Family physician preceptors' conceptualizations of health advocacy: implications for medical education

PURPOSE: Despite its official acceptance as an important physician responsibility, health advocacy remains difficult to define, teach, role model, and assess. The aim of the current study was to explore physicians' conceptions of health advocacy based on their experience with health-advocacy-related activities. METHOD: In 2012, the authors conducted 11 semistructured interviews with family physician clinical preceptors and analyzed the interviews in the tradition of phenomenography. RESULTS: The authors identified three distinct but related ways of understanding health advocacy: (1) Clinical: Health advocacy as support of individual patients in addressing health care needs related to the immediate clinical problem within the health care system, (2) Paraclinical: Health advocacy as support of individual patients in addressing needs that the physician preceptors viewed as peripheral yet parallel to both the health care system and the immediate clinical problem, and (3) Supraclinical: Health advocacy as population-based activities aimed at practice- and system-level changes that address the social determinants of health. CONCLUSIONS: The qualitatively different understandings of health advocacy shed light on why current approaches to defining, teaching, role modeling, and assessing health advocacy competencies in medical education appear idiosyncratic. The authors suggest the development of an inclusive and extensive conceptual framework that may allow the medical education community to imagine novel ways of understanding and engaging in health advocacy.

Explaining the variation in the management of lifestyle risk factors in primary health care: a multilevel cross sectional study

Background

Despite evidence for the effectiveness of interventions to modify lifestyle behaviours in the primary health care (PHC) setting, assessment and intervention for these behaviours remains low in routine practice. Little is known about the relative importance of various determinants of practice.

This study aimed to examine the relative importance of provider characteristics and attitudes, patient characteristics and consultation factors in determining the rate of assessment and intervention for lifestyle risk factors in PHC.

Methods

A prospective audit of assessment and intervention for lifestyle risk factors was undertaken by PHC nurses and allied health providers (n = 57) for all patients seen (n = 732) over a two week period. Providers completed a survey to assess key attitudes related to addressing lifestyle issues. Multi-level logistic regression analysis of patient audit records was undertaken. Associations between variables from both data sources were examined, together with the variance explained by patient and consultation (level 1) and provider (level 2) factors.

Results

There was significant variance between providers in the assessment and intervention for lifestyle risk factors. The consultation type and reason for the visit were the most important in explaining the variation in assessment practices, however these factors along with patient and provider variables accounted for less than 20% of the variance. In contrast, multi-level models showed that provider factors were most important in explaining the variance in intervention practices, in particular, the location of the team in which providers worked (urban or rural) and provider perceptions of their effectiveness and accessibility of support services. After controlling for provider variables, patients' socio-economic status, the reason for the visit and providers' perceptions of the 'appropriateness' of addressing risk factors in the consultation were all significantly associated with providing optimal intervention. Together, measured patient consultation and provider variables accounted for most (80%) of the variation in intervention practices between providers.

Conclusion

The findings highlight the importance of provider factors such as beliefs and attitudes, team location and work context in understanding variations in the provision of lifestyle intervention in PHC. Further studies of this type are required to identify variables that improve the proportion of variance explained in assessment practices.

Evaluating assessment practices in design based learning environment

This investigation is focused on evaluating assessment practices in design based learning environment. The School of Engineering at Deakin University practices project/design based learning as one of its learning and teaching approach. When identifying graduate attributes particularly for undergraduate engineering programs in Australia, the program accrediting body Engineers Australia (EA) initiates a set of graduate attribute elements which was mentioned in “Stage1 competencies and elements of competency”. Stage1 competencies state that one of the important engineering application ability for graduates is ‘application of systematic engineering synthesis and design processes’. By practicing the design focused learning environment and evaluating students perceptions, This investigation examines students’ experiences of assessment practices in their curriculum through an online survey given to the same cohort of students in third year and fourth year undergraduate engineering.

Antisubjectivism and the (spectral) return of consciousness in landscape research

This paper analyses the changing conceptions of consciousness within landscape research over a critical period from the late 20th century to the present. The 1980s and 1990s mark a radical shift in the framing of consciousness away from psychological, perceptual, or experiential perspectives towards an ontology of consciousness as signifier, cultural artifact, and ideology. In cultural geography and the visual arts, these reframings can be characterised as anti subjectivist in that they do not attempt to problematize human consciousness so much as deactivate it and disqualify it from discussion. I draw out the theoretical and critical foundations of these antisubjectivist approaches as well as the subsequent opening out of the notion of landscape in more recent discussion. This ‘opening out’ implicates a more complex reengagement with minds, bodies, and landscapes and with the contested distinctions between subject and object. At the same time however, consciousness is seldom formulated explicitly within the literature and hence consciousness often occupies a spectral presence in the landscape of landscape research. I use one of my own paintings, Dalek in Landscape, to presage the discussion and attempt to highlight the tensions between these ideological, cultural and biological dimensions of consciousness at play within the landscape idea. Given the broader adoption of these anti-subjectivist developments within the academy, the example of landscape serves as a potentially useful case study for thinking upon the changing conceptions of consciousness in cognate creative and academic disciplines.

The surveillance of social networking and the social value of privacy

This chapter argues that theories about privacy would benefit from embracing deliberative democratic theory on the grounds that it addresses harms to democracy, and widens our understandings of privacy infringements in social networking environments. We first explore how social networking services (SNS) have evolved through different phases and how they enable political deliberation. Subsequently, we discuss more traditional individualistic and intersubjective theories of privacy in relation to social networking and point out their limitations in identifying and redressing social networking-related harms. We then critique emerging claims concerning the social value of privacy in the context of the social Web. Here we point out how these theories might identify non-individualized harms, yet, at the same time, suffer important challenges in application. We conclude by arguing that deliberative democratic theory can add some critical insights into the privacy harms encountered on the contemporary “social Web” that are only imperfectly understood by individualistic and social conceptions of privacy.

The magnitude of association between overweight and obesity and the risk of diabetes: a meta-analysis of prospective cohort studies

The objectives of this meta-analysis were to examine the magnitude of the relative risk (RR) of developing type 2 diabetes for overweight and obese populations, compared to those with normal weight, and to determine causes of the variation in RR between various cohort studies. The magnitude of the RR was analyzed by combining 18 prospective cohort studies that matched defined criteria. The variance in RR between studies was explored. The overall RR of diabetes for obese persons compared to those with normal weight was 7.19, 95% CI: 5.74, 9.00 and for overweight was 2.99, 95% CI: 2.42, 3.72. The variation in RR among studies was explored and it was found that the effect of heterogeneity was highly related with sample size, method of assessment of body mass index (BMI) and method of ascertainment of type 2 diabetes. By combining only cohort studies with more than 400 cases of incident diabetes (>median), adjusted by at least three main confounding variables (age, family history of type 2 diabetes, physical activity), measured BMI, and diabetes determined by clinical diagnosis, the RR was 7.28, 95% CI: 6.47, 8.28 for obesity and 2.92, 95% CI: 2.57, 3.32 for overweight.

The League of Nations and the Refugees from Nazi Germany. James G. McDonald and Hitler’s victims

Greg Burgess's important new study explores the short life of the High Commission for Refugees (Jewish and Other) Coming from Germany, from its creation by the League of Nations in October 1933 to the resignation of High Commissioner, James G. McDonald, in December 1935.The book relates the history of the first stage of refugees from Germany through the prism of McDonald and the High Commission. It analyses the factors that shaped the Commission's formation, the undertakings the Commission embarked upon and its eventual failure owing to external complications.The League of Nations and the Refugees from Nazi Germany argues that, in spite of the Commission's failure, the refugees from Nazi Germany and the High Commission's work mark a turn in conceptions of international humanitarian responsibilities when a state defies standards of proper behaviour towards its citizens. From this point on, it was no longer considered sufficient or acceptable for states to respect the sovereign rights of another if the rights of citizens were being violated. Greg Burgess discusses this idea, amongst others, in detail as part of what is a crucial volume for all scholars and students of Nazi Germany, the Holocaust and modern Jewish history.

Privacy, surveillance, and the democratic potential of the social web

This chapter argues that theories about privacy would benefit from embracing deliberative democratic theory on the grounds that it addresses harms to democracy, and widens our understandings of privacy infringements in social networking environments. We fi rst explore how social networking services (SNS) have evolved through diff erent phases and how they enable political deliberation. Subsequently, we discuss more traditional individualistic and intersubjective theories of privacy in relation to social networking and point out their limitations in identifying and redressing social networking-related harms. We then critique emerging claims concerning the social value of privacy in the context of the social Web. Here we point out how these theories might identify non-individualized harms, yet, at the same time, suff er important challenges in application. We conclude by arguing that deliberative democratic theory can add some critical insights into the privacy harms encountered on the contemporary “social Web” that are only imperfectly understood by individualistic and social conceptions of privacy

Memory, image, matter: Trauma and acts of un-forgetting

How might we conceive of the role of memory as a non-representational mode of commemoration that reconstitutes and transforms lived experience? In this paper I will draw on aspects on Indigenous epistemology and apply conceptions of memory outlines in works of Edward Casey, Henri Bergson and others to consider how social and psychological effects of trauma are manifested through generations. An understanding of the relationship between images, memory and matter and of memory as a primarily eidetic and material process may also help to suggest how some people may be able to avoid or overcome trauma. As image production, art-making generates images that like memory, perform acts of "unforgetting" through which the past is returned as a presence that is materially apprehended. This process can both sustain and transform individual and collective histories. Central to this idea is the notion that, the structure of mind and of memory are co-extensive with the external world an that the articulation of consciousness is crucially dependent on space and place.

A systematic review of body dissatisfaction and sociocultural messages related to the body among preschool children.

This systematic review examines body dissatisfaction and the influence of sociocultural messages related to body image among preschool children. The review was conducted according to the PRISMA guidelines and 16 studies were included in the final analysis. Findings suggest that children under the age of 6 years old experience body dissatisfaction, however, the proportion of children who are dissatisfied varied from around 20% to 70%, depending on the method of assessment. The literature was divided on whether preschool aged girls experience more body dissatisfaction than boys. Parental influence appears to be an important factor in the development of preschool children's body dissatisfaction and attitudes. However, more research is needed to understand the influences of children's peers and the media. The need for more sensitive measures of body dissatisfaction and prevention programs for preschool children is discussed.

The emergence of

The emergence of as developed by the International Integrated Reporting Council (IIRC) is traced from antecedent concepts of integrated reporting and earlier voluntary corporate reporting initiatives. The paper uses actor network theory and its conceptions of detour, affordance and laboratory to examine the development of while still controversial and where meanings remained open and malleable to the inscription of interests from a wide coalition of actors. The programme of action is interpreted through interviews with key individuals, official documents, publications and integrated reports circulated by the IIRC. The analysis highlights the imperatives of private standard setters and indicates how integrated reporting corporate governance regulation in South Africa provided a laboratory prototype for reshaping the UK Connected Reporting initiative into the IIRC framework. The analysis reveals important detours and the associated affordances made during the development of : (a) the repositioning of in the corporate reporting infrastructure to ensure that it did not usurp the pre-existing frameworks of supporting actors; and (b) the specification of providers of financial capital as the intended reporting audience to ensure that it could meet the interests of those actors seeking a solution for more entity-specific, communicative, de-cluttered corporate reporting.

Fostering cultural diversity in Australia: a case study of teaching, learning and assessing African musical arts

Australia is forged by ongoing migration welcoming a range of cultures, languages and ethnicities thus celebrating a diverse range of musical arts. In this multicultural society, music and dance may serve as a positive medium to transmit and promote social cohesion. I argue that the inclusion of innovative and immersive practice of African music in particular where authentic teaching and learning is facilitated may help foster understandings of culture in educational settings and the wider society. As a migrant forming part of the African Diaspora in Melbourne, I am strongly connected to my ancestral homeland (South Africa) when teaching African music to Australian tertiary students. Having gained ethical clearance to undertake the two research projects at Deakin University in Melbourne (Attitudes and perceptions of Arts Education Students: preparing culturally responsive teachers and Pre-service teacher attitudes and understandings of Music Education), I discuss tertiary students experience in relation to the teaching and learning of African music within higher education courses. Drawing on interview, questionnaire, observation notes, anecdotal feedback and narrative reflection, I employ Interpretative Phenomenological Analysis to analyse and code the data into themes. By offering a discussion of assessment and evaluation, I explore and invite international dialogue in regards to how best we can prepare, assess and evaluate our students to improve the quality of musical arts education.

The diagnosis of attention-deficit/hyperactivity disorder in Australian children: current paediatric practice and parent perspective

Aims In a sample of newly diagnosed children with attention-deficit/hyperactivity disorder (ADHD), the aims were to examine (1) paediatrician assessment and management practices; (2) previous assessments and interventions; (3) correspondence between parent-report and paediatrician identification of comorbidities; and (4) parent agreement with diagnosis of ADHD. Methods Design: cross-sectional, multi-site practice audit with questionnaires completed by paediatricians and parents at the point of ADHD diagnosis. Setting: private/public paediatric practices in Western Australia and Victoria, Australia. Main outcome measures: paediatricians: elements of assessment and management were indicated on a study-designed data form. Parents: ADHD symptoms and comorbidities were measured using the Conners 3 ADHD Index and Strengths and Difficulties Questionnaire, respectively. Sleep problems, previous assessments and interventions, and agreement with ADHD diagnosis were measured by questionnaire. Results Twenty-four paediatricians participated, providing data on 137 patients (77% men, mean age 8.1 years). Parent and teacher questionnaires were used in 88% and 85% of assessments, respectively. Medication was prescribed in 75% of cases. Comorbidities were commonly diagnosed (70%); however, the proportion of patients identified by paediatricians with internalising problems (18%), externalising problems (15%) and sleep problems (4%) was less than by parent report (51%, 66% and 39%). One in seven parents did not agree with the diagnosis of ADHD. Conclusions Australian paediatric practice in relation to ADHD assessment is generally consistent with best practice guidelines; however, improvements are needed in relation to the routine use of questionnaires and the identification of comorbidities. A proportion of parents do not agree with the diagnosis of ADHD made by their paediatrician.

Literary English and the challenge of multimodality

How to understand and argue for the nature and place of literary texts and experience in contemporary English curriculum has been and continues to be the subject of much debate. While literature as traditionally conceptualised remains an important presence in much English curriculum, the notion of what 'literature' is, or what the category of 'literary' texts and cultural forms might encompass, in a context where literacy is understood as multimodal and English and literacy curriculum addresses multimodal literacies accordingly, is less clear. This paper addresses two areas with respect to literature and literature teaching in the digital age: first, issues surrounding the ways in which national curriculum guidelines in England and Australia envisage the teaching of literature, in principle and in practice; and second, the challenges presented to print-based conceptions of literature and literature teaching within English by significantly broader conceptualisations of literature encompassing a range of aesthetic multimodal texts and forms. The kinds of insights, experience and understandings generated through the study and creation of literary and aesthetic texts in English, it is argued, are now needed more than ever. However, as literary experience becomes increasingly transmodal, how English seeks to manage media shift to encompass both print and digital forms remains a challenging issue.

Conceptual domain of the matrix in fragmented landscapes

In extensively modified landscapes, how the matrix is managed determines many conservation outcomes. Recent publications revise popular conceptions of a homogeneous and static matrix, yet we still lack an adequate conceptual model of the matrix. Here, we identify three core effects that influence patch-dependent species, through impacts associated with movement and dispersal, resource availability, and the abiotic environment. These core effects are modified by five 'dimensions': spatial and temporal variation in matrix quality; spatial scale; temporal scale of matrix variation; and adaptation. The conceptual domain of the matrix, defined as three core effects and their interaction with these five dimensions, provides a much-needed framework to underpin management of fragmented landscapes and highlights new research priorities.