Do socioeconomic gradients in women's health widen over time and with age?

A population-based study was conducted to investigate changes over time in women's well-being and health service use by socio-economic status and whether these varied by age. Data from 12,328 mid-age women (aged 45–50 years in 1996) and 10,430 older women (aged 70–75 years) from the Australian Longitudinal Study on Women's Health were analysed. The main outcome measures were changes in the eight dimensions of the Short Form General Health Survey (SF-36) adjusted for baseline scores, lifestyle and behavioural factors; health care utilisation at Survey 2; and rate of deaths (older cohort only). Cross-sectional analyses showed clear socioeconomic differentials in well-being for both cohorts. Differential changes in health across tertiles of socioeconomic status (SES) were more evident in the mid-age cohort than in the older cohort. For the mid-aged women in the low SES tertile, declines in physical functioning (adjusted mean change of –2.4, standard error (SE) 1.1) and general health perceptions (−1.5, SE 1.1) were larger than the high SES group (physical functioning –0.8 SE 1.1, general health perceptions –0.8 SE 1.2). In the older cohort, changes in SF-36 scores over time were similar for all SES groups but women in the high SES group had lower death rates than women in the low SES group (relative risk: 0.79, 95% confidence interval 0.64–0.98). Findings suggest that SES differentials in physical health seem to widen during women's mid-adult years but narrow in older age. Nevertheless, SES remains an important predictor of health, health service use and mortality in older Australian women.

Cervical cancer services for Indigenous Women: Advocacy, Community-Based Research and Policy Change in Australia

Collaborative research undertaken in the state of Queensland, Australia, resulted in major changes in cervical cancer screening and treatment for Indigenous women. Guided by an Indigenous statewide reference group and with an Indigenous researcher playing a lead role, qualitative data were collected using interviews, focus groups, and larger community meetings; and case studies were conducted with health workers and community members from diverse rural, remote and urban communities, to explore the different cultural and structural factors affecting understanding and awareness of cervical cancer and Indigenous women's use of and access to health services for screening, diagnosis and treatment. These data were supplemented by an analysis of clinical data and health service checklists. We discuss the methodology and summarize the key social and structural factors that discourage women from presenting for screening or returning for follow-up. These include women's misunderstanding of cervical cancer screening, fear of cancer, distrust of health services, poor recall and follow-up systems, and the economic and social burden to women presenting for treatment. We describe how the research process and subsequent activities provided Indigenous women with a vehicle for their own advocacy, resulting in important policy and program changes.

A construct of sequential service quality in service encounter chains

Studies of the construct of service quality have traditionally been undertaken from the perspective of the service receiver. More recently, research has focused on both the service provider's perspective and the service receiver's perspective. In addition, there have also been some triadic network approaches to the study of service quality. However, there has been very little research into sequential service quality in service-encounter chains (that is, consecutive service performances in a series of service encounters). The incorporation of connected service encounters in services management can improve understanding of sequential service quality in service-encounter chains. This paper provides a customized construct of sequential service quality and  highlights the importance of time, context, and performance threshold in service-encounter chains. Furthermore, the paper presents a customized six-dimensional construct of sequential service quality.

Pathway planning and 'becoming somebody' : Exploring the tensions between wellbeing and credentialism with students at (educational) risk

This paper maps the policy shifts around the education and training of youth that frame how schools respond to issues of youth' at risk'. These shifts have occurred with the move from the self managing schools marked by market discourses of competition, autonomy and image management that supplanted earlier discourses of welfare and community, through to recent policies in Victoria arising from the Kirby Review of Post compulsory Education and Public Education, the Next Generation undertaken by the Labor government. These reports, and the policies emerging out of them, are producing new discourses about youth and schooling focusing on wellbeing, learning networks and more systemic support for schools at the same time as there is increased accountability and expectations of schools. Drawing on the school exclusion literature from the U.K, and using Bourdieu's notion of habitus, we examine the findings from a recent study undertaken on the Geelong Pathways Planning project, funded through a Victorian government strategy, to discuss how schools respond to such initiatives. The project explored the ways in which students in the Geelong region understood and worked with the job planning pathways program, and how service providers (schools, community education facilities, job networks etc) coordinated to meet the needs of individual youth. There was a disjuncture in the participating schools between the discourses of care and welfare for students at risk, and the actual practices and policies that ignored or excluded such students. This paper concludes with a discussion of what might be required systemically, in schools and in their relations to other education providers, to build the capacity to respond more effectively to all students.

Identifying the barriers to implementing the Victorian Department of Education and Training guidelines regarding the provisions of nutrient dense food options in school canteens

Aims & rationale/Objectives : To identify barriers to the full implementation of new guidelines regarding school canteen menus launched by The Victorian Education Department in May 2004.
Methods : A self-administered questionnaire was sent to principals, business mangers and canteen managers of 13 secondary schools in South West Victoria covered by The Greater Green Triangle area (response rate 59%). The questions explored the canteen's role, operation, staffing and profits; existence and content of canteen policy; enablers and barriers to the sale of healthier foods; introduction and promotion of healthier foods; and perceived implications of banning less healthy foods.
Principal findings : The study identified several barriers to implementing healthy menus in school canteens, these being largely consistent with those found in other studies. The majority of schools reported they were making attempts to follow the guidelines for school food services, but were experiencing difficulty in proceeding to full implementation. The barriers identified through the study were student preference for less healthy options, concerns about profitability, lack of policy or its active communication and promotion at the school level and competition from other food outlets.
Discussion : There was evidence that healthy foods had not been actively promoted, suggesting that identification of student preferences as a barrier was based on perception rather than observation. The Victorian guidelines are effectively voluntary, with no accountability measures in place.
Implications : Research needs to be conducted to provide reliable and tested information about factors which impact on student choice. Schools would benefit from specialised assistance to formulate business plans for contemporary canteens selling healthy food and a clarification of government policy.
Presentation type : Poster

Opportunities and challenges for global education in social education curriculum

This paper will explore understandings about global education as expressed in national and local curriculum statements. Despite curriculum statements in Studies of Society and Environment area including ‘global’ in their rationale, slippage occurs between policy documents and the translation to standards statements. The curriculum area - Studies of Society and Environment is - changing as new titles describe the field and a more integrated approach is being developed in some states – Tasmania and Victoria, this presents challenges for global education.

My work in global education is a result of many years as a Geography teacher, nine years at the Asia Education Foundation, a leader of teacher study tours to Asia and pre-service teacher education students to Canada and Northern Territory. I am a passionate believer in the power of travel to unsettle, to educate, and to be reminded of all I have, and to be thankful.

Informing decision-making in libraries: informetric research as input to LIS education and practice.(Library and Information Science).

Findings from informetric research represent an important background resource to add to the mix of information useful for resolving difficult and ongoing problems in specific library environments or information service settings. This paper provides examples of informetric research that can be useful input to decision-making in the field of library management and information service provision. This overview takes four of the challenges that Michael Buckland outlined for library research as a way of guiding the discussion of ways that informetric work can be used to inform library decision-making. (1) References are made to relevant informetric work undertaken or conducted in Australia, by Australian researchers, or with Australian data.

Informetrics includes both quantitative and qualitative methods, which when used in combination can provide a rounded set of findings that has great validity for management, policy and service applications. Quantitative methodologies are generally based on bibliometric techniques, such as mining and analysis of data from various bibliographic and textual databases. Qualitative methods include survey, case study and historical approaches. Used in combination, each set of findings adds richness and other perspectives to an analysis.

A systematic policy approach to changing the food system and physical activity environments to prevent obesity

As obesity prevention becomes an increasing health priority in many countries, including Australia
and New Zealand, the challenge that governments are now facing is how to adopt a systematic
policy approach to increase healthy eating and regular physical activity. This article sets out a
structure for systematically identifying areas for obesity prevention policy action across the food
system and full range of physical activity environments. Areas amenable to policy intervention can
be systematically identified by considering policy opportunities for each level of governance (local,
state, national, international and organisational) in each sector of the food system (primary
production, food processing, distribution, marketing, retail, catering and food service) and each
sector that influences physical activity environments (infrastructure and planning, education,
employment, transport, sport and recreation). Analysis grids are used to illustrate, in a structured
fashion, the broad array of areas amenable to legal and regulatory intervention across all levels of
governance and all relevant sectors. In the Australian context, potential regulatory policy
intervention areas are widespread throughout the food system, e.g., land-use zoning (primary
production within local government), food safety (food processing within state government), food
labelling (retail within national government). Policy areas for influencing physical activity are
predominantly local and state government responsibilities including, for example, walking and
cycling environments (infrastructure and planning sector) and physical activity education in schools
(education sector). The analysis structure presented in this article provides a tool to systematically
identify policy gaps, barriers and opportunities for obesity prevention, as part of the process of
developing and implementing a comprehensive obesity prevention strategy. It also serves to
highlight the need for a coordinated approach to policy development and implementation across
all levels of government in order to ensure complementary policy action.

Service migration in autonomic service oriented grids

The introduction of Web services into grids helped to address their two main obstacles to be embraced by business and industry, heterogeneity and useability. However, many problems are still open, e.g., grid reconfiguration, reliability and computing optimization. We argue here that a mechanism that could help solving these problems is Web Service migration, a part of automatic and transparent brokerage. Web service migration presents a number of new requirements not addressed in traditional process migration, being the outcome of Web services specific configuration of hosts and application servers, and availability of Web services / resources state. In this paper we report on our study into the development of a Web service migration facility focused on providing migration of services in a Service Oriented Grid environment. We present a novel approach to Web service migration, embodied in a System Management Broker, which is transparent, interoperable and flexible. We take the requirements of Web services into consideration when discovering suitable destination hosts and match services to suitable grid resources which are able to fulfil the needs of the service. We discuss a number of experiments conducted with different types of grid and Web service applications to highlight the feasibility and effectiveness of our migration facility and demonstrate how our facility significantly improves Service Oriented Grids.

Housing service officers : agents of the state or customer service officers?

Staff employed in the Victorian Office of Housing are invariably required to exercise discretion in their day-to-day work managing housing assets and providing services to public housing tenants. Policies specify processes but they never cover all situations and do not provide guidance on competing objectives. For example, preparing a property for reletting is a process with protocols and budget constraints. However, staff can make procedural variations that compy with policy. These variations, generally learnt from peers on the job, often result in budget over runs, but do result in improved properties for new tenants. Discretion is being exercised in balancing housing asset, budget control and tenant service objectives. A housing officer sums up the enduring tension in balancing objectives in the question and statement:’ Am I an agent of the state or a customer service officer? Because I can’t be both’. Organisationally these tensions are spoken about as ‘management issues’, ‘policy reengineering’ and ‘unrealistic understandings’. Using data from an ethnographic study in the Victorian Office of Housing, the paper addresses the question: ‘What do we know about the way in which front line housing officers manage competing objectives in their daily work and how might this knowledge be usefully used in the development of operational policy?’ The paper will explore the way in which complex administrative rules are used as a device to align staff to the Office of Housing objectives and limit the exercise of discretion by frontline staff. Against the background of this analysis the paper will consider the limitations of rule making and the extent to which other organisational strategies might be important for improvements in service provision in a context of constrained resources and limited resources.

Guideline for the non-surgical management of hip and knee osteoarthritis

Introduction: Chronic disease is a major public health burden on Australian society. An increasing proportion of the population has risk factors for, or at least one, chronic disease, leading to increasing public health costs. Health service policy and delivery must not only address acute conditions, it must also effectively respond to the wide range of health and public service requirements of people with chronic illness.^1,2 Strong primary health care policy is an important foundation for a successful national health delivery system and long term management of public health, and is linked to practical outcomes including lower mortality, decreased hospitalisation and improved health outcomes.¹ National strategic health policy has recently given increased recognition to the importance of chronic disease management, with the Australian Federal Government endorsement of a number of initiatives for the prevention (or delay in onset), early detection and evidence based management of chronic disease, including osteoarthritis.^1,3
Chronic musculoskeletal conditions, including arthritis, account for over 4% of the national disease burden in terms of disability adjusted life years. Over 6 million Australians (almost one-third of the population) are estimated to have a chronic musculoskeletal disease; chronic musculoskeletal disease represents the main cause of long term pain and physical disability. In Australia, osteoarthritis is self reported by more than 1.4 million people (7.3% of the population4) and is the tenth most commonly managed problem in general practice.5 This number is set to rise as the elderly population grows. Osteoarthritis exerts a significant burden on the individual and the community through reduction in quality of life, diminished employment capacity and an increase in health care costs. For further details, refer to the Evidence to support the National Action Plan for Osteoarthritis, Rheumatoid Arthritis and Osteoporosis: Opportunities to improve health-related quality of life and reduce the burden of disease and disability (2004).⁶
As such, federal government health policy has identified arthritis as a National Health Priority Area and adopted a number of initiatives aimed at decreasing the burden of chronic disease and disability; raising awareness of preventive disease factors; providing access to evidence based knowledge; and improving the overall management of arthritis within the community.4 In 2002, all Australian health ministers designated arthritis and musculoskeletal conditions as Australia’s seventh National Health Priority Area. In response, a National Action Plan was developed in 2004 by the National Arthritis and Musculoskeletal Conditions Advisory Group (NAMSCAG).6 The aim of this document was to provide a blueprint for national initiatives to improve the health related quality of life of people living with osteoarthritis, rheumatoid arthritis and osteoporosis; reduce the cost and prevalence of these conditions; and reduce the impact on individuals, their carers and their communities within Australia. The National Action Plan was developed to complement both the National Chronic Disease Strategy – which is broader – and the National Service Improvement Framework for Osteoarthritis, Rheumatoid Arthritis and Osteoporosis, in addition to other national and state/ territory structures.

How do school day activity patterns differ with age and gender across adolescence?

Purpose
A knowledge of how young people use their time could be instrumental in informing health interventions, modeling consumer behaviors, and planning service delivery. The aim of the present study was to describe age- and gender-related patterns in the self-reported use of time on school days in a large sample of Australian children and adolescents aged between 10 and 18 years.

Methods
A single, detailed use-of-time diary for a school day was collected from 6024 Australians aged 10–18 from several state and regional surveys conducted in the states of South Australia (SA) and Victoria between 2001 and 2006. Time–use profiles were analyzed for a range of active and sedentary state behaviors.

Results
Boys reported higher physical activity levels (PALs), moderate-to-vigorous physical activity (MVPA), and sports than girls. There were no differences in free play, and girls used more active transport. All activity-related variables decreased with age, except active transport, which peaked at 14–15 years. Boys exhibited higher levels of screen time, whereas girls had higher levels of passive transport. Screen time and its components (television, videogames, and computer use) peaked in the peripubertal years.

Conclusion
Age- and gender-related patterns of time use vary greatly within adolescence. This may reflect a mix of biological and social factors.

Boundary crossers, communities, and health : exploring the role of rural health professionals

Boundary crossers understand the culture and language of community and health service domains and have the trust of both. Rural health professionals living within the communities they serve are ideally placed to harness community capacity so as to influence community-level determinants of health. We analyse five case studies of rural health professionals acting as boundary crossers against indicators of capacity for communities and external agents such as health services working in partnership. A more explicit evidence base for inclusion of community health development in the jobs of rural health professionals is needed.

Strategic significance of the island state of Sri Lanka

The study is focused on an analysis of the major diplomatic documents from the mid eighteenth century to the present as regards Sri Lanka, or Ceylon as it was known till 1972. The objectives of the study are to identify the issues underlying these diplomatic documents. These include the political and strategic factors and other subsidiary issues like trade and commerce relevant at the time these treaties, agreements, and proposed treaties were formulated. It is also a geopolitical study as it relates to Sri Lanka's geographical position in the Indian Ocean, and her possession of the Trincomalee Harbour on its east coast, which is one of the great natural harbours of the world. Over the centuries this harbour has had significant strategic value for naval deployments. The case study of the eighteenth and nineteenth centuries studies the diplomatic documents against the political and strategic background for the French Revolution and actions of Napoleon, and the Anglo/French rivalry, spreading from Europe to North America and Asia. In the twentieth century the environment for studying the place of Sri Lanka in the Indian Ocean was created by the Russian Revolution, the failure to keep the peace of Versailles after World War I, the conflict and horrors of World War II which led to the disintegration of European colonial empires in Asia and Africa, and the tensions generated by the Cold War. A study of the documents would reveal that in international relations what matters is the ability of a party to promote its interests, and this depends on its power. This realist approach contrasts to the idealist approach where policies are based on moral and ethical principles. For the realist the states should follow to protect their interests and to survive. To achieve this is to strive for a ‘balance of power’. To do so is to form a favourable alliance system. As the documents examined cover a period from the mid-eighteenth century to the later part of the twentieth century, they reflect the changing technologies that have had an influence on naval and military matters. For example, this period witnessed great changes in technology of energy utilized to propel warships, from wind, to steam, to fuel and finally to nuclear power. These changes had an influence in determining strategic policies involving weapon systems and communications within a global and regional setting. The period covered was the beginning of the process described a ‘globalisation’. Its idea is not unique to this century; there were many attempts, in various times of history, to integrate societies within a global context. Viewed in this light, the Anglo-French rivalry of the eighteenth and nineteenth centuries was the indication of a global naval strategy, in which Sri Lanka was a major factor in the Indian Ocean region. This process was associated with the phenomena called the ‘expansion of Europe’. It covered all the oceans of the world and in the nineteenth and twentieth centuries led to the founding of the largest maritime empire the world has ever seen: The British Empire. After World War I, the British naval strength (the basis of the British Empire) and her consequent position as a great power, was challenged by other powers like the United States of America and Japan. After World War II, the US Navy was supreme: and there was a close alliance between Britain and the USA. The strength of the US/British alliance was based on the navy and its bases, which were spread throughout the globe; to project power, and act as deterrence and balancing force. Sri Lanka, due to her strategic position, was a part of this evolving process, and was tied to a global strategy (with its regional connotations) from the eighteenth century to the present.