Developing a culturally-specific peace curriculum for Vietnamese primary schools : a case study of participatory action research in cross-cultural design

In 2003 the International Conflict Resolution Centre at the University of Melbourne, Australia, produced a primary school teaching manual for UNESCO Vietnam in consultation with ASP schoolteachers and principals. The finished manual included lessons plans and materials for a five year, 50 lesson peace education course. The Manual is one of the first examples of a systematic core national curriculum in peace education worldwide.

Development of the Teaching Manual posed a number of challenges including differences in language, culture, government and education system. To meet these challenges, a Participatory Action Research approach was central in the project’s development and curriculum design. This case study is offered as a model for effective cross-cultural curriculum development of peace education materials. In particular, the creation of a systematic core course in peace education and the use of UNESCO’s peace keys are outlined as innovative aspects of the project.

Developing a peace education curriculum for Vietnamese primary schools : a case study of participatory action research in cross-cultural design

In 2003, the International Conflict Resolution Centre at the University of Melbourne, Australia, produced a primary school teaching manual for UNESCO Vietnam. The finished manual included lesson plans and materials for a five year, 50 lesson peace education course. The manual is one of the first examples of a systematic core national curriculum in peace education worldwide. Development of the Teaching Manual posed a number of challenges including differences in language, culture, government and education system. To meet these challenges, a participatory action research approach was central in the project’s development and curriculum design. This case study is offered as a model for effective crosscultural curriculum development of peace education materials. In particular, the use of games and reflective materials and the use of UNESCO’s peace keys are outlined as innovative outcomes of the project.

Changes in body mass index and health related quality of life from childhood to adolescence

Objective . To determine longitudinal relationships between body mass index (BMI) and health-related quality of life (HRQoL) in an adolescent population sample.
Design. Data collected in 2000 and 2005 within the Health of Young Victorians longitudinal cohort study.
Setting. Originally a community sample of elementary school students in Victoria, Australia. Follow-up occurred in either secondary schools or individuals homes.
Participants. Cohort recruited in 1997 via a random sampling design from Victorian elementary schools. Originally comprising 1 943 children, 1 569 (80.8%) participated in 2000 (wave 2, 8 – 13 years) and 851 (54%) in 2005 (wave 3, 13 – 19 years).
Main outcome measures. In both waves participants and their parents completed the PedsQL, a 23-item child HRQoL measure, and BMI z-scores and status (non-overweight, overweight or obese) were calculated from measured height and weight. Associations were tested cross-sectionally and longitudinally (linear regression, adjusted for baseline values)
Results. A total of 81.6% remained in the same BMI category, while 11.4% and 7.0% moved to higher and lower categories, respectively. Cross-sectional inverse associations between lower PedsQL and higher BMI categories were similar to those for elementary school children. Wave 2 BMI strongly predicted wave 3 BMI and wave 2 PedsQL strongly predicted wave 3 PedsQL. Only parent-reported Total PedsQL score predicted higher subsequent BMI, though this effect was small. Wave 2 BMI did not predict wave 3 PedsQL.
Conclusions. This novel study confi rmed previous cross-sectional associations, but did not provide convincing evidence that
BMI is causally associated with falling HRQoL or vice versa across the transition from childhood to adolescence.

Psychological needs of adolescents in the early phase of bipolar disorder : implications for early intervention

Aim: This paper will describe the rationale for, and importance of, psychological interventions for young people early in the course of bipolar disorder.
Methods: Emerging literature in this field will be discussed in addition to describing specific clinical challenges and opportunities with this population.
Results: In order to be more developmentally appropriate for young people with bipolar disorder, eight aspects of clinical work which may require modification were identified.
Conclusions: The evidence base for the effectiveness of psychological interventions for people diagnosed with bipolar disorder is growing. However, some aspects relating to working with adults with bipolar disorder require modification to be effective in working with young people early in the course of the disorder.

The cost-effectiveness of universal newborn screening for bilateral permanent congenital hearing impairment : systematic review

Objective - Universal newborn hearing screening for bilateral permanent congenital hearing impairment is standard practice in many developed economies, but until there is clear evidence of cost-effectiveness, it remains a controversial use of limited health care resources. We conducted a formal systematic review of studies of newborn hearing screening that considered both costs and outcomes to produce a summary of the available evidence and to determine whether there was a need for further research.

Methods - A search was conducted of medical and nursing databases and gray literature websites by the use of multiple keywords. The titles and abstracts of studies were examined for preliminary inclusion if reference was made to newborn hearing screening, and to both costs and outcomes. Studies of potential relevance were independently assessed by 2 health economists for final inclusion in the review. Studies that met inclusion criteria were appraised by the use of existing guidelines for observational studies, economic evaluations and decision analytic models, and reported in a narrative literature review.

Results - There were 22 distinct observational or modeled evaluations of which only 2 clearly compared universal newborn hearing screening to risk factor screening for bilateral permanent congenital hearing impairment. Of these, the single evaluation that examined long-term costs and outcomes found that universal newborn hearing screening could be cost-saving if early intervention led to a substantial reduction in future treatment costs and productivity losses.

Conclusions - There are only a small number of economic evaluations that have examined the long-term cost-effectiveness of universal newborn hearing screening. This is partly attributable to ongoing uncertainty about the benefits gained from the early detection and treatment of bilateral permanent congenital hearing impairment. There is a clear need for further research on long-term costs and outcomes to establish the cost-effectiveness of universal newborn hearing screening in relation to other approaches to screening, and to establish whether it is a good long term investment.

Preventing mental health problems in children : the families in mind population-based cluster randomised controlled trial.

Background

Externalising and internalising problems affect one in seven school-aged children and are the single strongest predictor of mental health problems into early adolescence. As the burden of mental health problems persists globally, childhood prevention of mental health problems is paramount. Prevention can be offered to all children (universal) or to children at risk of developing mental health problems (targeted). The relative effectiveness and costs of a targeted only versus combined universal and targeted approach are unknown. This study aims to the effectiveness, costs and uptake of two approaches to early childhood prevention of mental health problems ie: a Combined universal-targeted approach, versus a Targeted only approach, in comparison to current primary care services (Usual care).
Design

Three armed, population-level cluster randomised trial (2010-2014) within the universal, well child Maternal Child Health system, attended by more than 80% of families in Victoria, Australia at infant age eight months. Participants: Families of eight month old children from nine participating local government areas. Randomised to one of three groups: Combined, Targeted or Usual care. Intervention: (a) the Combined universal and targeted program where all families are offered the universal Toddlers Without Tears group parenting program followed by the targeted Family Check-Up one-on-one program or (b) the Targeted Family Check-Up program. The Family Check-Up program is only offered to children at risk of behavioural problems. Analysis: Participants will be analysed according to the trial arm to which they were randomised, using logistic and linear regression models to compare primary and secondary outcomes. An economic evaluation (cost consequences analysis) will compare incremental costs to all incremental outcomes from a societal perspective.
Discussion

This trial will inform public health policy by making recommendations about the effectiveness and cost-effectiveness of these early prevention programs. If effective prevention programs can be implemented at the population level, the growing burden of mental health problems could be curbed.

Facial affect recognition and schizotypal personality characteristics

Aim: Deficits in facial affect recognition are well established in schizophrenia, yet relatively little research has examined facial affect recognition in hypothetically psychosis-prone or ‘schizotypal’ individuals. Those studies that have examined social cognition in psychosis-prone individuals have paid little attention to the association between facial emotion recognition and particular schizotypal personality features. The present study therefore sought to investigate relationships between facial emotion recognition and the different aspects of schizotypy.

Methods: Facial affect recognition accuracy was examined in 50 psychiatrically healthy individuals assessed for level of schizotypy using the Schizotypal Personality Questionnaire. This instrument provides a multidimensional measure of schizophrenia proneness, encompassing ‘cognitive-perceptual’, ‘interpersonal’ and ‘disorganized’ features of schizotypy. It was hypothesized that the cognitive-perceptual and interpersonal aspects of schizotypy would be associated with difficulties identifying facial expressions of emotion during a forced-choice recognition task using a standardized series of colour photographs.

Results: As predicted, interpersonal aspects of schizotypy (particularly social anxiety) were associated with reduced accuracy on the facial affect recognition task, but there was no association between affect recognition accuracy and cognitive-perceptual features of schizotypy.

Conclusions: These results suggest that subtle deficits in facial affect recognition in otherwise psychiatrically healthy individuals may be related to the vulnerability for interpersonal communication difficulties, as seen in schizophrenia.

Improving outcomes of preschool language delay in the community : protocol for the Language for Learning randomised controlled trial

Background

Early language delay is a high-prevalence condition of concern to parents and professionals. It may result in lifelong deficits not only in language function, but also in social, emotional/behavioural, academic and economic well-being. Such delays can lead to considerable costs to the individual, the family and to society more widely. The Language for Learning trial tests a population-based intervention in 4 year olds with measured language delay, to determine (1) if it improves language and associated outcomes at ages 5 and 6 years and (2) its cost-effectiveness for families and the health care system.

Methods/Design

A large-scale randomised trial of a year-long intervention targeting preschoolers with language delay, nested within a well-documented, prospective, population-based cohort of 1464 children in Melbourne, Australia. All children received a 1.25-1.5 hour formal language assessment at their 4th birthday. The 200 children with expressive and/or receptive language scores more than 1.25 standard deviations below the mean were randomised into intervention or ‘usual care’ control arms. The 20-session intervention program comprises 18 one-hour home-based therapeutic sessions in three 6-week blocks, an outcome assessment, and a final feed-back/forward planning session. The therapy utilises a ‘step up-step down’ therapeutic approach depending on the child’s language profile, severity and progress, with standardised, manualised activities covering the four language development domains of: vocabulary and grammar; narrative skills; comprehension monitoring; and phonological awareness/pre-literacy skills. Blinded follow-up assessments at ages 5 and 6 years measure the primary outcome of receptive and expressive language, and secondary outcomes of vocabulary, narrative, and phonological skills.

Discussion

A key strength of this robust study is the implementation of a therapeutic framework that provides a standardised yet tailored approach for each child, with a focus on specific language domains known to be associated with later language and literacy. The trial responds to identified evidence gaps, has outcomes of direct relevance to families and the community, includes a well-developed economic analysis, and has the potential to improve long-term consequences of early language delay within a public health framework.

Assessing health literacy : a new domain for collaboration between language testers and health professionals

Health literacy, defined as an individual's capacity to process health information in order to make appropriate health decisions, is the focus of increasing attention in medical fields due to growing awareness that suboptimal health literacy is associated with poorer health outcomes. To explore this issue, a number of instruments, reported to have high internal consistency and strong correlations with general literacy tests, have been developed. However, their validity as measures of the target construct is seldom explored using multiple sources of evidence. The current study, involving collaboration between health professionals and language specialists, set out to assess the validity of the Rapid Estimate of Adult Literacy in Medicine (REALM), which describes itself as a “reading recognition” test that measures ability to pronounce common medical and lay terms. Drawing on a sample of 310 respondents, including both native and non-native speakers of English, investigations were undertaken to probe the REALM's validity as a measure of understanding the selected terms and to consider associations between scores on this widely used test and those derived from other recognized health literacy tests. Results suggest that the REALM is underrepresenting the health literacy construct and that the test may also be biased against non-native speakers of English. The study points to an expanded role for language testers, working in collaboration with experts from medical disciplines, in developing and evaluating health literacy tools.

Can a targeted psychological intervention be effective for young people following a first manic episode? Results from an 18-month pilot study

Aim: There is a scarce literature describing psychological interventions for a young, first-episode cohort who have experienced psychotic mania. This study aimed to assess whether a manualized psychological intervention could be effective in reducing symptomatology and relapse, and improve functional outcome in this population.

Methods: The study was an open-label design, drawn from a larger pharmacotherapy trial. All participants in the pharmacotherapy trial were offered a manualized psychological intervention in addition to case management. Inclusion in the psychotherapy group was based on participant's choice, and on completion of four or more of the eight modules offered. All clinical files were audited to ensure accuracy of group allocation. Forty young people aged 15 to 25 years old who had experienced a manic episode with psychotic features were recruited into the study, with 20 people in the combined treatment as usual plus psychotherapy group (P+TAU), and an equal number of matched control participants who received treatment as usual (TAU) within the same service. All participants were prescribed antipsychotic and mood-stabilizing medication. Symptomatic, functional and relapse measures were taken both at baseline and at 18-month follow-up.

Results: Manic symptoms improved significantly for both groups, with no differences between groups. Depression scores and overall symptom severity were significantly lower in the P + TAU group. No differences were evident between groups with regard to numbers or type of relapse. The P + TAU group had significantly better social and occupational functioning after 18 months.

Conclusion: This study suggests that a manualized psychological intervention targeted to a first-episode population can be effective in reducing depression and overall symptom severity, and can improve functional outcome following a first episode of psychotic mania.

Methazolamide is a new hepatic insulin sensitizer that lowers blood glucose in vivo

We previously used Gene Expression Signature technology to identify methazolamide (MTZ) and related compounds with insulin sensitizing activity in vitro. The effects of these compounds were investigated in diabetic db/db mice, insulin-resistant diet-induced obese (DIO) mice, and rats with streptozotocin (STZ)-induced diabetes. MTZ reduced fasting blood glucose and HbA1c levels in db/db mice, improved glucose tolerance in DIO mice, and enhanced the glucose-lowering effects of exogenous insulin administration in rats with STZ-induced diabetes. Hyperinsulinemic-euglycemic clamps in DIO mice revealed that MTZ increased glucose infusion rate and suppressed endogenous glucose production. Whole-body or cellular oxygen consumption rate was not altered, suggesting MTZ may inhibit glucose production by different mechanism(s) to metformin. In support of this, MTZ enhanced the glucose-lowering effects of metformin in db/db mice. MTZ is known to be a carbonic anhydrase inhibitor (CAI); however, CAIs acetazolamide, ethoxyzolamide, dichlorphenamide, chlorthalidone, and furosemide were not effective in vivo. Our results demonstrate that MTZ acts as an insulin sensitizer that suppresses hepatic glucose production in vivo. The antidiabetic effect of MTZ does not appear to be a function of its known activity as a CAI. The additive glucose-lowering effect of MTZ together with metformin highlights the potential utility for the management of type 2 diabetes.

Australian Unity wellbeing index survey 25.1 part A : report "The wellbeing of Australians - bushfires and floods : following up the effects of fires in Victoria and floods in Queensland"

The Australian Unity Wellbeing Index monitors the subjective wellbeing of the Australian population. Our first survey was conducted in April 2001 and this report concerns a special Survey 25.1, undertaken in October 2011. The survey was commissioned to detect whether the disastrous floods in North Queensland in the period December 2010 through February 2011, and fires in Victoria in the period January through February 2009, continued to affect the subjective wellbeing of people continuing to live in the disaster areas.

This survey involved 1,215 respondents, with 600 drawn from Victoria and 615 from Queensland. The questionnaire comprised only the Personal Wellbeing Index and a small set of demographic questions. In all other respects the methodology of the survey followed our normal procedures.1