Contribution of Australian cardiologists, general practitioners and dietitians to adult cardiac patients’ dietary behavioural change

Aim:  To investigate the use of behavioural change techniques by cardiologists, general practitioners and dietitians in adult cardiac patients within 12 months of their cardiac event.
Method:  Quantitative cross-sectional surveys. Frequency analyses were conducted on the respondents' answers to questionnaire items. Chi-squared test of independence compared responses of the three professional groups on the questionnaire items. Analyses of variance were conducted to explore the impact of the independent variables: age, sex and time worked on the behavioural change techniques used by the respondents.
Results:  The respondents included 248 general practitioners (30% response), 189 cardiologists (47% response) and 180 dietitians (60% response). General practitioners and cardiologists acted mainly as advocates for dietary change in the dietary management process. Dietitians provided nutrition knowledge and a range of techniques to assist dietary behavioural change. Cardiologists and dietitians shared little nutrition information with general practitioners (cardiologists with general practitioners = 8%, dietitians with general practitioners = 49%).
Conclusion:  The present study shows that cardiac patients may have insufficient access to knowledge of nutrition and techniques to assist them with dietary behavioural change.

A survey of occupational therapists providing services under the Better Access to Mental Health initiative

The Australian government launched the Better Access to Mental Health initiative in 2006, to help more people access psychological therapies. Occupational therapists can register to offer these services, and this survey aimed to investigate their participation within the first 12 months of operation.
Two surveys were conducted with occupational therapists registered to offer Better Access to Mental Health services, at the six and twelve month mark of the initiative. These surveys collected both quantitative and qualitative data. While the demographic profile of occupational therapists remained stable across the surveys, the client population varied over time. Depression and anxiety were the most common conditions treated under this scheme. Occupational therapists reported generally positive attitudes towards the initiative, and did not identify any pressing training needs. However, the current rebate for services was a source of dissatisfaction for many respondents.
This survey has established a baseline for further investigation in this area. The provision and outcomes of this particular initiative needs to be a priority for future research to secure occupational therapy's place in this developing area of practice, thereby providing consumers with greater choice and access to intervention at a primary health level.

Domino Heck-Aza-Michael reactions : efficient access to 1-substituted tetrahydro-β-carbolines

A simple and efficient palladium-catalyzed domino reaction for the synthesis of a series of C1-substituted tetrahydro-β-carbolines is described. This domino process involves a Heck reaction at the indole 2-position of a halogenated tryptamine precursor, followed by intramolecular aza-Michael addition.

Microwave-assisted direct amination : rapid access to multi-functionalized N6-substituted adenosines

Analogues of adenosine have a range of interesting biological activities and potential therapeutic applications. A method for the efficient preparation of highly functionalized N6-substituted adenosines has been developed from the corresponding tert-butyldimethylsilyl-protected inosine. The key step in this procedure is a microwave-assisted amination reaction between an appropriately substituted inosine and an amine in the presence of PyBroP. High yields of desired N6-substituted adenosines were achieved with hindered amines and the reaction was also found to accommodate a range of substituents on the inosine precursor.

Just out of reach : access to equity in Australian higher education

This paper provides an account of access and equity in Australian higher education across the period of recent Federal Labor governments and specifically of the discourses and practices surrounding A Fair Chance For All: Higher Education That's Within Everyone's Reach, Labor's latest policy on equal access to Australian higher education. The paper positions such an account within Australia's changing national and global economic condition, and the influence of New Right ideologies that proffer efficient and effective public sector management practices and market freedoms that have witnessed a privatisation and peeling back of the welfare state. The paper argues that while Federal Labor has clearly established social justice on the agenda of Australian higher education, it is a justice mediated by particular economic and managerial practices which tend to limit equity to issues of access and place broader equity concerns for higher education just out of reach.

Better access to mental health : mapping the evidence supporting participation in meaningful occupations

Introduction: The purpose of this scoping and mapping project is to assess evidence for the use of focused psychological strategies (FPS) under the Better Access to Mental Health (BAMH) scheme to enable people with mental health problems to increase their functional performance and to participate in meaningful occupations. In particular, it aims to provide an accessible summary of evidence for practitioners who use FPS with their clients.

Methods: Evidence scoping and mapping is a relatively new technique, used to provide an overview of key findings in an area of practice. A five stage process of scoping and mapping was used in this project.

Results: A total of 81 studies which addressed the use of focused psychological strategies to promote functional performance and participation in meaningful occupations were found. Surprisingly, only three were published in occupational therapy journals with one further article being authored by occupational therapists. Three maps are provided showing this evidence by diagnosis, intervention and level of evidence.

Conclusion: Clinicians can say with some confidence that cognitive behavioural therapies are effective functional tools, particularly when working with people with depression or schizophrenia. They can also be confident that good quality evidence exists across a range of diagnoses, although there are many gaps where little to no research has been conducted. Suggestions for further research are provided which take into account the findings of these maps.

Access to alcohol outlets and harmful alcohol consumption : a multi-level study in Melbourne, Australia

Aims To assess the association between access to off-premises alcohol outlets and harmful alcohol consumption.
Design, setting and participants Multi-level study of 2334 adults aged 18–75 years from 49 census collector districts (the smallest spatial unit in Australia at the time of survey) in metropolitan Melbourne.
Measurements Alcohol outlet density was defined as the number of outlets within a 1-km road network of respondents’ homes and proximity was the shortest road network distance to the closest outlet from their home. Using multi-level logistic regression we estimated the association between outlet density and proximity and four measures of harmful alcohol consumption: drinking at levels associated with short-term harm at least weekly and monthly; drinking at levels associated with long-term harm and frequency of consumption.
Findings Density of alcohol outlets was associated with increased risk of drinking alcohol at levels associated with harm. The strongest association was for short-term harm at least weekly [odds ratio (OR) 1.10, 95% confidence interval (CI) 1.04–1.16]. When density was fitted as a categorical variable, the highest risk of drinking at levels associated with short-term harm was when there were eight or more outlets (short-term harm weekly: OR 2.36, 95% CI 1.22–4.54 and short-term harm monthly: OR 1.80, 95% CI 1.07–3.04). We found no evidence to support an association between proximity and harmful alcohol consumption.
Conclusions The number of off-premises alcohol outlets in a locality is associated with the level of harmful alcohol consumption in that area. Reducing the number of off-premises alcohol outlets could reduce levels of harmful alcohol consumption.

Reduced food access due to a lack of money, inability to lift and lack of access to a car for food shopping : a multilevel study in Melbourne, Victoria

Objective: To describe associations between demographic and individual and arealevel socio-economic variables and restricted household food access due to lack of money, inability to lift groceries and lack of access to a car to do food shopping.
Design: Multilevel study of three measures of restricted food access, i.e. running out of money to buy food, inability to lift groceries and lack of access to a car for food shopping. Multilevel logistic regression was conducted to examine the risk of each of these outcomes according to demographic and socio-economic variables.
Setting: Random selection of households from fifty small areas in Melbourne, Australia, in 2003.
Subjects: The main food shoppers in each household (n 2564).
Results: A lack of money was significantly more likely among the young and in households with single adults. Difficultly lifting was more likely among the elderly and those born overseas. The youngest and highest age groups both reported reduced car access, as did those born overseas and single-adult households. All three factors were most likely among those with a lower individual or household socio-economic position. Increased levels of area disadvantage were independently associated with difficultly lifting and reduced car access.
Conclusions: In Melbourne, households with lower individual socio-economic position and area disadvantage have restricted access to food because of a lack of money and/or having physical limitations due difficulty lifting or lack of access to a car for food shopping. Further research is required to explore the relationship between physical restrictions and food access.

Mobile technology platforms for flexible access to information resources : considerations in the use of ebook readers, smart phones, netbooks and iPads

Smart phones are everywhere, people are taking eBook readers on holiday, the iPad has queues of people wanting to buy one, and some netbooks can fit in a pocket. The technology is attractive and increasingly affordable – how can it help an individual in their access to and use of texts, journals, databases, clinical sources, the web and day-to-day information? The Library has been investigating and trialling mobile devices during 2010, and has received interesting feedback from staff and students on the effectiveness of the technology in the University and personal environments. Each device has its strengths and weaknesses depending on the needs of the individual or activity it is supporting – productivity, research, study, clinical or recreational. The presentation will explore these issues along with some of the practical implications at Deakin, and international experiences in academic environments.

EU-India free trade negotiations threatening access to medicines

Indian firms are major global producers of relatively affordable generic medicines. Access to such drugs makes the difference between life and death for billions of people in the Global South. The Economist noted recently that ‘America should not use trade deals to swaddle drugmakers in excessive patent protections’. Nor should the European Union (EU) impose obstacles to the supply of generic drugs by Indian firms beyond those already mandated by the Trade Related Aspects of Intellectual Property Rights (TRIPS) Agreement. Free trade negotiations between the EU (reported to be close to completion) constitute a clear threat to the role of India as the ‘pharmacy of the developing world’.

Better access to mental health program : influence of mental health occupational therapy

Background/aim

The Better Access to Mental Health program has enabled eligible occupational therapists to provide services to people with a mental health condition. No studies have yet reported the influence of occupational therapy under this scheme. The aim of this study was to investigate whether attending an occupational therapist under this initiative influences change in psychological distress of clients as measured by the Kessler Psychological Distress Scale (K10).
Method

A quasi-experimental pretest–posttest design, using pre-existing data collected in the process of regular treatment was used. Data from a total of 31 clients (mean = 17.13 years, SD = 3.603) were accessed for this study. Pre- and post-intervention scores on the K10 were used to determine if psychological distress had changed over the course of intervention.
Results

Highly significant improvements (P < 0.001) were found between the K10 pre-intervention score (mean = 25.68, SD = 9.944) and the K10 post-intervention score (mean = 21.00, SD = 9.212). Male K10 post-intervention scores (mean = 17.64, SD = 5.3) significantly improved (P = 0.05), whereas results for females were not statistically significant. Medication use, diagnosis, age, number of sessions and prior contact with health services did not influence the results. Results from specific evidence-based interventions were not able to be considered in this study.
Conclusion

The results of this study demonstrate effectiveness of occupational therapy services for adolescents and provide support for the ongoing participation of occupational therapists in this scheme.