaged adults in developed countries experience a higher prevalence of a number of chronic diseases, such as cardiovascular disease, type 2 diabetes, osteoarthritis and some forms of cancer. Overweight and obesity are major risk factors for these diseases. Lower socioeconomic groups have a greater prevalence of overweight and obesity and this may contribute to their higher morbidity and mortality. International studies suggest that socioeconomic groups may differ in their self-perceptions of weight status and their engagement in weightcontrol behaviours (WCBs). Research has shown that lower socioeconomic adults are more likely to underestimate their weight status, and are less likely to engage in WCBs. This may contribute (in part) to the marked inequalities in weight status observed at the population level. There are few, and somewhat limited, Australian studies that have examined the types of weight-control strategies people adopt, the barriers to their weight control, the determinants of their perceived weight status and WCBs. Furthermore, there are no known Australian studies that have examined socioeconomic differences in these factors to better understand the reasons for socioeconomic inequalities in weight status. Hence, the overall aim of this Thesis is to examine why socioeconomically-disadvantaged group experience a greater prevalence of overweight and obesity than their more-advantaged counterparts. Methods This Thesis used data from two sources. Men and women aged 45 to 60 years were examined from both data source. First, the longitudinal Australian Diabetes, Obesity and Lifestyle (AusDiab) Study were used to advance our knowledge and understanding of socioeconomic differences in weight change, perceived weight status and WCBs. A total of 2753 participants with measured weights at both baseline (1999-2000) and follow-up (2004-2005) were included in the analyses. Percent weight change over the five-year interval was calculated and perceived weight status, WCBs and highest attained education were collected at baseline. Second, the Candidate conducted a postal questionnaire from 1013 Brisbane residents (69.8 % response rate) to investigate the relationship between socioeconomic position, determinants of perceived weight status, WCBs, and barriers and reasons to weight control. A test-retest reliability study was conducted to determine the reliability of the new measures used in the questionnaire. Most new measures had substantial to almost perfect reliability when considering either kappa coefficient or crude agreement. Results The findings from the AusDiab Study (accepted for publication in the Australian and New Zealand Journal of Public Health) showed that low-educated men and women were more likely to be obese at baseline compared to their higheducated respondents (O.R. = 1.97, 95 % C.I. = 1.30-2.98 and O.R. = 1.52, 95 % C.I. = 1.03-2.25, respectively). Over the five year follow-up period (1999-2000 to 2004- 05) there were no socioeconomic differences in weight change among men, however socioeconomically-disadvantaged women had greater weight gains. Participants perceiving themselves as overweight gained less weight than those who saw themselves as underweight or normal weight. There was no relationship between engaging in WCBs and five-year weight change. The postal questionnaire data showed that socioeconomically-disadvantaged groups were less likely to engage in WCBs. If they did engage in weight control, they were less likely to adopt exercise strategies, including moderate and vigorous physical activities but were more likely to decrease their sitting time to control their weight. Socioeconomically-disadvantaged adults reported more barriers to weight control; such as perceiving weight loss as expensive, requiring a lot of cooking skills, not being a high priority and eating differently from other people in the household. These results have been accepted for publication in Public Health Nutrition. The third manuscript (under review in Social Science and Medicine) examined socioeconomic differences in determinants of perceived weight status and reasons for weight control. The results showed that lower socioeconomic adults were more likely to specify the following reasons for weight control: they considered themselves to be too heavy, for occupational requirements, on recommendation from their doctor, family members or friends. Conversely, high-income adults were more likely to report weight control to improve their physical condition or to look more attractive compared with those on lower-incomes. There were few socioeconomic differences in the determinants of perceived weight status. Conclusions Education inequalities in overweight/obesity among men and women may be due to mis-perceptions of weight status; overweight or obese individuals in loweducated groups may not perceive their weight as problematic and therefore may not pay attention to their energy-balance behaviours. Socioeconomic groups differ in WCBs, and their reasons and perceived barriers to weight control. Health promotion programs should encourage weight control among lower socioeconomic groups. More specifically, they should encourage the engagement of physical activity or exercise and dietary strategies among disadvantaged groups. Furthermore, such programs should address potential barriers for weight control that disadvantaged groups may encounter. For example, disadvantaged groups perceive that weight control is expensive, requires cooking skills, not a high priority and eating differently from other people in the household. Lastly, health promotion programs and policies aimed at reducing overweight and obesity should be tailored to the different reasons and motivations to weight control experienced by different socioeconomic groups. Weight-control interventions targeted at higher socioeconomic groups should use improving physical condition and attractiveness as motivational goals; while, utilising social support may be more effective for encouraging weight control among lower socioeconomic groups.

The psychological treatment of refugees and asylum seekers : what does the literature tell us?

Over the past five years, Australia has accepted approximately 50 000 individuals through its Humanitarian program. To integrate these individuals specialised medical and psychological services have been established in major centres of Australia. Australia has been involved in a heated and partisan debate as to the policy of the government in responding to the refugee situation. Regardless of the outcome of the debate, it is imperative that Australia establishes and develops effective policies and processes to respond to the mental health needs of refugees and asylum seekers. To this end, the current review provides an overview of published studies relating to the psychological treatment of refugees and asylum seekers, as well as studies covering the delivery of related services in response to the needs of this group. In this review we aim to provide an informed perspective in terms of research evidence where this is available. Reported research is supported by findings from local focus groups conducted in Queensland, Australia. The overall aim is to provide an optimum response to facilitate the development of effective and humane programs for a significantly disadvantaged group in our community.

Diversity in action : minority group media and social change

My thesis consists of a creative work plus an exegesis. This exegesis uses case study research to investigate three Brisbane-based media organisations and the role they play in encouraging social inclusion and other positive social change for specific disadvantaged and stigmatised minority groups. Bailey, Cammaerts and Carpentier’s theoretical approach to alternative media forms the basis of this research. Bailey et al. (2008, p. 156) view alternative media organisations as having four important roles, two media-centred and two society-centred, which must all be considered to best understand them: • serving their communities • acting as an alternative to mainstream media discourses • promoting and advocating democratisation in the media and through the media in society • functioning as a crossroads in civil society. The first case study, about community radio station 4RPH (Radio for the Print Handicapped), centres on promoting social inclusion for people with a print disability through access to printed materials (primarily mainstream print media) in an audio format. The station also provides important opportunities for members of this group to produce media and, to a lesser extent, provides disability-specific information and discussions. The second case study, about gay print and online magazine Queensland Pride, focuses on promoting social inclusion and combating the discrimination and repression of people who identify as lesbian, gay, bisexual or transgender. Central issues include the representation (including sexualised representation) of a subculture and niche target market, and the impact of commercialisation on this free publication. The third case study, about community radio station 98.9FM, explores the promotion of social inclusion for peoples whose identity, cultures, issues, politics and contributions are often absent or misrepresented in the mainstream media. This radio station provides “a first level of service” (Meadows & van Vuuren, 1998, p. 104) to these people, but also informs and entertains those in the majority society. The findings of this research suggest that there are two key mechanisms that help these media organisations to effect social change: first, strengthening the minority community and serving its needs, and second, fostering connections with the broader society.

Evaluating parent-child group music therapy programmes: challenges and successes for Sing & Grow

Sing & Grow is an early intervention music therapy programme for families with children from birth to 3 years of age, who are socially, economically, or physically disadvantaged. It aims to improve parenting skills and confidence, promote positive parent–child interactions, stimulate child development, and provide social networking opportunities. Music and song activities are used in a therapeutic context to enhance parenting skills, improve parent–child interactions, provide essential developmental stimulation for children, promote social support for parenting, and strengthen links between parents and community services.

Preparing high achieving English teachers to work in disadvantaged schools : 'I'll teach Shakespeare when I'm 60'

The recent release of the Gonski Review recognises the decline in Australia’s schooling performances over the last decade, noting in particular a distressing increase in the ‘achievement gap’ affecting students from low SES backgrounds (Gonski, 2012). The report details the need for more quality in teachers throughout the schooling system, particularly within the schools with the greatest academic needs. This paper specifically focuses on a group of high-achieving pre-service English teachers. In their last two years of university study, they participated in a program called Exceptional Teachers for Disadvantaged Schools (ETDS), designed to prepare them to work in disadvantaged or low SES schools. We wanted to capture their experiences of teaching in challenging settings during their practicum, and as they prepared to graduate, we wondered what they now felt about teaching English in low SES schools. Using narrative inquiry, we analysed a range of reflective data to gain insight into such things as their initial motivations for entering the teaching profession and how their preconceived expectations may or may not have shifted after practicum experiences in low SES schools. We encouraged open reflection about how they perceived themselves as English teachers.

Cost-effectiveness of a telephone-delivered education programme to prevent early childhood caries in a disadvantaged area : a cohort study

Objectives Early childhood caries is a highly destructive dental disease which is compounded by the need for young children to be treated under general anaesthesia. In Australia, there are long waiting periods for treatment at public hospitals. In this paper, we examined the costs and patient outcomes of a prevention programme for early childhood caries to assess its value for government services. Design Cost-effectiveness analysis using a Markov model. Setting Public dental patients in a low socioeconomic, socially disadvantaged area in the State of Queensland, Australia. Participants Children aged 6 months to 6 years received either a telephone prevention programme or usual care. Primary and secondary outcome measures A mathematical model was used to assess caries incidence and public dental treatment costs for a cohort of children. Healthcare costs, treatment probabilities and caries incidence were modelled from 6 months to 6 years of age based on trial data from mothers and their children who received either a telephone prevention programme or usual care. Sensitivity analyses were used to assess the robustness of the findings to uncertainty in the model estimates. Results By age 6 years, the telephone intervention programme had prevented an estimated 43 carious teeth and saved £69 984 in healthcare costs per 100 children. The results were sensitive to the cost of general anaesthesia (cost-savings range £36 043–£97 298) and the incidence of caries in the prevention group (cost-savings range £59 496–£83 368) and usual care (cost-savings range £46 833–£93 328), but there were cost savings in all scenarios. Conclusions A telephone intervention that aims to prevent early childhood caries is likely to generate considerable and immediate patient benefits and cost savings to the public dental health service in disadvantaged communities.

Rural dispositions of floating children within the field of Beijing schools: can disadvantaged rural habitus turn into recognised cultural capital?

The rapid pace of urbanisation in China has seen a massive increase in the movement of the rural population to work and live in urban regions. In this large-scale migration context, the educational, health, and psychological problems of floating children are becoming increasingly visible. Different from extant studies, we focus our investigation on the rural dispositions of floating children through interviews with leaders, teachers, and students in four schools in Beijing. Drawing on Bourdieu’s key notions of habitus, capital, and field, our study indicates that the rural habitus of floating children can differentiate these children from their urban peers. This habitus can be marginalised and stigmatised in certain fields but can be recognised and valued as capital in other fields. Our paper offers some implications for research and practice in relation to the schooling of floating children.

Associated schools of construction of southern Africa infrastructure design and delivery workshop - Report. CIB task group 91 infrastructure

This workshop comprised a diverse group of African construction experts, ranging far wider than RSA. Each of the attendees had attended the annual ASOCSA conference and was additionally provided with a short workshop pre-brief. The aim was to develop a view of their 15-20 year vision of construction improvement in RSA and the steps necessary to get there. These included sociological, structural, technical and process changes. Whilst some suggestions are significantly challenging, none are impossible, given sufficient collaboration between government, industry, academia and NGOs. The highest priority projects (more properly, programmes) were identified and further explored. These are: 1. Information Hub (‘Open Africa’). Aim – to utilise emerging trends in Open Data to provide a force for African unity. 2. Workforce Development. Aim – to rebuild a competent, skilled construction industry for RSA projects and for export. 3. Modular DIY Building. Aim – to accelerate the development of sustainable, cost-efficient and desirable housing for African economic immigrants and others living in makeshift and slum dwellings. Open Data is a maturing theme in different cities and governments around the world and the workshop attendees were very keen to seize such a possibility to assist in developing an environment where Africans can share information and foster collaboration. It is likely that NGOs might be keen to follow up such an initiative. There are significant developments taking place around the world in the construction sector currently, with comparatively large savings being made for taxpayers (20% plus in the UK). Not all of these changes would be easy to transplant to RSA (even more so to much of the rest of Africa). Workforce development was a keen plea amongst the attendees, who seemed concerned that expertise has leaked away and is not being replaced with sufficient intensity. It is possible today to develop modular buildings in such a way that even unskilled residents can assist in their construction, and even their appropriate design. These buildings can be sited nearly autonomously from infrastructures, thus relieving the tensions on cities and townships, whilst providing humane accommodation for the economically disadvantaged. Development of suitable solutions could either be conducted with other similarly stressed countries or developed in-country and the expertise exported. Finally, it should be pointed out that this was very much a first step. Any opportunity to collaborate from an Australian, QUT or CIB perspective would be welcomed, whilst acknowledging that the leading roles belong to RSA, CSIR, NRF, ASOCSA and the University of KwaZulu-Natal.