Microfinance best practice : ten parameters of success for development NGOs

Experience has shown that development NGOs typically do not succeed in transforming themselves into financially sustainable providers of financial intermediation services. The reasons for this failure are complex (see Dichter 1999). Nonetheless, the role that NGOs play as microfinance providers is important and the contribution they could make to poverty reduction would be greatly enhanced if they adhered to some simple but essential parameters of success.

Sensory adaptability of foods with added Lupin (Lupinus angustifolius) kernel fibre using pre-set criteria

Fiber-enriched white bread, muffin. pasta, orange juice, and breakfast bar were prepared with lupin (Lupin us angusti/olius) kernel fiber. Consumer panelists (n = 44) determined that all these fiber-enriched foods, except orange juice, fulfilled pre-set acceptability criteria. Fiber enrichment did not change overall acceptability (p> 0.05) of the bread and pasta, but reduced overall acceptability (p < 0.05) of the muffin, orange juice, and breakfast bar. In all fiber-enriched products, flavor was the attribute most highly correlated with overall acceptability (p < 0.05). The lupin kernel fiber used in this study therefore appears to have potential as a 'nonintrusive' ingredient in some processed cereal-based foods_ For other applications, fiber modification appears worthy of investigation to accomplish 'nonintrusive' fiber enrichment.

Euthanasia and assisted suicide : a liberal approach versus the traditional moral view

Within the context of the debate over the recent suspended sentence given to John Stuart Godfrey by Underwood J in the Supreme Court of Tasmania for assisting his elderly mother with her suicide, this article examines some of the more popular arguments for and against the moral acceptability of euthanasia and assisted suicide. This article considers the arguments put forward on the “difference principle” by Rachels and Nesbitt before critically examining the liberal approach to the euthanasia issue as proposed by Kuhse. It is argued that whilst Kuhse is correct to reject the difference principle, she does so for the wrong reasons. The penultimate section of the article provides an overview of the traditional moral view against killing. The final part assesses whether the arguments put forward by proponents of the liberal approach are capable of overcoming this view.

Development and reliability of a self-report questionnaire to examine children's perceptions of the physical activity environment at home and in the neighbourhood

Background: Environmental factors are increasingly being implicated as key influences on children's physical activity. Few studies have comprehensively examined children's perceptions of their environment, and there is a paucity of literature on acceptable and reliable scales for measuring these. This study aimed to develop and test the acceptability and reliability of a scale which examined a broad range of environmental perceptions among children.
Methods: Based on constructs from ecological models, a survey incorporating items on children's perceptions of the physical and social environment at home and in the neighbourhood was developed. This was administered on two occasions, nine days apart, to a sample of 39 children aged 11 years (54% boys), attending a metropolitan Australian elementary school. The acceptability of the survey was determined by the proportion of missing responses to each item. The test-retest reliability of individual items, scores and scales were determined using Kappa statistics and percent agreement for categorical variables, and intraclass correlation coefficients (ICC) for continuous variables.
Results: There were few missing responses to each question, with only 4% of all responses missing. Although some Kappa values were low, all categorical variables showed acceptable reliability when examined for percent agreement between test and retest (range 68%–100% agreement). Continuous variables all showed moderate to good ICC values (range 0.72–0.92).
Conclusion: Findings suggest this questionnaire is reliable and acceptable to children for assessing environmental perceptions relevant to physical activity among 11-year-old children.

Assessing cost-effectiveness in mental health : family interventions for schizophrenia and related conditions

Objective: Existing evidence suggests that family interventions can be effective in reducing relapse rates in schizophrenia and related conditions. Despite this, such interventions are not routinely delivered in Australian mental health services. The objective of the current study is to investigate the incremental cost-effectiveness ratios (ICERs) of introducing three types of family interventions, namely: behavioural family management (BFM); behavioural intervention for families (BIF); and multiple family groups (MFG) into current mental health services in Australia.

Method: The ICER of each of the family interventions is assessed from a health sector perspective, including the government, persons with schizophrenia and their families/carers using a standardized methodology. A two-stage approach is taken to the assessment of benefit. The first stage involves a quantitative analysis based on disability-adjusted life years (DALYs) averted. The second stage involves application of 'second filter' criteria (including equity, strength of evidence, feasibility and acceptability to stakeholders) to results. The robustness of results is tested using multivariate probabilistic sensitivity analysis.

Results: The most cost-effective intervention, in order of magnitude, is BIF (A$8000 per DALY averted), followed by MFG (A$21 000 per DALY averted) and lastly BFM (A$28 000 per DALY averted). The inclusion of time costs makes BFM more cost-effective than MFG. Variation of discount rate has no effect on conclusions.

Conclusions: All three interventions are considered 'value-for-money' within an Australian context. This conclusion needs to be tempered against the methodological challenge of converting clinical outcomes into a generic economic outcome measure (DALY). Issues surrounding the feasibility of routinely implementing such interventions need to be addressed.

Exploratory economic analyses of two primary care mental health projects : implications for sustainability

We evaluated an Internet-based psychological intervention supported by either general practitioners or psychologists (Panic Online), and a Primary-care Evidence-based Psychological-interventions (PEP) strategy which involves training GPs to deliver specific psychological interventions.

Economic modelling suggests that Panic Online is cost-effective when supported by either GPs or psychologists.

Threshold analysis of the psychological training of GPs suggests that a modest effect size for clinical benefit would be sufficient to provide an acceptable cost-effectiveness ratio.

The sustainability of these approaches depends on a range of factors, including funding, workforce availability, and acceptability to consumers and health care providers.

Evidence-based practice and the borders of data in the global information era

This article explores the range of boundaries to negotiate the demands of evidence-based practice. Increasing demands that social work be a profession committed to evidence-based practice have coincided with innovations in information technology, which potentially give social workers unprecedented access to a plethora of sources and types of evidence. Because these innovations can enable access to evidence beyond traditional boundaries, the question of how the author establish the borders of acceptability warrants consideration. Recommendations for a critical approach to selective evidence based for social work interventions are also provided.

How acceptable is a referral and telephone-based outcall programme for men diagnosed with cancer? A feasibility study

The objective of this study was to determine the feasibility and acceptability of a referral and outcall programme from a telephone-based information and support service, for men newly diagnosed with colorectal or prostate cancer. A block randomized controlled trial was performed involving 100 newly diagnosed colorectal and prostate cancer patients. Patients were referred to the Cancer Information Support Service (CISS) through clinicians at diagnosis. Clinicians were randomized into one of three conditions. Active referral 1: specialist referral with four CISS outcalls: (1) ≤1 week of diagnosis; (2) at 6 weeks; (3) 3 months; and (4) 6 months post diagnosis. Active referral 2: specialist referral with one CISS outcall ≤1 week of diagnosis. Passive referral: specialist recommended patient contacts CISS, but contact at the patient's initiative. Patients completed research questionnaires at study entry (before CISS contact), then 4 and 7 months post diagnosis. Overall, 96% of participants reported a positive experience with the referral process; 87% reported they were not concerned about receiving the calls; and 84% indicated the timing of the calls was helpful. In conclusion, the referral and outcall programme was achievable and acceptable for men newly diagnosed with colorectal or prostate cancer.

A new approach to assessing the health benefit from obesity interventions in children and adolescents: the assessing cost-effectiveness in obesity project

OBJECTIVE: To report on a new modelling approach developed for the assessing cost-effectiveness in obesity (ACE-Obesity) project and the likely population health benefit and strength of evidence for 13 potential obesity prevention interventions in children and adolescents in Australia. METHODS: We used the best available evidence, including evidence from non-traditional epidemiological study designs, to determine the health benefits as body mass index (BMI) units saved and disability-adjusted life years (DALYs) saved. We developed new methods to model the impact of behaviours on BMI post-intervention where this was not measured and the impacts on DALYs over the child's lifetime (on the assumption that changes in BMI were maintained into adulthood). A working group of stakeholders provided input into decisions on the selection of interventions, the assumptions for modelling and the strength of the evidence. RESULTS: The likely health benefit varied considerably, as did the strength of the evidence from which that health benefit was calculated. The greatest health benefit is likely to be achieved by the 'Reduction of TV advertising of high fat and/or high sugar foods and drinks to children', 'Laparoscopic adjustable gastric banding' and the 'multi-faceted school-based programme with an active physical education component' interventions. CONCLUSIONS: The use of consistent methods and common health outcome measures enables valid comparison of the potential impact of interventions, but comparisons must take into account the strength of the evidence used. Other considerations, including cost-effectiveness and acceptability to stakeholders, will be presented in future ACE-Obesity papers. Information gaps identified include the need for new and more effective initiatives for the prevention of overweight and obesity and for better evaluations of public health interventions.

Training general practitioners in flexible sigmoidoscopy to screen for colorectal cancer

Background: A screening programme to detect polyps or early carcinoma would significantly reduce the mortality and morbidity of colorectal cancer (CRC). The aims of the present study were to evaluate: (i) the feasibility of training general practitioners in flexible sigmoidoscopy (FS) for CRC screening; (ii) the acceptability of screening by faecal occult blood testing (FOBT) and FS in asymptomatic standard risk Australians aged over 50 years; and (iii) the yield of such screening. Methods: Subjects were recruited by general practitioner (GP) referral, newspaper advertisement or by a direct approach to retirement villages. Participants were mailed a FOBT kit and a prescreening questionnaire. Flexible sigmoidoscopy was performed by a GP supervised by an experienced endoscopist. Subjects then completed a second questionnaire. General practitioners were assessed after 50 unassisted procedures. Results: A total of 264 individuals contacted the study coordinator; 169 were screened. Screening was accepted well by the participants. Fifteen per cent of subjects had polyps and 4% had a positive FOBT. Training in FS was adversely affected by the availability of resources. Three GPs completed 50 unassisted procedures over a 15-month period, but none were able to reliably assess the distal bowel. Conclusions: Although the three trainees and their supervisors did not consider that the GPs were adequately trained after 50 unassisted procedures, training was adversely affected by limited resources within the Victorian public hospital system. Screening by FOBT and FS was considered to be acceptable by the patients undergoing these procedures. Existing facilities are not adequate if GPs are to be trained in FS as part of a national CRC screening program.

Australian consumers expectations for expanded nursing roles in general practice - choice not gatekeeping

While research has focussed on the current and potential role of the practice nurse (PN) in Australia, the acceptability of this role by consumers has not been investigated. In 2002, two independent studies were carried out into consumer perceptions of PNs. A discussion between the two groups of researchers at the inaugural National Practice Nurse Conference in 2003, identified significant similarities in the findings of these studies. This article reports the combined findings as they relate to consumers' desire for access to the health practitioner of their choice, and their concern that PNs may assume a gatekeeping role. These perceptions may have significant impact on the acceptance of PNs across Australia.

Ethical performance evaluation (EPE) in business practices: framework and case illustrations

Purpose – A set of principal parameters (i.e. time, context, gap, outcome, and consequence) influences the ethical performance evaluation (EPE) of business practices in the marketplace and society. The purpose of this paper is to describe a managerial framework of EPE based upon these parameters.

Design/methodology/approach – Case illustrations are used to underpin the introduced managerial framework of EPE.

Findings – The EPE of business practices is not only dependent upon the ethical values and principles of today, but those principles of tomorrow may be equally, or even more, crucial. The EPE of business practices is also dependent upon the surrounding context and its specific ethical values and principles. Furthermore, it is dependent upon the gap between different perceptions of ethical values and principles and if the outcome of the corporation's ethical values and principles are proactive or reactive in relation to the reigning ethical values and principles in the marketplace and society. Finally, it is also dependent upon the potential and eventual consequences of ethical values and principles.

Research limitations/implications – The only way that we can “objectively” evaluate past ethical values and principles is through the use of ethical values and principles at the time and in respect to the context at hand. Research tends to fail when considering the longitudinal and evolutionary dimensions in the exploration of ethical values and principles in business practices. There is too much focus upon on-the-spot-accounts in the past and in current research efforts. An important area for further research is how to deal with the durability and variability of ethical values and principles in business practices in the marketplace and society. The key may be a stronger emphasis on longitudinal research efforts that may explore them over time and as contexts evolve. Ethical values and principles are connected and re-connected over time and across contexts in one way or another. They have a past, a current status and a future.

Practical implications – The decision as to whether business practices are ethical or unethical is – relatively speaking – easy to determine from a narrow perspective, however, the decision whether business practices are ethical or unethical becomes complicated as the perspective is widened and deepened. An introduced managerial framework of EPE provides a generic foundation and structure to examine the acceptability versus unacceptability of business practices.

Originality/value – The paper introduces a managerial framework of EPE, followed by case illustrations. It addresses the impact of time on ethical values and principles in any context on the potential and eventual gaps, outcomes and consequences in business practices. The managerial framework of EPE may also be used in non-business areas whenever found applicable and convenient to use.

Impact of ripening stages of banana flour on the quality of extruded products

The study investigated the physical, nutritional and sensory properties of different ripening stages of banana during extrusion processing in combination with rice flour to develop quality snack products. Dehydrated banana flours at ripening stages 4, 5 and 6 (peel colour) were mixed separately at 40% banana to 60% rice flour levels. The mixtures were extruded through a twin-screw extruder at 120 °C barrel temperature, 220 and 260 r.p.m, screw speed and 12% feed moisture. Increase in ripeness indicated negative effect on expansion and water absorption capacity while increasing the water solubility index and moisture retention (wet basis) of the products. Protein and mineral (except for zinc and copper) content of the products were significantly different (P < 0.05) from 4 to 6 of the ripening stages. Most of the essential amino acids in the extruded products increased significantly (P < 0.05) at the ripening stage of 6. All the products were within the acceptable range in the 9-point Hedonic scale showing the best texture and flavour scores for stage 4 and 6, respectively. The extruded products show potential as snack products because of their nutritional quality and sensory acceptability.

Roman concept of mental capacity to make end-of-life decisions

When assessing decisional competence of patients, psychiatrists have to balance the patients' right to personal autonomy, their condition and wishes against principles of medical ethics and professional discretion. This article explores the age-old legal and ethical dilemmas posed by refusal of vital medical treatment by patients and their mental capacity to make end-of-life decisions against the background of philosophical, legal and medical approaches to these issues in the time of the Younger Pliny (c62–c113 CE). Classical Roman discourse regarding mental competency and "voluntary death" formed an important theme of the vast corpus of Greco-Roman writings, which was moulded not only by legal permissibility of suicide but also by philosophical (in modern terms, moral or ethical) considerations. Indeed, the legal and ethical issues of evaluating the acceptability of end of life decisions discussed in the Letters are as pertinent today as they were 2000 years ago. We may gain valuable insights about our own methodologies and frames of reference in this area of the law and psychiatry by examining Classical Roman approaches to evaluating acceptability of death-choices as described in Pliny's Letters and the writings of some of his peers.

Does interpersonal psychotherapy improve clinical care for adolescents with depression attending a rural child and adolescent mental health service? Study protocol for a cluster randomised feasibility trial

Background: Depression amongst adolescents is a costly societal problem. Little research documents the effectiveness of public mental health services in mapping this problem. Further, it is not clear whether usual care in such services can be improved via clinician training in a relevant evidence based intervention. One such intervention, found to be effective and easily learned amongst novice clinicians, is Interpersonal Psychotherapy (IPT). The study described in the current paper has two main objectives. First, it aims to investigate the impact on clinical care of implementing Interpersonal Psychotherapy for Adolescents for the treatment of adolescent depression within a rural mental health service compared with Treatment as Usual (TAU). The second objective is to record the process and challenges (i.e. feasibility, acceptability, sustainability) associated with implementing and evaluating an evidence-based intervention within a community service. This paper outlines the study rationale and design for this community based research trial.

Methods/design: The study involves a cluster randomisation trial to be conducted within a Child and Adolescent Mental Health Service in rural Australia. All clinicians in the service will be invited to participate.  Participating clinicians will be randomised via block design at each of four sites to (a) training and delivery of IPT, or (b) TAU. The primary measure of impact on care will be a clinically significant change in depressive  symptomatology, with secondary outcomes involving treatment satisfaction and changes in other symptomatology. Participating adolescents with significant depressive symptomatology, aged 12 to 18 years, will complete assessment measures at Weeks 0, 12 and 24 of treatment. They will also complete a depression inventory once a month during that period. This study aims to recruit 60 adolescent participants and their parent/guardian/s. A power analysis is not indicated as an intra-class correlation coefficient will be calculated and used to inform sample size calculations for subsequent large-scale trials. Qualitative data regarding process implementation will be collected quarterly from focus groups with participating clinicians over 18 months, plus phone interviews with participating adolescents and parent/guardians at 12 weeks and 24 weeks of treatment. The focus group qualitative data will be analysed using a Fourth Generation Evaluation methodology that includes a constant comparative cyclic analysis method.

Discussion: This study protocol will be informative for researchers and clinicians interested in considering, designing and/or conducting cluster randomised trials within community practice such as mental health services.