Depression, anxiety and stress in women following acute coronary syndrome: implications for secondary prevention

Objective
To document incidence of depression, anxiety, and stress in women more than 6 months following an acute coronary syndrome.

Design
Participants were identified from a coronary care unit database. The Depression Anxiety Stress Scales 21 (DASS 21) was sent to potential participants via postal survey.

Setting
A metropolitan teaching hospital in Melbourne, Australia.

Participants
The cohort of women was aged between 55 and 70 years. They had been admitted to hospital with a diagnosis of acute coronary syndrome (ACS) between 6 and 14 months prior to participating in this study.

Main outcome measures
Scores on Depression, Anxiety, and Stress Scale (DASS 21).

Results
Of the 117 posted questionnaires, 39 women with a mean age of 63 (S.D. 4.97) responded to the survey, representing a response rate of 33.3%. Most participants scored within normal levels of depression (66.7%), anxiety (60.5%), and stress (70.3%), however, mild to extremely severe levels of each construct (33.4%, 39.6%, and 29.7%, respectively) were found.

Conclusions
The reporting of elevated levels of depression, anxiety and stress in a subset of women more than 6 months following an ACS event underscores the importance of ongoing screening for risk factors impacting on psychological well-being and the inclusion of this information in education and counseling strategies in both the inpatient and outpatient settings. Based on these pilot data, consideration of a screening system in the immediate post discharge period for women at risk and an education or support service are recommended.

Permian of West Yunnan, Southwest China: a biostratigraphic synthesis

Recent progress in the study of Permian stratigraphy of western Yunnan, southwest China, is reviewed with particular references to the Tengchong and Baoshan blocks and the Changning–Menglian Belt. Where confusion or controversy exists in stratigraphical nomenclature and/or dating, we attempt to clarify the situation based on our recent field observations and newly obtained research results. The Permian within the Changning–Menglian Belt embraces different stratigraphic successions, suggesting different tectonic settings, ranging from passive margin and active margin, to oceanic basin and seamounts. Permo-Carboniferous faunas in the carbonate sequences of the Changning–Menglian Belt are of typical Cathaysian affinity, as demonstrated by abundant fusulinaceans and compound rugose corals. The Permian stratigraphy and faunas of the Tenchong and Baoshan blocks are markedly different from those of the Changning–Menglian Belt. The Baoshan Block lacks Upper Carboniferous deposits, and its subsequent Lower Permian sequence consists predominantly of siliciclastic strata yielding cool-water faunas and possibly glaciogene diamictites, overlain by thick basaltic lava and volcaniclastics of probably rift origin. The upper part of the Permian in the Baoshan Block is characterized by carbonates containing mixed Cathaysian and Gondwanan faunas. The Tengchong Block has a similar evolutionary history to the Baoshan Block, but completely lacks volcanic rocks.

Rural sports and recreational injuries in Australia: what do we know?

Objective: It is widely recognised that individuals residing in regional or rural areas have poorer health outcomes than those from metropolitan areas. Factors associated with these poorer health outcomes include geographical isolation, population declines, limited health care provision and higher levels of inactivity compared to urban areas. The mental, social and physical health of individuals and communities in rural areas can be improved through active participation in sport and recreation activities. Unfortunately, participation in such activities can potentially lead to injury. There is a suggestion that there is an increased risk of sports injuries in rural areas due to the lack of health professionals and coaching personnel, fewer available volunteers to organise and deliver sport, and the general attitude towards injuries in rural settings.

Results: There is very limited information about the number and types of injuries sustained during participation in sports activities in rural and regional settings. This is largely related to a lack of formal sporting structures and support mechanisms including research funding and trained personnel.

Conclusion: A range of factors need to be implemented to improve safety for sporting and recreational participants in these areas. These include improved monitoring of injury occurrence, stronger promotion of safety initiatives and wider implementation of education strategies.

Family and carer smoking control programmes for reducing children's exposure to environmental tobacco smoke

Background: Exposure to other people’s cigarette smoke (environmental tobacco smoke, or ETS) is an important child health issue.
Objectives: To determine the effectiveness of interventions aiming to reduce exposure of children to ETS.
Search strategy: The Tobacco Addiction Group register of studies was searched.MEDLINE, EMBASE and four other health and psychology databases were searched electronically, bibliographies of retrieved primary studies were checked and specialists in the area consulted.
Selection criteria: Controlled trials with or without random allocation were included in this review if they addressed participants (parents and other family members, child care workers and teachers) involved with the care and education of infants and young children (aged 0-12 years). All mechanisms for reduction of children’s environmental tobacco smoke exposure, and smoking prevention, cessation, and control programmes targeting these participants are included. These include smoke free policies and legislation, health promotion, social behavioural therapies, technology, education and clinical interventions.
Data collection and analysis: Two reviewers independently assessed studies and extracted data. Due to heterogeneity of methodologies and outcomes, no summary measures were possible and results were synthesised using narrative summaries.
Main results: Nineteen studies met the inclusion criteria, one of which was subsequently excluded. Three interventions were targeted at populations or community settings, seven studies were conducted in the well child health care setting and eight in the ill child health care setting. Twelve of these studies are from North America. In 12 of the 18 studies there was reduction of ETS exposure for children in both intervention and comparison groups. In only four of the 18 studies was there a statistically significant intervention effect. Three of these successful studies employed intensive counselling interventions targeted to smoking parents. There is little difference between the well infant, child respiratory illness and other child illness settings as contexts for parental smoking cessation interventions. The fourth successful intervention was in the school setting targeting the ETS exposure of children from smoking fathers.
Authors’ conclusions: Brief counselling interventions, successful in the adult health setting when coming from physicians, cannot be extrapolated to adults in the setting of child health. There is limited support for more intensive counselling interventions. There is no clear evidence for differences between the respiratory, non-respiratory ill child, well child and peripartum settings as contexts for reduction of children’s ETS exposure.

Permian Chonetoidea and Spiriferoidea of Australasia : Gondwanan relationships, provincialism, palaeobiogeography

Members of the Spiriferoidea are dominant in the Permian marine invertebrate faunas of Australia. Genera can be endemic to a particular province, demonstrate a wider Gondwanan and peri-Gondwanan distribution and several indicate a bipolar distribution. Australasian spiriferoids are included within the families Spiriferidae, Neospiriferidae, Trigonotretidae and the Spiriferellidae. Several genera and species are the largest spirferoids ever recorded. Few genera are shared between the Westralian and Austrazean provinces but a higher proportion of genera are shared between the Westralian province and the Cimmerian Realm.
Representatives of the Chonetoidea are a less common but significant element of the faunas. They were used over 20 years ago to define the Westralian and Austrazean provinces of Australasia – concepts that are in widespread use today. The Paratinan and Cimmerian provinces were also defined at that time despite difficulties in their definition. Through more recent studies the Cimmerian Province has been upgraded to a Realm while the Paratinan Province is more clearly defined for the earliest Permian, based on the chonetoids of Patagonia and western and eastern central Argentina.
Distribution of the various genera is best explained by an interplay of factors including surface and deeper oceanic currents, marine water temperatures and tectonic events such as the clockwise rotation of Gondwanan and the dispersal of the peri-Gondwanan Cimmerian terranes. Austrazean faunas developed in isolation under the influence of cooler and cold waters during the early Permian. Late Permian faunas demonstrated more widespread linkages.

The relative and absolute reliability of two balance performance measures in chronic stroke patients

Purpose. To examine the relative reliability and absolute reliability of the Berg Balance Scale (BBS) and the Postural Assessment Scale for Stroke Patients (PASS) in chronic stroke patients. Method. A total of 52 mild to moderate stroke patients, who had a stroke more than 6 months previously, participated in the study. Both balance measures were administered twice, seven days apart, to the patients. A relative reliability index (intra-class correlation coefficient, ICC2,1) was used to examine the level of agreement between test and retest. Absolute reliability indices, including the Bland and Altman method, the standard error of measurement (SEM), and the smallest real differences (SRD), were used to define the extent to which a balance score varies on test-retest measurements. Results. Test-retest agreements were high (ICC2,1: BBS = 0.98; PASS = 0.97), indicating excellent agreement from a relative perspective. The SEM of the BBS and PASS, representing the smallest change threshold that indicates a real improvement for a group of individuals, were 2.4 and 1.1, respectively. The SRD of the BBS and PASS were 6.7 and 3.2, respectively, exhibiting the smallest change threshold that indicates a real improvement for a single individual. Conclusions. The test-retest agreements of the BBS and PASS were high in mild to moderate chronic stroke patients. The thresholds of both measures to detect real change are acceptable in research and clinical settings.

Gambling and corporate social responsibility (CSR) : re-defining industry and state roles on duty of care, host responsibility and risk management

During the 1990s, states embraced legalised gambling as a means of supplementing state revenue. But gaming machines (EGMs, pokies, VLTs, Slots) have become increasingly controversial in countries such as Australia, Canada and New Zealand, which experienced unprecedented roll-out of gaming machines in casino and community settings; alongside revenue windfalls for both governments and the gambling industry. Governments have recognised that gambling results in a range of social and economic harms and, similar to tobacco and alcohol, have introduced public policies predicated on harm minimisation. Yet despite these, gaming losses have continued to climb in most jurisdictions, along with concerns about gambling-related harms. The first part of this article discusses an emerging debate in Ontario Canada, that draws parallels between host responsibility in alcohol and gambling venues. In Canada, where government owns and operates the gaming industry, this debate prompts important questions on the role of the state, duty of care and regulation ‘in the public interest’ and on CSR, host responsibility and consumer protection. This prompts the question: Do governments owe a duty of care to gamblers?

The article then discusses three domains of accumulating research evidence to inform questions raised in the Ontario debate: evidence that visible behavioural indicators can be used with high confidence to identify problem gamblers on-site in venues as they gamble; new systems using player tracking and loyalty data that can provide management with high precision identification of problem gamblers and associated risk (for protective interventions); and research on technological design features of new generation gaming products in interaction with players, that shows how EGM machines can be the site for monitoring/protecting players. We then canvass some leading international jurisdictions on gambling policy CSR and consumer protection.

In light of this new research, we ask whether the risk of legal liability poses a tipping point for more interventionist public policy responses by both the state and industry. This includes a proactive role for the state in re-regulating the gambling industry/products; instituting new forms of gaming machine product control/protection; and reinforcing corporate social responsibility (CSR) and host responsibility obligations on gambling providers – beyond self-regulatory codes. We argue the ground is shifting, there is new evidence to inform public policy and government regulation and there are new pressures on gambling providers and regulators to avail themselves of the new technology – or risk litigation

Second Life and the role of educators as regulators

Regulation, governance and harms stemming from the use of virtual worlds and other Massive Multi Media Online Role Playing Games (MMMORPGs) in higher education, are poorly understood and under-researched issues. Second Life, developed by Linden Labs, provides users with a series of generic ‘terms of service’ and codes of conduct, yet place the bulk of responsibility on individual users or groups to report misbehaviour or develop their own behavioural codes, enforcement procedures and punishments suited to their particular needs. There is no guidebook to assist users in the processes of risk identification and management. As such, the various benefits of MMMORPG technologies could be offset by the risks to users and user-groups from a range of possible harms, including the impact of actual or perceived violence within teaching and learning settings.

While cautioning against the direct translation of real-world regulatory principles into the governance of virtual worlds, this paper suggests theoretical and practical guidance on these issues can be taken from recent criminological developments. Using Lawrence Lessig’s (1999) landmark work on cyber-regulation as a starting point, this paper examines the literature on video-game violence to illustrate the need for educators show awareness of both real and perceived risks in virtual worlds as a core element of an emerging educational pedagogy. We identify how the multiple roles of the virtual-world educator become useful in framing this pedagogy to improve student learning, to dispel myths about the risks of immersive technologies and advocate for their adoption and acceptance in the educational community.

The validation of an Australian sign language instrument for outcome measurement of adults in mental health settings

Objective: There are currently no adult mental health outcome measures that have been translated into Australian sign language (Auslan). Without a valid and reliable Auslan outcome measure, empirical research into the efficacy of mental health interventions for sign language users is unattainable. To address this research problem the Outcome Rating Scale (ORS), a measure of general functioning, was translated into Auslan and recorded on to digital video disk for use in clinical settings. The purpose of the present study was therefore to examine the reliability, validity and acceptability of an Auslan version of the ORS (ORS-Auslan).
Method: The ORS-Auslan was administered to 44 deaf people who use Auslan as their first language and who identify as members of a deaf community (termed ‘Deaf’ people) on their first presentation to a mental health or counselling facility and to 55 Deaf people in the general community. The community sample also completed an Auslan version of the Depression Anxiety Stress Scale-21 (DASS-21).
Results: t-Tests indicated significant differences between the mean scores for the clinical and community sample. Internal consistency was acceptable given the low number of items in the ORS-Auslan. Construct validity was established by significant correlations between total scores on the DASS-21-Auslan and ORS-Auslan. Acceptability of ORS-Auslan was evident in the completion rate of 93% compared with 63% for DASS-21-Auslan.
Conclusions: This is the only Auslan outcome measure available that can be used across a wide variety of mental health and clinical settings. The ORS-Auslan provides mental health clinicians with a reliable and valid, brief measure of general functioning that can significantly distinguish between clinical and non-clinical presentations for members of the Deaf community.

Academic and business ethical misconduct and cultural values : a cross national comparison

Efforts to promote ethical behaviour in business and academic contexts have raised awareness of the need for an ethical orientation in business students. This study examines the similarities and differences between the personal values of Iranian and Australian business students and their attitudes to cheating behaviour in universities and unethical practices in business settings. Exploratory factory analysis provided support for three distinct ethics factors—serious academic ethical misconduct, minor academic ethical misconduct, and business ethical misconduct. Results reveal statistically significant differences between the two cultural groups for ethical (altruism/universalism) values, and for attitudes to serious academic misconduct. No differences were found between the two groups for attitudes to minor academic unethical practices or unethical business practices. Gender influenced responses where females were found to indicate higher levels of unacceptability of unethical practices in academic and business settings than males. This pilot study highlights the need for higher education institutions to develop and enforce policies and practices to publicise, encourage and reinforce higher awareness of the need for adhering to ethical behaviour in university studies as a necessary component of training business professionals.

'Rushing behind the wheel' : investigating the prevalence of 'drug driving' among club and rave patrons in Melbourne, Australia

The paper reports the findings of survey research recently completed in Melbourne, Australia, among a sample of 455 club and rave festival patrons. This research aims to provide a clearer account of the prevalence of drug driving within such settings in Melbourne, as well as identifying relevant ‘predictors’ of this drug driving. Just under half of the sample (48%) indicated that they had driven a motor vehicle within four hours of consuming an illicit substance at least once in the past year; 22% of respondents reported driving while ‘knowingly intoxicated’ in the previous year. Fifteen percent reported such behaviour ‘several times’ or more in this time. Relatively permissive attitudes towards drug driving, coupled with higher than average prevalence of drug driving in one's peer group, were found to be significant predictors of drug driving. So too was the reported frequency of the use of cannabis and ecstasy, and the propensity to use these substances in ‘rave’ and ‘party’ settings. Given the levels of drug driving revealed in this study, the paper closes with a series of recommendations regarding the design and delivery of more effective anti-drug-driving strategies within rave and club settings.

Train the trainer model : implications for health professionals and farm family health in Australia

Australia is a large country with 60% of land used for agricultural production. Its interior is sparsely populated, with higher morbidity and mortality recorded in rural areas, particularly farmers, farm families, and agricultural workers. Rural health professionals in addressing health education gaps of farming groups have reported using behavioralist approaches. These approaches in isolation have been criticized as disempowering for participants who are identified as passive learners or 'empty vessels.' A major challenge in rural health practice is to develop more inclusive and innovative models in building improved health outcomes. The Sustainable Farm Families Train the Trainer (SFFTTT) model is a 5-day program developed by Western District Health Service designed to enhance practice among health professionals working with farm families in Australia. This innovative model of addressing farmer health asks health professionals to understand the context of the farm family and encourages them to value the experience and existing knowledge of the farmer, the family and the farm business. The SFFTTT program has engaged with health agencies, community, government, and industry groups across Australia and over 120 rural nurses have been trained since 2005. These trainers have successfully delivered programs to 1000 farm families, with high participant completion, positive evaluation, and improved health indicators. Rural professionals report changes in how they approach health education, clinical practice, and promotion with farm families and agricultural industries. This paper highlights the success of SFFTTT as an effective tool in enhancing primary health practice in rural and remote settings. The program is benefiting not only drought ravaged farmers but assisting rural nurses, health agencies, and health boards to engage with farm families at a level not identified previously. Furthermore, nurses and health professionals are now embracing a more 'farmer-centered model of care.'

Improving the coordination of care for low back pain patients by creating better links between acute and community services

This paper reports on the development of a care-pathway to improve service linkages between the acute setting and community health services in the treatment of low back pain. The pathway was informed by two processes: (1) a literature review based on best-practice guidelines in the assessment, treatment and continuity of care for low back pain patients; and (2) consultation with staff and key stakeholders. Stakeholders from both the acute and community sectors comprised the Working Group, who identified central areas of concern to be addressed in the care-pathway, with the goal of preventing chronicity of low back pain and reducing emergency department presentations. The main outcomes achieved include: the development of a new care-coordinator role, which would support a greater focus on integration between acute and community sectors for low back pain patients; identifying the need to screen at-risk patients; implementation of the SCTT (Service Coordination Tool Templates) tool as a system of referral across the acute and community settings; and agreement on the need to develop an evidence-based self-management program to be offered to low back pain patients. The benefits and challenges of implementing this care pathway are discussed.

Building equitable literate futures : home and school computer-mediated literacy practices and disadvantage

This paper examines the complex connections between literacy practices, the use of information and communication technologies (ICTs) and disadvantage. It reports the findings of a year-long study which investigated the ways in which four families use ICTs to engage with formal and informal literacy learning in home and school settings. The research set out to explore what it is about computer-mediated literacy practices at home and at school in disadvantaged communities that make a difference in school success. The findings demonstrate that the 'socialisation' of the technology - its appropriation into existing family norms, values and lifestyles - varied from family to family. Having access to ICTs at home was not sufficient for the young people and their families to overcome the so-called 'digital divide'. Clearly, we are seeing shifts in the meaning of 'disadvantage' in a globalised world mediated by the use of new technologies. New definitions of disadvantage that take account not only of access to the new technologies but also include calibrated understandings of what constitutes the access are required. The article concludes that old inequalities have not disappeared, but are playing out in new ways in the context of the networked society.

Building equitable literate futures : home and school computer-mediated literacy practices and disadvantage

This article examines the complex connections between literacy practices, the use of information and communication technologies (ICTs) and disadvantage. It reports the findings of a year-long study which investigated the ways in which four families use ICTs to engage with formal and informal literacy learning in home and school settings. The research set out to explore what it is about computer-mediated literacy practices at home and at school in disadvantaged communities that makes a difference in school success. The findings demonstrate that the 'socialisation' of the technology--its appropriation into existing family norms, values and lifestyles--varied from family to family. Having access to ICTs at home was not sufficient for the young people and their families to overcome the so-called 'digital divide'. The article concludes that old inequalities have not disappeared, but are playing out in new ways in the context of the networked society.