Knowing from where?

Exploring western philosophies which have shifted down through time but have also held firm on key features that dominate, separate and shatter at the core I realised this was not us as I tried to "develop the right orientation to ourselves and our place first" (Meyer2003 : 60) as an Arabana udyurla. Thus, despite there being some opportunity here and there within these philosophic positions I turned to the Ularaka -- the Arabana worldview -- to consider methodology and method drawing from our ancient knowledge. The sun shone brightly. I was able to 'See...hear...feel and smell (take it in)' -- think. My approach shifted from a marking out of an Indigenous space within or being an addendum to western philosophies to understanding and therefore doing from an embodiment and embodying within the ontologies and cultural knowledge of the Ularaka. From here while in dialogue with and being 'grown' or mentored by key Elders, I could powerfully experience, engage and interpret 'data' from an Indigenous knowledge position.

Staying connected : the lived experiences of volunteers and older adults

Many housebound older adults lack meaningful social relationships. In this study we explore the phenomenon of social connectedness in the volunteer-older adult relationship through the experiences of frail and isolated older adults and volunteers. We conceptualise this relationship as a journey whereby each traveller plays an active role in its direction and outcome. The emergent phenomenological essence of social connectedness from these dyad’s narratives provides meaning for both differences and similarities into the way the construct is conceptualised. When volunteers maintain the boundaries of the relationship through structured conversation and visits, it is described as friendly. Transgressing the boundaries involves doing extra for the elder and is both a function of the dyad’s compatibility, and the volunteer’s sense of ongoing agency and lack of elder expectations. The sense of social connectedness inherent in these relationships often feels like that of friendship or family, and these relationships are perceived as meaningful and close for both parties. Social connectedness in family-like relationships is a function of the playing out of an otherwise missing family role. However, if volunteer volition is compromised, this results in feelings of obligation and responsibility, similar to the dynamic between blood relatives. Participants’ narratives suggest that when the boundaries of the relationship are mutually negotiated, this serves to strengthen the relationship’s socioemotional quality, and potential for the continuity of the unique sense of social connectedness that has already been established.

Maintaining dignity and managing stigma in the interview encounter : the challenge of paid-for participation

The interview is both popular and problematic in social research. In this article, we describe and make problematic interviews from a study conducted with impoverished elders in Melbourne, Australia. Participants were paid $20 for each of two interviews. The result of the paid-for participation was double-edged in that it provided funds for impoverished participants, but the payment modified the exchange of free and open discussion. We describe key exchanges within the research interviews to exemplify how participants managed their experience and presentation of stigma and dignity. We demonstrate, with examples from the transcripts, strategies used by participants to gain agency over the process, while at the same time maintain enough of a semblance of conversational genre to make paid-for participation legitimate. We see this as an interesting methodological event that should inform analysis, interpretations, and the validity of interviews, rather than a problem with the interviewee.

Talking it up! Project report : Aboriginal voices in the formulation of health policy that works : short report

Initially, there were three separate strands to the work of the project: a series of forums involving group interviews/discussions with community members; a policy analysis that reviewed policies relating to Aboriginal health at federal and state level; and a literature review. The results of these three separate strands of analysis were then brought together in a fourth strand to the work, a process involving community members to discuss and agree the overall recommendations contained in this report.

Through this structure, the project employed a participatory methodology as the basis for individual and collective empowerment in relation to health outcomes. As mentioned above, the need for the project was identified by Aboriginal people, through their own processes of healing. The need was presented by appropriate figures within their communities, namely community elders. They invited other Aboriginal people to take part through their own communication channels, thus ensuring that responsibility for engagement in the project, and in formulating action for improvement, remained with Aboriginal people and their families. However, the project design also recognised that Aboriginal people exist within broader structural and policy constraints which impact on their ability to manage their own lives successfully or otherwise. Thus the project sought to combine indigenous and non-indigenous knowledge through bringing together the three strands of work in the way described.

A Community Reference Group guided the work of the project at all stages, endorsed the findings and drafted the recommendations. The two elders who had identified the need for the project formed the core of the group, and worked on the project from start to finish. At different times during the project, other community members joined the group to assist in its work, including training Aboriginal researchers, letting others know about the forums, discussing findings and drafting recommendations.

Talking it up! Project report : Aboriginal voices in the formulation of health policy that works : full report

Initially, there were three separate strands to the work of the project: a series of forums involving group interviews/discussions with community members; a policy analysis that reviewed policies relating to Aboriginal health at federal and state level; and a literature review. The results of these three separate strands of analysis were then brought together in a fourth strand to the work, a process involving community members to discuss and agree the overall recommendations contained in this report.

Through this structure, the project employed a participatory methodology as the basis for individual and collective empowerment in relation to health outcomes. As mentioned above, the need for the project was identified by Aboriginal people, through their own processes of healing. The need was presented by appropriate figures within their communities, namely community elders. They invited other Aboriginal people to take part through their own communication channels, thus ensuring that responsibility for engagement in the project, and in formulating action for improvement, remained with Aboriginal people and their families. However, the project design also recognised that Aboriginal people exist within broader structural and policy constraints which impact on their ability to manage their own lives successfully or otherwise. Thus the project sought to combine indigenous and non-indigenous knowledge through bringing together the three strands of work in the way described.

A Community Reference Group guided the work of the project at all stages, endorsed the findings and drafted the recommendations. The two elders who had identified the need for the project formed the core of the group, and worked on the project from start to finish. At different times during the project, other community members joined the group to assist in its work, including training Aboriginal researchers, letting others know about the forums, discussing findings and drafting recommendations.
Initially, there were three separate strands to the work of the project: a series of forums involving group interviews/discussions with community members; a policy analysis that reviewed policies relating to Aboriginal health at federal and state level; and a literature review. The results of these three separate strands of analysis were then brought together in a fourth strand to the work, a process involving community members to discuss and agree the overall recommendations contained in this report.

Through this structure, the project employed a participatory methodology as the basis for individual and collective empowerment in relation to health outcomes. As mentioned above, the need for the project was identified by Aboriginal people, through their own processes of healing. The need was presented by appropriate figures within their communities, namely community elders. They invited other Aboriginal people to take part through their own communication channels, thus ensuring that responsibility for engagement in the project, and in formulating action for improvement, remained with Aboriginal people and their families. However, the project design also recognised that Aboriginal people exist within broader structural and policy constraints which impact on their ability to manage their own lives successfully or otherwise. Thus the project sought to combine indigenous and non-indigenous knowledge through bringing together the three strands of work in the way described.

Positive pathways for couples and families : meeting existing and emerging challenges of relationships

There is a growing need to develop an understanding of the positive pathways that strengthen the relationships of Australian couples and families. The couples and families in contemporary society are faced with many challenges and pressures that can mitigate against maintaining satisfying and enduring couple and family relationships. For example, increasing need for dual income families, longer working hours and demographic shifts that see older people living longer and children staying at home longer mean that couples are often required to provide familial care across two generations – frail ageing parents and children. These highlight just some of the pressures faced which can lead to couples not taking the time to cultivate their relationships. The aim of the workshop was to deal with many of these issues by linking research, policy and practice in ways that would help families meet such challenges. The two-day workshop, held 1-2 November 2008 in Melbourne, brought together leading and emerging Australian and international relationship researchers with practitioners, educators, policy makers and service-delivery organisations. Alongside the Academy, the event was sponsored by Deakin University, the University of Queensland, the Department of Families, Housing and Community Services and Indigenous Affairs (FaCHSIA), the Attorney General's Department (AG Department), the Australian Institute of Family Studies (AIFS) and Lifeworks. The workshop comprised seven sessions and two break-out discussions. A total of 28 participants attended the workshop. Of these participants, there were 19 speakers and 7 delegates from the various sponsor organisations that took part in group discussions.

Gut health immunomodulatory and anti-inflammatory functions of gut enzyme digested high protein micro-nutrient dietary supplement-Enprocal

Background: Enprocal is a high-protein micro-nutrient rich formulated supplementary food designed to meet the nutritional needs of the frail elderly and be delivered to them in every day foods. We studied the potential of Enprocal to improve gut and immune health using simple and robust bioassays for gut cell proliferation, intestinal integrity/permeability, immunomodulatory, anti-inflammatory and anti-oxidative activities. Effects of Enprocal were compared with whey protein concentrate 80 (WPC), heat treated skim milk powder, and other commercially available milk derived products.

Results: Enprocal (undigested) and digested (Enprocal D) selectively enhanced cell proliferation in normal human intestinal epithelial cells (FHs74-Int) and showed no cytotoxicity. In a dose dependent manner Enprocal induced cell death in Caco-2 cells (human colon adencarcinoma epithelial cells). Digested Enprocal (Enprocal D: gut enzyme cocktail treated) maintained the intestinal integrity in transepithelial resistance (TEER) assay, increased the permeability of horseradish peroxidase (HRP) and did not induce oxidative stress to the gut epithelial cells. Enprocal D upregulated the surface expression of co-stimulatory (CD40, CD86, CD80), MHC I and MHC II molecules on PMA differentiated THP-1 macrophages in coculture transwell model, and inhibited the monocyte/lymphocyte (THP-1/Jurkat E6-1 cells)-epithelial cell adhesion. In cytokine secretion analyses, Enprocal D down-regulated the secretion of proinflammatory cytokines (IL-1β and TNF-α) and up-regulated IFN-γ, IL-2 and IL-10.

Conclusion: Our results indicate that Enprocal creates neither oxidative injury nor cytotoxicity, stimulates normal gut cell proliferation, up regulates immune cell activation markers and may aid in the production of antibodies. Furthermore, through downregulation of proinflammatory cytokines, Enprocal appears to be beneficial in reducing the effects of chronic gut inflammatory diseases such as inflammatory bowel disease (IBD). Stimulation of normal human fetal intestinal cell proliferation without cell cytotoxicity indicates it may also be given as infant food particularly for premature babies.

Passing time in Clifton Court : an ethnographic study of a unit for confused older people

An exploration of how the residents of a 30 bed unit for confused older people spent their time and a description of the impact upon this of any associated factors. The study demonstrates that it is possible for for elders with dementia and mental health problems to enjoy a range of activities, however, these need to be individualised to take into account the skills they have to meet the challenges with which they are presented. The informed contribution from the activities personnel and the support of nurses is vital to ensure a high quality of social interaction. Sound leadership at the clinical level is essential.

Frailty, aging, and incontinence in the elderly : an interactive case-based discussion of best practices

Urinary incontinence and frailty are both highly prevalent in older adults. Workshop goals include review of available evidence on frailty and differentiation from normal physiological aging. The influence of frailty on continence in older adults will be examined. Presentations will explore associated risks such as falls, pressure ulcers, and nursing home placement, as well as barriers and facilitators of continence care in various living environments. The role of urodynamics and various treatments will be considered. A majority of the session will focus on interactive discussion of case-based examples of common but challenging clinical situations seen in frail older adults.

Vascular access surveillance : the role of the access nurse in the renal dialysis unit.

Introduction
In January 2006, the Renal Dialysis Unit at Geelong Hospital appointed a Vascular Access Nurse. A Transonic Flow Qc HDO2 Ultrasound Dilution Monitor was purchased to monitor access flow and recirculation in arteriovenous fistulae in an attempt to predict AVF stenoses requiring early surgical correction.

Methods
A bi-monthly monitoring program tested all facility-based patients. 82 patients were assessed for access flow and recirculation between February and December 2006.

Results
18 (22%) had poor AVF function; 13 with access flows <500ml/minute on initial testing and 5 with an access flow decreasing >25% over a four month period. Of the 18 patients shown to have poor access flow, 2 died within one month of measurement while 5 were too frail to attempt corrective surgery. The remaining 11 proceeded to ultrasound or fistulography. A >50% stenosis was detected in all 11 cases. Of these, 4 had successful vein patch surgery and one had PTFE grafting, each with marked improvement in access flow. One had failed vein patch surgery requiring creation of a femoral AVF, one patient required cvc insertion to await AVF creation, and one had failed stenting requiring a permanent cvc. 3 died before planned surgery.

Conclusion
5 of the 82 patients that had access flow assessment, and needed further evaluation, proceeded to successful pre-emptive surgical intervention. We believe the Transonic is a useful adjunct to routine clinical AVF surveillance, in providing early evidence of AVF failure that can be avoided by pre-emptive surgery.

Walking for recreation and perceptions of the neighbourhood environment in older chinese urban dwellers

Engagement in walking for recreation can contribute to healthy aging. Although there is growing evidence that the neighborhood environment can influence walking for recreation, the amount of such evidence in relation to older adults is scarce and limited to Western low-density urban locations. Asian urban environments are typified by distinctive environmental and cultural characteristics that may yield different patterns to those observed in Western countries. Therefore, the main aim of this study was to examine associations of perceived environmental attributes with overall and within-neighborhood walking for recreation in Chinese elders (65+ years) residing in Hong Kong, an ultradense Asian metropolis. A sample of 484 elders was recruited from 32 neighborhoods stratified by socio-economic status and walkability (dwelling and intersection densities). Validated questionnaires measuring perceived neighborhood environment and weekly minutes of overall and within-neighborhood walking for recreation were interviewer administered. Results showed that the level of recreational walking was twice to four times higher than that reported in Western adults and elders. While overall walking for recreation showed a general lack of associations with perceived environmental attributes, within-neighborhood recreational walking was positively related with proximity of recreational facilities, infrastructure for walking, indoor places for walking, and presence of bridge/overpasses connecting to services. Age and educational attainment moderated the associations with several perceived environmental attributes with older and less-educated participants showing stronger associations. Traditional cultural views on the benefits of physical activity and the high accessibility of facilities and pedestrian infrastructure of Hong Kong may explain the high levels of walking. Although specific neighborhood attributes, or their perception, may influence recreational walking within the neighborhood, the compactness and public transport affordability of ultradense metropolises such as Hong Kong may make it easy for elders to compensate for the lack of favorable neighborhood attributes by walking outside the neighborhood.

Inclusion in participatory research: what were the whitefellas doing in an Aboriginal health project?

Health research in indigenous communities, like many interactions between such communities and white-dominated institutions, has a chequered history leading to a three-fold decrement: suspicion and resistance to research that is seen as coming from outside of the community; a shortage of research generators and leaders within the community; and cumulative gaps in the research evidence base, both in terms of coverage of topics and in terms of meeting the priorities of the community.

Additionally, these decrements have been mistakenly located as problems being caused from within the community, rather than recognising that these are outcomes of wider contextual, historical and institutional factors and failings. Good research, as culturally appropriate, inclusive of community voices and meeting the needs and priorities of the community, is necessary in an increasingly evidence-based-practice culture within policy and health settings. Culturally safe research with and for indigenous communities has the potential to be empowering, and to bring community voices, views and experiences into the influential realm of'evidence.

This process of developing safe, appropriate and inclusive research is not straightforward: the decrements are recursive, with a shortage of connections between the community, its priorities and research. However, as the Healing Stories project that we discuss here has shown, it is possible to develop culturally safe participatory research by working with Elders from within the community and with leaders from within white institutions, in a spirit of reconciliation. The methods and findings of Healing Stories have been reported elsewhere, with an emphasis on the voices from the community; this chapter explores some of the 'behind the scenes' processes, from the perspective of the white researchers working from within white- dominated institutions.

After briefly describing the Healing Stories project, this chapter reflects on three parts of the participatory research process: getting started, leading together, and working together. The first of these considers laying the foundations for participatory research, working with Elders and leaders, and planning for inclusion, examining participatory research as a recognisable research design, with potential for rigour, cultural safety and inclusion. The second explores developing participatory methods, working with communities, and opportunities and choices for inclusion. The third examines the process of being participatory, working together and engaging in inclusion across the long-term commitment to the project.

Reliability and validity of the IPAQ-L in a sample of Hong Kong urban older adults : does neighborhood of residence matter?

This study examined reliability and validity of the Chinese version of the International Physical Activity Questionnaire–Long Form (IPAQ-LC) in Chinese seniors, including moderating effects of neighborhood walkability and socioeconomic status (SES) on reliability and validity. The IPAQ-LC was interviewer-administered (n = 96), accelerometer and 7-day walk-diary data were collected (n = 94), and the IPAC-LC was readministered (N = 92). Acceptable reliability was found for all measures of physical activity (PA) overall and across different types of neighborhood. Participants from highly walkable neighborhoods were more reliable at estimating walking for transport. Participants from low-SES areas were less reliable at estimating leisure-time PA and sitting but more reliable at estimating transport-related walking. IPAQ-LC walking was significantly related to light- but not moderate-intensity accelerometry-based PA. It was moderately to strongly related to a 7-day diary of walking. The data imply slow-paced walking, probably due to age, climate, and terrain. The findings suggest that the IPAQ-LC’s reliability and validity are acceptable in Chinese seniors.

Carving into country: the work of Badger Bates

Badger Bates (William Brian Bates) was born on the Darling River at Wilcannia in 1947. His grandmother, Granny Moysey, a revered Paakantyi woman who spoke several Aboriginal languages, raised him, teaching him stories and traditional songs. This was the beginning of Badger’s journey into a complex and sophisticated knowledge system. As a child Badger experienced the knowledge and practice imparted by his grandmother which informs his artwork today. Badger learnt carving from her and other Paakantyi elders, and by 1986 he was selling his carvings of wood and emu eggs to the Australian Museum in Sydney.

Socioeconomic status, neighborhood characteristics, and walking within the neighborhood among older Hong Kong Chinese

Objective: