Being there: how teachers of students facing adversity promote positive relationships

While it is said that building positive relationships between students and teachers promotes both student emotional wellbeing and learning, the literature currently provides few clues on how to go about building such relations (and the priorities for action) which are grounded in the research. Interviews and a focus group were used to explore the perspectives of experienced teachers in promoting wellbeing among students facing adversity (i.e. prolonged difficulties and misfortune, such as poverty and issues associated with being a refugee). The results showed that teachers who nurtured relationships with students facing adversity meet considerable challenges. Priority challenges included grappling with unfamiliar student values; facing their own and other staff judgements; boundary issues; schools becoming refuges in communities under strain; and trying to still care when workplace changes appeared to work against positive teacher–student (TS) relationships. The paper concludes that such relationships are a site of tension, contradiction and intensity. Nevertheless, for these teachers, the specific challenges in relationships laid the foundations for meaningful student learning and mental health promotion.

The Health Education Impact Questionnaire (heiQ): An outcomes and evaluation measure for patient education and self-management interventions for people with chronic conditions

Objective: This paper describes the development and validation of the Health Education Impact Questionnaire (heiQ). The aim was to develop a user-friendly, relevant, and psychometrically sound instrument for the comprehensive evaluation of patient education programs, which can be applied across a broad range of chronic conditions.

Methods: Item development for the heiQ was guided by a Program Logic Model, Concept Mapping, interviews with stakeholders and psychometric analyses. Construction (N = 591) and confirmatory (N = 598) samples were drawn from consumers of patient education programs and hospital outpatients. The properties of the heiQ were investigated using item response theory and structural equation modeling.

Results: Over 90 candidate items were generated, with 42 items selected for inclusion in the final scale. Eight independent dimensions were derived: Positive and Active Engagement in Life (five items, Cronbach's alpha (α) = 0.86); Health Directed Behavior (four items, α = 0.80); Skill and Technique Acquisition (five items, α = 0.81); Constructive Attitudes and Approaches (five items, α = 0.81); Self-Monitoring and Insight (seven items, α = 0.70); Health Service Navigation (five items, α = 0.82); Social Integration and Support (five items, α = 0.86); and Emotional Wellbeing (six items, α = 0.89).

Conclusion:The heiQ has high construct validity and is a reliable measure of a broad range of patient education program benefits.

Practice Implications: The heiQ will provide valuable information to clinicians, researchers, policymakers and other stakeholders about the value of patient education programs in chronic disease management.

Pituitary disease - perspectives of patients and partners

Aim. To explore experiences of pituitary disease of people with pituitary disease (PD) and their partners (PT).

Background. Pituitary disease encompasses a range of hormonal abnormalities that produce a variety of signs and symptoms depending on the underlying cause.

Design. A triangulated exploratory study.

Methods. The study was conducted in three phases: (a) non-participant monitoring of an Internet pituitary chat room over four months; (b) in-depth structured interviews with PD attending a pituitary outpatient clinic (n = 8) and PT (n = 6), (c) focus groups (n = 12). Data were collected in 2005.

Results. Four themes emerged from the discussion in each phase: 'need to be normal', 'emotional merry-go-round', 'damage to the self', and 'doctor ignorance'. Symptoms of pituitary disease were often mistaken for sinusitis, 'getting old before my time', hypochondria, stress, and 'something sinister changing the way I look'. Time to diagnosis varied from four weeks to 15 years. PD felt included in decision-making but partners relied on PD for information. Body image changes were significant making PD feel like a 'freak show for medical students' and the emotional distress persisted after treatment and 'cure'. The word 'tumour' caused significant stress and anxiety and depression was common. PD and PT felt general practitioners (GP) lacked information about pituitary disease.

Conclusions. Pituitary disease has a major impact on psychological well-being. PD but not PT felt involved in decisions about their management. GPs may need more education about pituitary disease. The study adds important information about the emotional effects of pituitary disease and its treatment.

Relevance to clinical practice. Pituitary disease is a generic term encompassing a range of underlying disease processes that often produce vague symptoms, often attributed to other causes, which delays diagnosis and treatment. Pituitary disease has a significant under recognised impact on people's mental and physical wellbeing and self-concept. Although the underlying hormonal imbalances associated with pituitary disease are largely reversible (cured), emotional distress persists. Regular monitoring of emotional wellbeing as well as medical and hormone status is warranted.

Mental health, criminal justice and culture : some ways forward?

Objective: This paper aims to offer an overview of the mental health needs of Indigenous men and women in the criminal justice system and how Indigenous cultural perspectives on mental health might infl uence forensic mental health service provision.
Conclusion: There is a need for both mental health and criminal justice agencies to collaborate more closely in developing new models of service provision that incorporate Indigenous perspectives on social and emotional wellbeing, recognize culturally specifi c mental health risk and protective factors in relation to prevention, early intervention and treatment, and take advantage of the opportunities for treatment that arise in the context of criminal justice system intervention.

The primary caregiver approach

The early years of a child’s life are especially important, and the quality of those experiences set the scene for the future. Children’s first and most enduring bond is within their own family. However, a high proportion of young children in the Australia spend time as the responsibility of non-family adults within the many different types of early years settings.

The NQS outlines through Quality Area 5: Relationships with children, the need for educators to develop and maintain respectful and equitable relationships with each child. These relationships are brought about by educators and children forming trusting and reciprocal bonds where each child feels secure and included.

This book gives practical advice on:

the importance of attachment for children’s emotional wellbeing
implications for early years educators and the need for a primary caregiver system in group settings
details of the role of a primary caregiver for children and their families
dealing with uncertainty about how the primary caregiver system should work
how managers can support educators in their primary caregiver role

Changes in exposure to 'life stressors' in the Aboriginal and Torres Strait Islander population, 2002 to 2008

The Negative Life Events Scale (NLES) has been included in nationally representative surveys of the Indigenous and Australian population since 2002 as a measure of exposure to a range of 'life stressors'. There has been limited reporting or analysis of estimates of the NLES from these surveys. This paper reports changes in exposure to stressors from 2002 to 2008 for the Indigenous population, and examines inter-relationships between eleven NLES items. Data for the 2006 Australian population is also included for comparative purposes.

Associations of diet quality with health-related quality of life in older Australian men and women

This study investigated associations between diet quality measures and quality of life two years later. Adults 55-65 years participating in the Wellbeing, Eating and Exercise for a Long Life (WELL) study in Victoria, Australia (n = 1150 men and n = 1307 women) completed a postal survey including a 111-item food frequency questionnaire in 2010. Diet quality in 2010 was assessed via the dietary guideline index (DGI), recommended food score (RFS) and Mediterranean diet score (MDS). The RAND 36-item survey assessed health-related quality of life in 2012. Associations were assessed using logistic regression adjusted for covariates. In men, DGI and RFS were associated with better reported energy (OR = 1.79, CI: 1.25, 2.55 and OR = 1.56, CI: 1.11, 2.19 respectively), and DGI was additionally associated with better general health (OR = 1.54, 95% CI: 1.08, 2.20), and overall mental component summary scale (OR = 1.51, CI: 1.07, 2.15) in the fully adjusted model. In women, associations between two indices of diet quality (DGI, RFS) physical function (OR = 1.66, CI: 1.19, 2.31 and OR = 1.70, CI: 1.21, 2.37 respectively) and general health (OR = 1.83, CI: 1.32, 2.54 and OR = 1.54, CI: 1.11, 2.14 respectively) were observed. DGI was also associated with overall physical component summary score (OR = 1.56, CI: 1.12, 2.17). Additional associations between emotional wellbeing and DGI (OR = 1.40, CI: 1.01, 1.93) and RFS (OR = 1.44, CI: 1.04, 1.99), and MDS and energy (OR = 1.53, CI: 1.11, 2.10) were observed in the fully adjusted model, in women only. Older adults with better quality diets report better health-related quality of life, with additional associations with emotional wellbeing observed in women.

Explaining psychological insulin resistance in adults with non-insulin-treated type 2 diabetes: the roles of diabetes distress and current medication concerns. Results from diabetes MILES-Australia.

AIMS: To investigate the contribution of general and diabetes-specific emotional wellbeing and beliefs about medicines in the prediction of insulin therapy appraisals in adults with non-insulin-treated type 2 diabetes. METHODS: The sample included Diabetes MILES-Australia cross-sectional survey participants whose primary diabetes treatment was oral hypoglycaemic agents (N=313; 49% women; mean±SD age: 57±9 years; diabetes duration: 7±6 years). They completed validated measures of beliefs about the 'harm' and 'overuse' of medications in general (BMQ General); 'concerns' about and 'necessity' of current diabetes medications (BMQ Specific); negative insulin therapy appraisals (ITAS); depression (PHQ-9); anxiety (GAD-7), and diabetes distress (DDS-17). Factors associated with ITAS Negative scores were examined using hierarchical multiple regressions. RESULTS: Twenty-two percent of the variance in ITAS Negative scores (52±10), was explained by: number of complications (β=-.15, p=.005), DDS-17 subscale 'emotional burden' (β=.23, p<.001), and 'concerns' about current diabetes treatment (β=.29, p<.001). General beliefs about medications and general emotional wellbeing did not contribute significantly to the model. CONCLUSIONS: Psychological insulin resistance may reflect broader distress about diabetes and concerns about its treatment but not general beliefs about medicines, depression or anxiety. Reducing diabetes distress and current treatment concerns may improve attitudes towards insulin as a potential therapeutic option.

The effectiveness of outcome measures for Malaysian children with Down Syndrome

Study found that the assessments used were reliable and acceptable culturally for Malaysian children with Down Syndrome, with some changes on Parent Strengths and Difficulties Questionnaire. To identify specific difficulties with motor movement, level of involvement in the learning process, and socio-emotional wellbeing, the use of accurate assessment tools were crucial among health care teams, especially Occupational Therapist in Malaysia.

Willingness to initiate insulin among adults with type 2 diabetes in Australian primary care: results from the Stepping Up Study

AIMS: To determine 'hypothetical willingness' to initiate insulin, and identify associated factors, among adults with type 2 diabetes (T2DM) in primary care for whom insulin is clinically indicated.

METHODS: Eligible participants were adults with T2DM with an HbA1c ≥7.5% (58mmol/mol) and prescribed maximum oral hypoglycaemic agents. A total of 261 participants were recruited from 74 Victorian general practices: mean age 62±10 years; 39% (n=103) women; diabetes duration 10±6 years; HbA1c 9.0±1.3% (75±14mmol/mol). Data collected by the Stepping Up Study: demographic and clinical characteristics, 'willingness' to initiate insulin, insulin appraisals, depressive symptoms, and diabetes-related distress. A multinomial regression investigated predictors of 'willingness'.

RESULTS: Nineteen percent (n=50) were 'very willing' to initiate insulin, if recommended. The final regression model (R(2)=.44, χ(2)(12) 145.91, p<.001) demonstrated higher socioeconomic status and less negative attitudes to insulin were associated with increased willingness to initiate insulin.

CONCLUSIONS: Among adults with T2DM for whom insulin is clinically indicated, only one in five are 'very willing' to begin insulin therapy. Independent of demographics, clinical factors and emotional wellbeing, insulin appraisals were associated with 'willingness'. This study highlights the importance of addressing attitudinal barriers to insulin therapy among adults with T2DM in primary care to improve insulin receptiveness.

Book Review: Diabetes and wellbeing: Managing psychological and emotional challenges of diabetes types 1 and 2

Book Review in peer revewed Journal of Diabetes Nursing about the psychological and emotional challenges associated with living with Diabetes. The book is recommended to both health professionals and people with Diabetes.

Population health and wellbeing: identifying priority areas for Victorian children

Background
Population health information, collected using soundly-designed methodologies, is essential to inform policy, research, and intervention programs. This study aimed to derive policy-oriented recommendations for the content of a health and wellbeing population survey of children 0–12 years living in Victoria, Australia.

Results
Qualitative interviews were conducted with 54 academic and policy stakeholders, selected to encompass a wide breadth of expertise in areas of public health and inter-sectoral organisations relevant to child health outcomes, including universities, government and non-government agencies across Victoria. These stakeholders were asked to provide advice on strategic priorities for child health information (data) using a structured interview technique. Their comments were summarised and the major themes were extracted. The priority areas of health and wellbeing recommended for regular collection include obesity and its determinants, pregnancy and breastfeeding, oral health, injury, social and emotional health and wellbeing, family environment, community, health service utilisation, illness, and socioeconomic position. Population policy questions for each area were identified.

Conclusion
In contrast to previous population survey programs nationally and internationally, this study sought to extract contemporary policy-oriented domains for inclusion in a strategic program of child health data collection, using a stakeholder consultation process to identify key domains and policy information needs. The outcomes are a rich and relevant set of recommendations which will now be taken forward into a regular statewide child health survey program.

The Resilient Families program: promoting health and wellbeing in adolescents and their parents during the transition to secondary school.

Resilient Families is a school-based prevention program designed to help students and parents develop knowledge, skills and support networks to promote health and wellbeing during the early years of secondary school. the program is designed to build within-family connectedness (parent--adolescent communication, conflict resolution) as well as improve social support between different families, and between families and schools. It is expected to promote social, emotional and academic competence and to prevent health and social problems in youth.

Leaders and their teams : learning to improve performance with emotional intelligence and using choice theory

Looks at the relationship between emotional intelligence and choice theory in the work world, with particular emphasis on the implications on health and productivity. Most of us have a managing or leading role of some sort, whether at home, in community life, or at work. Also, as a professional, one can be leading through professional expertise and not necessarily because of one's place in the organizational hierarchy. There is an increasing awareness of the role of leadership and team development in organizational development, for example in health care where change is needed to manage the chronic disease burden (Dunbar et al., 2007) and utilizing and retaining a dwindling workforce (Schoo, Stagnitti, Mercer, & Dunbar, 2005). This is forcing leaders and their teams to work as smart as they can with resources that are available to them. Positive leadership has been associated with outcomes that include happy relationships, teamwork, learning, recognition, staff retention, and health and wellbeing. There is evidence that emotionally intelligent leaders in workplaces are able to bring about these positive out- comes because they are attuned to the emotions that move people around them (Goleman, Boyatzis, & McKee, 2002). In this sense, emotion can be defined as aroused energy that takes a direction (Hunt, 2004a) (Latin: e = from, movere = to move). Valerie Hunt regards emotion as the metronome of life (Hunt, 2004b). Although emotion can be a feeling state (e.g., fear, anger, joy, hate or sorrow) associated with action, its energy is, according to Hunt, directed to action, to behave(Hunt, 2004b). As mentioned in an earlier publication (Schoo, 2005), Pert (Flowers, Grubin, & Meryman-Brunner, 1993) regards emotions as a bridge that connects the mental and physical realities (p.187), and sees neuropeptides as the physical representations of these emotions. Negative thoughts and emotions such as excitement and anger have been found to increase gut motility, cancer risk and arterial plaque formation which can lead to a heart infarct (Pert, 1997), whereas positive emotions seem to do the opposite.

Wild adventures in wellbeing

This study examined the foundations, features and wellbeing impacts of Australian outdoor adventure interventions (OAI). According to literature- and practice-based evidence, Australian OAI support positive impacts for individuals across physical, emotional, behavioural, social, cultural, spiritual, economic and environmental wellbeing in the Australian context.