Reaching those most in need: a review of diabetes self-management interventions in disadvantaged populations

There has been increased recognition of the importance of developing diabetes self-management education (DSME) interventions that are effective with under-served and minority populations. Despite several recent studies in this area, there is to our knowledge no systematic review or synthesis of what has been learned from this research. An electronic literature search identified five formative evaluations and ten controlled DSME intervention trials focused on under-served (low-income, minority or aged) populations. The RE-AIM (Reach, Efficacy, Adoption, Implementation, Maintenance) evaluation framework was used to evaluate the controlled studies on the dimensions of reach, efficacy, adoption, implementation, and maintenance. Fifty percent of the studies identified reported on the percentage of patients who participated, and the percentages were highly variable. The methodological quality of the articles was generally good and the short-term results were encouraging, especially on behavioral outcomes. Data on adoption (representativeness of settings and clinicians who participate) and implementation were almost never reported. Studies of modalities in addition to group meetings are needed to increase the reach of DSME with under-served populations. The promising formative evaluation work that has been conducted needs to be extended for more systematic study of the process of intervention implementation and adaptation with special populations. Studies that explicitly address the community context and that address multiple issues related to public health impact of DSME interventions are recommended to enhance long-term results. Copyright (C) 2002 John Wiley Sons, Ltd.

A qualitative study of Australian GPs' attitudes and practices in the diagnosis and management of attention-deficit/hyperactivity disorder (ADHD)

Background. The importance of general practice involvement in the care of attention-deficit/hyperactivity disorder (ADHD) is increasing due to the rising numbers of patients who present with the disorder. It has been suggested by consensus bodies that GPs should be identifying and referring patients at the severe end of the ADHD spectrum and managing those with less severe symptoms. However, GPs' views of their role in ADHD care are unknown. Objective. Our aim was to explore the attitudes and practices of Australian GPs towards the diagnosis and management of ADHD. Methods. We conducted a series of focus groups to explore GPs' beliefs regarding the causes of ADHD, their perceived role in ADHD diagnosis and management and their views on the role of behaviour therapies and pharmacotherapies in ADHD management. The subjects were 28 GPs in six focus groups. Results. GPs in this study did not want to be the primary providers of care for patients with ADHD. Participants indicated a preference to refer the patient to medical specialists for diagnosis and treatment of ADHD, and expressed low levels of interest in becoming highly involved in ADHD care. Concerns about overdiagnosis and misdiagnosis of the disorder, diagnostic complexity, time constraints, insufficient education and training about the disorder, and concerns regarding misuse and diversion of stimulant medications were the reasons cited for their lack of willingness. Conclusions. The Australian GPs in this study identify a role for themselves in ADHD care which is largely supportive in nature, and involves close liaison with specialist services.

Management are aliens! Rumours during organisational change

Rumors collected from a large public hospital undergoing change were content analyzed, and a typology comprising the following five broad types of change-related rumors was developed: rumors about changes to job and working conditions, nature of organizational change, poor change management, consequences of the change for organizational performance, and gossip-rumors. Rumors were also classified as positive or negative on the basis of their content. As predicted, negative rumors were more prevalent than positive rumors. Finally, employees reporting negative rumors also reported more change-related stress as compared to those who reported positive rumors and those who did not report any rumors. The authors propose that rumors be treated as verbal symbols and expressions of employee concerns during organizational change.

Economic constraints on public policy

Economics is commonly described as "the science of allocating scarce resources." By contrast, a popular description of politics is "the art of the possible." Both of these descriptions refer to the same central feature of human existence: our wants generally exceed our capacity to satisfy them. However, economic and political approaches to the problem of scarcity are quite different. [Extract from Introduction]

Improved case management and continued government investment are needed for malaria eradication in Henan Province, China

A two-year study of malaria control began in Henan Province following cuts in government malaria spending in 1993. Cost data were collected from all government levels and on treatment-seeking (diagnosis, treatment) from 12,325 suspected malaria cases in two endemic counties. The cost burden was found to fall mainly on patients, but using government infrastructure. Good stewardship requires continuing government investment, to at least current levels, along with improved case management. In mainland China, vivax malaria is a significant factor in poverty and economic underdevelopment.

Public attitudes to the use of wildlife by Aboriginal Australians: Marketing of wildlife and its conservation

Indigenous Australians have socioeconomic attributes similar to those of residents in some developing countries. Their utilisation of wildlife could add to their economic opportunities. Attitudes of a sample of the Australian public towards the subsistence use of wildlife by Indigenous Australians and whether or not they should be allowed to sell wildlife and wildlife products are examined. Allowing such possibilities could provide economic incentives for nature conservation among local people. We explore whether those sampled believe that Indigenous Australians should do more than other groups and institutions to conserve Australia's tropical species, and whether or not they should be allowed to take common as well as endangered wildlife species for food. Attitudes of the sampled public towards Indigenous Australians earning income from trophy hunting and from the harvesting of northern long-necked turtles for the pet trade are canvassed. The possible conservation consequences of sale of wildlife by Indigenous Australians are discussed.

Modelling basin level allocation of water in the Murray-Darling Basin in a world of uncertainty, Murray-Darling Program Working Papers WPM05-1, Risk and Sustainable Management Group, 8 February 2005

Abstract: The Murray-Darling Basin comprises over 1 million km2; it lies within four states and one territory; and over 12, 800 GL of irrigation water is used to produce over 40% of the nation's gross value of agricultural production. This production is used by a diverse collection of some-times mutually exclusive commodities (e.g. pasture; stone fruit; grapes; cotton and field crops). The supply of water for irrigation is subject to climatic and policy uncertainty. Variable inflows mean that water property rights do not provide a guaranteed supply. With increasing public scrutiny and environmental issues facing irrigators, greater pressure is being placed on this finite resource. The uncertainty of the water supply, water quality (salinity), combined with where water is utilised, while attempting to maximising return for investment makes for an interesting research field. The utilisation and comparison of a GAMS and Excel based modelling approach has been used to ask: where should we allocate water?; amongst what commodities?; and how does this affect both the quantity of water and the quality of water along the Murray-Darling river system?

A risk-based system to penalize and reward line management for occupational safety and health performance

Penalizing line management for the occurrence of lost time injuries has in some cases had unintended negative consequences. These are discussed. An alternative system is suggested that penalizes line management for accidents where the combination of the probability of recurrence and the maximum reasonable consequences such a recurrence may have exceeds an agreed limit. A reward is given for prompt effective control of the risk to below the agreed risk limit. The reward is smaller than the penalty. High-risk accidents require independent investigation by a safety officer using analytical techniques. Two case examples are given to illustrate the system. Continuous safety improvement is driven by a planned reduction in the agreed risk limit over time and reward for proactive risk assessment and control.

The Role of Non-Market Valuation in Forest Management and Recreation Policy

Forests, and particularly those where native and mixed species are gown, provide a variety of non-wood values, important among which are recreation and environmental services. Substantial progress has been made in recent years in estimating economic values on these services. A considerable amount of research on forest values has been carried out recently in tropical and sub-tropical eastern Australia, some of which is reported in the following papers. The need for estimates of non-wood forest benefits is apparent, and it is clear that further development of techniques and a greater understanding of the way these values can be integrated into public-sector decision making is required.

The paradox of commercialising public sector intellectual property

The juxtapositioning of government providing a public good through research and development investment on one hand and engaging in commercialisation of the research outcome on the other is a paradox. Using agricultural research as an example, we examine the nature of the paradox to determine if commercialisation potentially leads to a conflict in the role of public research institutions set up to fulfil public good responsibilities. We identify the reasons for the shift in policy towards commercialisation and greater exploitation of public sector intellectual property and how this has contributed to the emergence of the apparent inconsistency. We argue that the belief in working for public good is inherent and embedded in an organisation's history and its wider operating environment. We propose that the creation of public sector intellectual property and its commercialisation are influenced by the political, social and economic environment in which the public institutions operate. [ABSTRACT FROM AUTHOR]