A nurse managed kidney disease program in regional and remote Australia

Health services that aim to prevent and manage chronic kidney disease (CKD) in rural and remote Aboriginal communities in Australia, including the Goldfields region of Western Australia (WA), require innovative approaches. Nursing roles can significantly improve access to renal services in rural and remote areas as they are able to address a range of renal health promotion and prevention activities, and provide renal clinical education and support to Aboriginal people. The Goldfields Kidney Disease Nursing Management Program (GKDNMP), funded through the Council of Australian Governments (COAG) National Partnership Agreements, was developed to provide a comprehensive approach to primary health care that incorporates a range of health promotion and disease management activities. In the first year, the program increased home dialysis rates and decreased patient travel due to expanded access to renal care within the region. Context-specific health programs generated in response to local needs can be successful in addressing specific health care challenges in rural and remote health.

Asymmetric Nash bargaining solutions: a simple Nash program

This article proposes a simple Nash program. Both our axiomatic characterization and our noncooperative procedure consider each distinct asymmetric and symmetric Nash solution. Our noncooperative procedure is a generalization of the simplest known sequential Nash demand game analyzed by Rubinstein etal. (1992). We then provide the simplest known axiomatic characterization of the class of asymmetric Nash solutions, in which we use only Nash's crucial Independence of Irrelevant Alternatives axiom and an asymmetric modification of the well-known Midpoint Domination axiom.

Associations between adverse social position and bone mineral density in women aged 50 years or older: data from the Manitoba bone density program

The authors examined the independent contribution of income to low bone mineral density in women aged 50 years and older. A significant dose–response association was observed between low income and low (bone mineral density) BMD, which was not explained by clinical risk factors or osteoporotic treatment in the year prior.

The association between social disadvantage and osteoporosis is attracting increased attention; however, little is known of the role played by income. We examined associations between income and bone mineral density (BMD) in 51,327 women aged ≥50 years from Manitoba, Canada.

The development and evaluation of a post-separation parenting program

In response to the detrimental impact of post-separation parental conflict on children and families, an empirically-based post-separation parenting program targeting separated parents in high conflict was developed. Following its implementation into Victorian-based Family Mediation Centres, the program was then evaluated for effectiveness across various parenting, psychological adjustment and conflict-related domains.

Effects of a specialist-led, school physical education program on bone mass, structure and strength in primary school children: a 4-year cluster randomised controlled trial

This 4-year cluster randomised controlled trial of 365 boys and 362 girls (mean age 8.1 ± 0.3 years) from grade 2 in 29 primary schools investigated the effects of a specialist-taught physical education (PE) program on bone strength and body composition. All children received 150 min/week of common practice (CP) PE from general classroom teachers but in 13 schools 100 min/week of CP PE was replaced by specialized-led PE (SPE) by teachers who emphasized more vigorous exercise/games combined with static and dynamic postural activities involving muscle strength. Outcome measures assessed in grades 2, 4, and 6 included: total body bone mineral content (BMC), lean mass (LM) and fat mass (FM) by DXA, and radius and tibia (4% and 66% sites) bone structure, volumetric density and strength, and muscle cross-sectional area (CSA) by pQCT. After 4-years, gains in total body BMC, FM and muscle CSA were similar between the groups in both sexes, but girls in the SPE group experienced a greater gain in total body LM [mean (95%CI), 1.0kg (0.2, 1.9)]. Compared to CP, girls in the SPE group also had greater gains in cortical area (CoA) and cortical thickness (CoTh) at the mid-tibia [CoA, 5.0% (0.2, 1.9); CoTh 7.5% (2.4, 12.6)] and mid-radius [CoA, 9.3% (3.5, 15.1); CoTh 14.4% (6.1, 22.7)], while SPE boys had a 5.2% (0.4, 10.0) greater gain in mid-tibia CoTh. These benefits were due to reduced endocortical expansion. There were no significant benefits of SPE on total bone area, cortical density or bone strength at the mid-shaft sites, nor any appreciable effects at the distal skeletal sites. This study indicates that a specialist-led school-based PE program improves cortical bone structure, due to reduced endocortical expansion. This finding challenges the notion that periosteal apposition is the predominant response of bone to loading during the pre- and early-pubertal period. This article is protected by copyright. All rights reserved.

Effectiveness, costs, and cost-effectiveness of recruitment strategies for a mammographic screening program to detect breast cancer

BACKGROUND AND PURPOSE: Since effective and affordable recruitment methods are essential for the widespread implementation of mammographic screening for detection of breast cancer, we studied the effectiveness, the costs, and the cost-effectiveness of various recruitment strategies in the population targeted by a pilot Australian program that offered free mammography screening between 1988 and 1990. METHODS: We evaluated three public recruitment strategies--local newspaper articles, community promotion, and promotion to physicians--and five personal strategies--invitation letters with or without specified appointment times, either alone or with a follow-up letter, or telephone call to nonattenders. The effectiveness of public recruitment strategies was estimated from monthly attendance rates by Poisson regression analysis, while the probability of attendance in response to personal strategies was calculated using logistic regression analysis. Costs were determined by resource usage studies. The cost-effectiveness ratios for personal strategies were determined using decision analysis. RESULTS: The costs in 1988-1989 Australian dollars per woman recruited were $22 for local newspaper articles and $106 for community promotion. No detectable increase in attendance resulted from promotion to physicians. When the cost of reserving an appointment was considered, the most cost-effective personal recruitment strategy was an invitation letter without a specified appointment time, followed by a second letter to nonattenders. This strategy recruited 35.6% of women in the sample targeted and cost $10.52 per attendee. In comparison, the most effective personal recruitment strategy was a letter with a specified appointment time followed by a second letter to nonattenders, which recruited 44.1% of women at an average cost of $19.99 and a marginal cost of $59.71 per additional attendee. CONCLUSIONS: Personal recruitment strategies were more cost-effective than public strategies. The most cost-effective personal strategy was an invitation letter without a specified appointment time, followed by a second letter to nonattenders.

Factor structure and measurement invariance of the Health Education Impact Questionnaire: does the subjectivity of the response perspective threaten the contextual validity of inferences?

Objective:
On-going evidence is required to support the validity of inferences about change and group differences in the
evaluation of health programs, particularly when self-report scales requiring substantial subjectivity in response generation are used as outcome measures. Following this reasoning, the aim of this study was to replicate the factor structure and investigate the measurement invariance of the latest version of the Health Education Impact Questionnaire, a widely used health program evaluation measure.
Methods:
An archived dataset of responses to the most recent version of the English-language Health Education Impact
Questionnaire that uses four rather than six response options (N=3221) was analysed using exploratory structural equation
modelling and confirmatory factor analysis appropriate for ordered categorical data. Metric and scalar invariance were
studied following recent recommendations in the literature to apply fully invariant unconditional models with minimum
constraints necessary for model identification.
Results:
The original eight-factor structure was replicated and all but one of the scales (Self Monitoring and Insight) was
found to consist of unifactorial items with reliability of ⩾0.8 and satisfactory discriminant validity. Configural, metric and scalar
invariance were established across pre-test to post-test and population sub-groups (sex, age, education, ethnic background).
Conclusion:
The results support the high level of interest in the Health Education Impact Questionnaire, particularly for use as a pre-test/post-test measure in experimental studies, other pre–post evaluation designs and system-level monitoring and evaluation.

Relationships between civil engineering students’ learning approaches and their perception of curriculum and teaching quality

BACKGROUND: Deakin University graduated its first cohort from four-year undergraduate civil engineering course/program in 2012. The internal annual Course Experience Survey, which has been running annually since 2012, targets to identify the graduating students’ learning approaches and students’ perceptions of the curriculum and teaching quality. Literature suggests that students’ learning outcomes can be achieved more efficiently when the students’ perceptions of curriculum and teaching quality are closely aligned with their learning approaches. Where the students’ approaches to learning and their perception of curriculum and teaching quality are mismatched, a series of frustrations can result for the students that may not only negatively impact their learning achievement but also their learning experience.
PURPOSE OR GOAL: This study explores the relationships between students’ learning approaches and their perception of curriculum and teaching quality in an undergraduate civil engineering program/course. This will help understand whether the curriculum and teaching quality provided by the university have actually accommodated ‘all’ enrolled students in the similar way.
APPROACH: To uncover these relationships, this study adopts questionnaire survey approach to collect response data over a two year period by asking students about their perception through a series of statements. 5-point Likert-scale questionnaire survey (strongly disagree, disagree, neutral, agree, strongly agree) is developed and responses are collected. The responses are then statistically analysed in order to uncover the relationships between students’ learning approaches and their perception of curriculum and teaching quality provided by the university.
DISCUSSION: Deep learners and surface learners had a statistically different perception of curriculum and teaching quality. These results contradict the assumption that learners will have uniform preferences on the curriculum, teaching quality and the way they deal with the demands of specific learning situations. Anecdotal belief that ‘good course/program curriculum and good teaching approaches are good for all students and vice-versa’ may not be strictly true for contemporary heterogeneous student cohorts.
RECOMMENDATIONS/IMPLICATIONS/CONCLUSION: This finding highlights the challenge for curriculum designer to design appropriate course curriculum and teaching staff to implement efficient teaching strategies that benefit both surface and deep learners, who are usually enrolled together. It may be beneficial to provide diversity and flexibility in the curriculum and teaching approaches (rather than a uniform approach). However, this may demand additional resources and may also be questioned for equity and consistency of education. It is also important to note that due to relatively a small dataset, these results may not be generalised.

Transition to specialty practice program characteristics and professional development outcomes

BACKGROUND: Transition to Specialty Practice Programs was introduced to facilitate the transition of nurses to specialty practice, and is recognised as preparatory for emergency nurses. Emergency nursing Transition to Specialty Practice Programs and their characteristics have developed locally in response to unit needs. OBJECTIVE: The aim of this study was to examine the characteristics of emergency nursing Transition to Specialty Practice Programs in Australia, and identify which characteristics were associated with improved professional development outcomes. METHODS: An explanatory sequential design was used. Data were collected via online surveys and interviews of emergency Nurse Managers and Nurse Educators. Transition to Specialty Practice Program characteristics were compared using Mann Whitney U and Chi-Square tests. Content analysis was used to analyse qualitative data. RESULTS: Survey data were collected from 118 emergency departments, and 13 interviews were conducted. Transition to Specialty Practice Programs were offered in most emergency departments (n=80, 72.1%), with one or two intakes per year. Transition to Specialty Practice Program characteristics varied; duration ranged from 5-12months, clinical preparation time ranged from 7-22days, and the number of study days provided ranged from 2-6. When Transition to Specialty Practice Programs of 6 and 12months duration were compared, there was no difference in the content covered. Emergency departments with 12month Transition to Specialty Practice Programs had lower percentages of Clinical Specialists (9% vs 18%, p=0.03) and postgraduate qualified nurses (30.5% vs 43.8%, p=0.09). CONCLUSION: The target participants, duration and clinical preparation of Transition to Specialty Practice Programs participants varied, impeding workforce mobility and articulation to postgraduate study and there were no professional development advantages from longer programs. There is an urgent need for a nationally consistent, evidence-based and fiscally responsible approach to Transition to Specialty Practice Programs.