Depression : an important comorbidity with metabolic syndrome in a general population

OBJECTIVE—There is a recognized association among depression, diabetes, and cardiovascular disease. The aim of this study was to examine in a sample representative of the general population whether depression, anxiety, and psychological distress are associated with metabolic syndrome and its components.

RESEARCH DESIGN AND METHODS—Three cross-sectional surveys including clinical health measures were completed in rural regions of Australia during 2004–2006. A stratified random sample (n = 1,690, response rate 48%) of men and women aged 25–84 years was selected from the electoral roll. Metabolic syndrome was defined by the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, Adult Treatment Panel III (NCEP ATP III), and International Diabetes Federation (IDF) criteria. Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale and psychological distress by the Kessler 10 measure.

RESULTS—Metabolic syndrome was associated with depression but not psychological distress or anxiety. Participants with the metabolic syndrome had higher scores for depression (n = 409, mean score 3.41, 95% CI 3.12–3.70) than individuals without the metabolic syndrome (n = 936, mean 2.95, 95% CI 2.76–3.13). This association was also present in 338 participants with the metabolic syndrome and without diabetes (mean score 3.37, 95% CI 3.06–3.68). Large waist circumference and low HDL cholesterol showed significant and independent associations with depression.

CONCLUSIONS—Our results show an association between metabolic syndrome and depression in a heterogeneous sample. The presence of depression in individuals with the metabolic syndrome has implications for clinical management.

Market makers v's the general public : a first look at S & P500 futures trade data

This paper considers 15 minute records of trading volume and traded prices coinciding with the reporting intervals required by the Commodity Futures Trading Commission. Records are extracted from trade records for market trade and also two way trade between market makers (CT1) and the general public (CT4) from January 1994 to June 2004. Futures price records are matched with S&P500 cash index price records. Simultaneous volatility models are specified and estimated to test trading volume to futures volatility lead/lag effects and also futures volatility to cash index volatility lead/lag effects. As we disaggregate from the market records to CT1 and CT4 records and further into year to year samples volume to futures volatility leading effects and also futures volatility to cash volatility leading effects dominate. The results raise important issues for risk management and dynamic hedging models employing intra-day trader data. A number of important issues for further analysis are also raised in this paper.

Accounting services and SMEs : an Australian study

Background: The observance of regulation has become a fundamental part of life for the conduct of business around the world. Governments and their duly appointed designates, acting in the interest of the collective public, have relied on regulation to moderate economic and social behaviour through the imposition and enforcement of rules. While it can be commonly accepted that such a prescriptive framework may be necessary for the achievement of desired economic and social outcomes, regulation does impose costs on society and on individual firms. These costs, which can include the costs for government departments to administer, the cost for firms to comply, and the multitude of indirect costs such as lost innovation and productivity or their interrelated opportunity costs, have received ample attention.

Accountants are key advisers to all businesses on all aspects of doing business, including regulation. As such, it is appropriate that ACCA has sponsored this study, which explores the regulatory issues facing SMEs and the critical role that accountants and other organisations play in helping SMEs be aware of, comply with and generally manage effectively the regulations that apply to their business.

ACCA has consistently argued for a balanced view to be taken on regulation, recognising that certain rules are necessary for the fair development of business and for employees’ rights. Yet at the same time, ACCA recognises that SMEs are likely to be disproportionately burdened by regulatory requirements and, as a consequence, it actively campaigns for fairness in regulation, recognising the issue as a significant factor in the success, productivity and growth of small businesses.

Overview: This study complements similar research commissioned by ACCA in the United Kingdom and Canada (Blackburn et al. 2006), with the aim of helping to provide a more international picture of the effects of regulation on adviceseeking by SMEs and how accountants can help SMEs meet their regulatory obligations.

The research commenced in November 2006 and was conducted over the Australian summer period 2006/7, among SMEs and accounting practices, as follows:

* telephone survey among 250 SMEs
* postal survey among 130 accounting practitioner firms.

Key findings: The SME section of this study revealed the following points.

* Most SMEs (between 70% and 80%), agreed that the regulations under review were reasonable, however there were significantly high levels of concern regarding:
* the number of regulations affecting their business (80%)
* staying up to date with changing regulations (80%)
* complexity of regulation or the ease of understanding regulations (77%)
* inequity, or the cost of regulation in proportion to the business (66%)
* duplication, or being required to provide the same information to more than one government department (55%).
* External accountants were the most common source of advice, being used by 72% of SMEs; this was followed by federal government agencies,    62%; trade or industry bodies, 61%; and a lawyer or solicitor, 53%.
* Highest levels of satisfaction with the advice provided were recorded for lawyers/solicitors (94%), banks (91%) and external accountants (90%).
* Overall, 80% of SMEs who had used accountants rated their service as excellent or good. Thirty per cent gave accountants an excellent rating.
* Accountants rated particularly well on the following attributes:
* the potential for a long-term relationship with the business (81% excellent/good)
* technical understanding of the regulatory requirements that apply to the business (79%)
* ability to meet the needs of the business (77%)
* understanding of the business of the SME and its operations (73%).

The survey of accounting practitioners produced the following information.
* The results indicate that SME firms with fewer than 10 employees are the main source of revenue for the respondent accounting practitioners.
* Virtually all accountants provide regulatory advice, primarily in the areas of taxation (particularly Goods and Services Tax, GST), and Do-It-      Yourself (DIY) superannuation requirements. These services provided the accountants with their largest business growth in the two years before the time of the survey.

Seventy-nine per cent of accountants referred their SME clients to external professional advisers. Their comments indicate (see Appendix 4) that some accountants consider their role to be as convenors or advisers for their SME clients. Importantly, according to the accountants, SME firms with fewer than 10 employees did not update their knowledge of regulatory requirements; they relied on their accountant for the right advice. The main types of external adviser to whom accountants referred their SME clients were lawyers and financial planners.

* Accountants expressed their concern regarding the complexity and amount of regulations affecting their SME clients.
* The accountants also stated that they would like to provide additional advice to their SME clients.
 
Confidence intervals – SME survey:  The survey sample size was 250 SMEs from the total of 1.2 million Australian SMEs. Any estimate of proportions agreeing or disagreeing with particular statements must be considered with respect to the margin of possible statistical error. Owing to the small sample size, generalising the results from this study to a wider population of SMEs may be constrained.

A 95% confidence interval of the sample mean for the following estimates based on a percentage agreement of 75% to a proposition with a sample size of 250 would be from 69.5% to 80.5%. The 95% confidence interval for estimates of any other value will diverge slightly in magnitude from the numbers given.

In general then we can be highly confident that the actual sample mean will be within approximately ± 5% of the figure given, with a survey of this size. Confidence intervals – acounting practitioner survey IBISWorld estimates reveal a figure of 9,222 accounting practices in Australia as at June 2006 (IBISWorld 2007). The sample size of 133 accounting practitioners gives a 95% confidence limit that the results reported from the mail-out survey are within the ± 5% confidence interval of the reported values.

Conclusions:  This report describes the results of two parallel surveys undertaken on the impact of business regulation on small and medium-sized enterprises in Australia and on the perceptions of accounting firms about the ways in which the regulatory impact on the SME sector drove their business.

The survey of SMEs provides empirical support for many of the concerns raised with the Regulation Taskforce, which reported to the Australian government in 2006. Many businesses are concerned about the volume and complexity of government legislation as it applies to their business. They are concerned that they are unable to keep up with new legislation and that there is apparent duplication of reporting requirements across the various tiers of government.

The survey of accountants revealed that accounting firms derive a significant proportion of their revenue from SMEs. While the SMEs are concerned with regulatory changes, the accountants surveyed reported that the major growth areas in their businesses were in what could be seen as traditional accounting areas of tax and superannuation. Some SMEs sought advice on areas such as employment law, environmental regulation and health and safety but it appears that many accountants refer their clients to specialists in these areas. Recent changes to the laws regarding financial planning in Australia may lead to changes in the market for financial advice in Australia, with many accountants apparently regarding this as a key driver of future business opportunities.

The surveys were conducted using a similar instrument to similar surveys conducted in the UK and Canada and reported in Blackburn et al. (2006). Comparisons of the Australian survey results with those from the UK and Canada seem to support the perception that Australian business is not over-regulated, but the SME sector is concerned with the volume and complexity of regulation. This suggests that the SME sector wants to see improvements to Australia’s regulatory regime as a result of the work of the Regulation Taskforce undertaken in 2005/6. In its response to the work of the Taskforce the government agreed with 158 of the 178 specific recommendations of the Taskforce. This now needs to be followed through at all levels of government.

Accountants in all three countries understand their SME clients’ concerns with the burden of regulation and they are prepared to advise their clients where appropriate or refer them to specialist advisers. Most business growth for accountants has come from the taxation area. Very few accountants in the UK or Australia specialise in providing advice in the areas of environmental regulation or health and safety regulation.

International comparisons show that in all three countries accountants are generally highly regarded by SMEs for their professionalism and competence. The major area of client concern is the value for money offered by the accountant’s service. In an era of rapidly shifting professional and technical boundaries, accountants need to be more strongly attuned to levels of client satisfaction. Lawyers, financial planners and a plethora of specialist advisers operate in the business services market and if they have an opportunity to take business from accountants by competing on price they may well do so. This suggests a stronger role for professional accounting bodies in monitoring the broader business services market for opportunities and threats on behalf of their membership.

Is there global inclusion in publishing in the five leading advertising journals and does this relate to general publishing performance : a regional comparison

The question has been raised in academia whether there is global inclusion of authors in publishing. This has generally not been explored in the 30 years of research on advertising research activity and those works that do exist in advertising have generally only examined three North American focused journals. This paper expands the set of journals to five advertising focused journals and thus is a global examination of publishing in advertising. Within these five advertising journals there is an increased international involvement and thus it appears that a broader set of perspectives are being considered in the advertising literature. We also found that there is a positive correlation between publishing in the five leading advertising journals and four leading generalist journals, suggesting that institutions may be developing broader research cultures, rather than targeting works only in advertising.

Dispersion of information or market behaviour : general public trading in S & P 500 index futures

This paper considers 15 minute records of trading volume and traded prices coinciding with the reporting intervals required by the Commodity Futures Trading Commission. Records are extracted from trade records for two way trade between market makers (CTI1) and the general public (CTI4) from January 1994 to June 2004. Futures price records are matched with S&P500 cash index price records. Simultaneous volatility models are specified and estimated to test trading volume to futures volatility lead/lag effects and also futures volatility to cash index volatility lead/lag effects. There is evidence that existing theoretical models of the general public trading behaviour do not explain such behaviour in these very actively traded markets. These effects can depend more on market conditions than what is suggested in theoretical models.

Are rural health professionals also social entrepreneurs?

Social entrepreneurs formally or informally generate community associations and networking that produces social outcomes. Social entrepreneurship is a relatively new and poorly understood concept. Policy promotes generating community activity, particularly in rural areas, for health and social benefits and ‘community resilience’. Rural health professionals might be well placed to generate community activity due to their status and networks. This exploratory study, conducted in rural Tasmania and the Highlands and Islands of Scotland considered whether rural health professionals act as social entrepreneurs. We investigated activities generated and processes of production. Thirty-eight interviews were conducted with general practitioners, community nurses, primary healthcare managers and allied health professionals living and working rurally. Interviewees were self-selecting responders to an invitation for rural health professionals who were ‘formally or informally generating community associations or networking that produced social outcomes’. We found that rural health professionals initiated many community activities with social outcomes, most related to health. Their identification of opportunities related to knowledge of health needs and examples of initiatives seen elsewhere. Health professionals described ready access to useful people and financial resources. In building activities, health professionals could simultaneously utilise skills and knowledge from professional, community member and personal dimensions. Outcomes included social and health benefits, personal ‘buzz’ and community capacity. Health professionals' actions could be described as social entrepreneurship: identifying opportunities, utilising resources and making ‘deals’. They also align with community development. Health professionals use contextual knowledge to envisage and grow activities, indicating that, as social entrepreneurs, they do not explicitly choose a social mission, rather they act within their known world-view. Policymakers could consider ways to engage rural health professionals as social entrepreneurs, in helping to produce resilient communities.

Meta-philosophy of religion : the analytic-continental divide in philosophy of religion

How is the philosophical study of religion best pursued? Responses to this meta-philosophical question tend to recapitulate the analytic-Continental divide in philosophy in general. My aim is to examine the nature of this divide, particularly as it has manifested itself in the philosophy of religion. I begin with a comparison of the stylistic differences in the language of the two traditions, taking the work of Alvin Plantinga and John Caputo as exemplars of the analytic and Continental schools respectively. In order to account for these stylistic divergences, however, it is necessary to delve further into meta-philosophy. I go on to show how each philosophical school models itself on different theoretical practices, the analytic school mimicking the scientific style of inquiry, while in Continental philosophy it is the arts and humanities rather than the sciences that provide the model for philosophical discourse. By situating themselves in such different genres,  analytic and Continental philosophers have developed contrasting, if not mutually exclusive, methods for pursuing the philosophy of religion.

How do we compare? - Applying UK pay for performance indicators to an Australian general practice

BACKGROUND United Kingdom general practitioners receive payment based on their performance in multiple clinical indicators. We set out to apply the same indicators in an Australian general practice to benchmark our performance and to see how much work was required to obtain the data.

METHODS Clinical indicators for the 2008–2009 UK Quality and Outcomes Framework (QOF) cycle were examined and achievement levels measured in a large rural Australian general practice, mainly by computer searching of the clinical database.

RESULTS Outcome measures were obtainable for 79 out of 80 indicators. Manual perusal of computer records was required for 16 indicators. Data collection takes approximately 130 hours. The Australian general practice achieved 66% of available pay for performance points compared to the UK average of 97%.

DISCUSSION United Kingdom QOF clinical data is obtainable relatively easily in a well computerised Australian rural general practice. The exercise identified significant areas in which clinical performance could be improved.

Unfree associations : inside psychoanalytic institutes

In an age of managed care and new biological therapies for mental illness, psychoanalysis is generally seen as a 'profession on the ropes' whose hour is up. What went wrong? While external factors have played their part in the fall of psychoanalysis, psychoanalysts have generally disregarded their own crucial role in creating this decline. This thesis examines this role as played out through their own institutions, the freestanding psychoanalytic institutes. Freud was an explorer but he also codified his ideas. His work has been taken as an inspiration to explore without presuppositions but also as Holy Writ. Psychoanalysis deals with emotions and excites passions. Like religion, psychoanalysis asks big questions, and, like religion, is easily influenced and seduced by dogmatic answers to these difficult questions. Psychoanalytic institutes have been notable as closed shops. Their solid walls have kept them sealed off and mysterious to the outside world, including the mental health professions and the academy. Authoritarian cliques, power struggles and intrigues have predominated inside the institutes. Institute life has been secret, the subject of rumour rather than knowledge. Insiders often know little about of other institutes (unless they are involved in site visits to particular institutes). Sometimes, insiders have a limited view of their own institutions because they see them through the vantage points of their own experience and that of some close colleagues. I have interviewed central participants of the dramas of the histories of some key psychoanalytic institutes in the US. For the first time, this thesis recounts the intricate inside history of these organizations. The thesis reveals the detailed inner political histories of arguably the four most important and varied psychoanalytic institutes affiliated with the APsaA. The New York Psychoanalytic Institute was the first and for decades the prestigious institute which set the model for many others. It became pre-eminent on a world scale with the immigration of leading European analysts fleeing the Nazis. The Boston Psychoanalytic Society and Institute, the Chicago Psychoanalytic Institute and the Los Angeles Psychoanalytic Society and Institute are quite varied in their organization and histories. The cultures are often quite different yet many of the problems will be found to be similar at base. I first examine the detailed political history of the New York Psychoanalytic Institute which provides a quintessential example of analytic anointment in practice, together with its pitfalls. I then examine a split that occurred in the Boston Psychoanalytic Society and Institute, which demonstrates some of the tensions and ambiguities that seem inherent in psychoanalytic organizations, especially where society and institute are part of the same institution. I move on to investigate a very different history in the Chicago Psychoanalytic Institute, which is quite differently organized: in Chicago, the institute with a lay Board of Trustees is quite separate from the society, and has for most of its history been headed by a powerful director. Then I look at the very complex history of the Los Angeles Psychoanalytic Society and Institute which in the 1970s came very close to being closed down by the APsaA. The Los Angeles Institute history is especially colourful and informative, given the introduction of Kleinian and object relations ideas into the institute and the reactions to them. These histories provide dramatic insights into what psychoanalysts and their institutions have contributed to what has gone wrong with psychoanalysis from the basis of a critique. A major aspect of the problem, in my view, is that a basically humanistic discipline has conceived and touted itself as a positivist science while organizing itself institutionally as a religion. I argue that psychoanalysts approach psychoanalysis with an inappropriate paradigm, 'as if it were a science. Their systemic misconception of their own discipline, and the resultant, widespread creation of what Christopher Bollas calls a 'false expertise' contributes to their present-day decline. I argue that qualification from an institute assumes the transmission of a body of knowledge which has not really been established as knowledge. This presumed knowledge is then transmitted by means of anointment reminiscent of the Bible. There is no unified body of knowledge within the psychoanalytic field nor is there a unified practice that can be readily empirically tested. Therefore, by default, psychoanalytic education has become a process of anointment, transmission through a subjective process akin to consecration. The large gap between the small knowledge base of psychoanalysis and the high level of 'pretend' knowledge which is inculcated during training and upon which qualification is based entrench conditions which themselves make real knowledge in this complex field more and more difficult to attain. This argument has implications not only for psychoanalysis but for many other professions where knowledge and qualification have unrealistic and inappropriate bases.

Investigation of educator adoption of knowledge media

Human development has occurred against a timeline that has seen the creation of and diffusion of one innovation after another. These innovations range from language to complex computing and information technologies. The latter are assisting with the distribution of information, and extend to the distribution of the human species beyond the planet Earth. From early times, information has been published and mostly for a fee to the publisher. The absorption and use of information has had a high priority in most societies from early times, and has become institutionalised in universities and institutes of technical learning. For most in Western societies, education is now a matter of ‘lifelong learning’. Today, we see higher education institutions, worldwide, adapting their organisational structures and operating procedures and forming strategic alliances with communications content providers and carriers as well as with information technology companies. Modern educational institutes seek productivity and efficiency. Many also seek to differentiate themselves from competitors. Technological convergence is often seen by management to be a saviour in many educational organisations. It is hoped that lower capital and recurrent costs can be achieved, and that competitors in an increasingly globalised industry can be held at bay by strategic use of knowledge media (Eisenstadt, 1995) commonly associated with distance education in the campus setting. Knowledge media set up costs, intellectual property costs and training costs for staff and students are often so high as to make their use not viable for Australian institutes of higher education. Against this backdrop, one might expect greater educator and student use of publisher produced textbooks and digital enhancements to the textbook, particularly those involved in distance education. A major issue is whether or not the timing of instructor adoption of converging information technology and communications technologies aligns with the wishes of both higher education management and government, and with those who seek commercial gain from the diffusion and adoption of such technologies. Also at issue is whether or not it is possible to explain variance in stated intentions to recommend adoption of new learning technologies in higher education and implementation. Will there occur educator recommendation for adoption of individual knowledge media such as World Wide Web access to study materials by students? And what will be the form of this tool and others used in higher education? This thesis reports on more recent changes in the technological environment and seeks to contribute to an understanding of the factors that lead to a willingness, or unwillingness, on the part of higher education instructors, as influencers and content providers, to utilise these technologies. As such, it is a diffusion study which seeks to fill a gap in the literature. Diffusion studies typically focus on predicting adoption based on characteristics of the potential adopter. Few studies examine the relationship between characteristics of the innovation and adoption. Nearly all diffusion studies involve what is termed discontinuous innovation (Robertson, 1971). That is, the innovation involves adoptees in a major departure from previous practice. This study seeks to examine the relationship between previous experience of related technologies and adoption or rejection of dynamically continuous innovation. Continuous and dynamically continuous innovations are the most numerous in the real world, yet they are numerically the least scrutinised by way of academic research. Moreover, the three-year longitudinal study of educators in Australian and New Zealand meets important criteria laid down by researchers Tornatzky and Klein (1982) and Rogers (1995), that are often not met by similar studies. In particular the study examines diffusion as it is unfolding, rather than selectively examining a single innovation and after the fact, thus avoiding a possible pro-innovation bias. The study examines the situation for both ‘all educators’ and ‘marketing / management educators’ alone in seeking to meet the following aim: Establish if intended adopters of specific knowledge media have had more experience of other computer-based technologies than have those not intending to adopt said knowledge media. The analytical phase entails use of factor analysis and discriminant analysis to conclude that it is possible to discriminate adopters of selected knowledge media based on previous use of related technologies. The study does not find any generalised factor that enables such discrimination among educators. Thus the study supports the literature in part, but fails to find generalised factors that enable unambiguous prediction of knowledge media adoption or otherwise among each grouping of educators examined. The implications are that even in the case of related products and services (continuous or dynamically continuous innovation), there is not statistical certainty that prior usage of related products or technologies is related to intentions to use knowledge media in the future. In this regard, the present study might be said to confirm the view that Rogers and Shoemaker's (1971) conceptualisation of perceived innovation characteristics may only apply to discontinuous innovations (Stratton, Lumpkin & Vitell, 1997). The implications for stakeholders such as higher education management is that when seeking to appoint new educators or existing staff to knowledge media project teams, there is some support for the notion that those who already use World Wide Web based technologies are likely to take these technologies into teaching situations. The same claim cannot be made for computer software use in general, nor Internet use in general.

Integrity of the circadian time-keeping system in chronic fatigue syndrome

Chronic Fatigue Syndrome (CFS) is a debilitating condition in which severe, ongoing fatigue is the most prominent of a complex of somatic, psychological and neuropsychological symptoms. The aetiology of CFS remains uncertain and, to date, efforts to distinguish a clear pathophysiological profile for the disorder have been unsuccessful. Current evidence suggests that, rather than being a discrete disease entity with a single cause, CFS is a clinical condition resulting from the interaction of a number of pathophysiological factors, including acute infections, stress and psychiatric disorder. Recently, there has been some interest in the proposition that disordered circadian time-keeping may contribute to the development and/or course of the illness. The rationale for the investigation of circadian factors in CFS is based on the fact that disorders known to be associated with circadian dysregulation, such as jet lag and shiftwork related syndromes have a high degree of symptomatological overlap with CFS. Also, the presence of circadian disturbance could account, in part, for other phenomenological aspects of CFS, including the high rates of comorbid affective disturbance, and the reports of low-level immune dyregulation among sufferers. While several recent studies have produced some evidence of chronobiological dysregulation in CFS patients, much work remains before conclusions can be drawn about the presence, nature and clinical significance of circadian disturbance in CFS. This thesis describes a series of studies that were designed to systematically investigate: 1. whether CFS is associated with a state of circadian dysregulation, and 2. whether circadian dysregulation contributes significantly to the symptomatology of CFS. The first of the 5 studies reported here compared the circadian patterns of sleep-activity of CFS sufferers with those of healthy controls. Results indicated that CFS patients' sleep-activity cycles were significantly phase delayed compared to controls, and that some aspects of their circadian profiles of sleep-activity were related to some measures of sleep-disturbance and well-being. Studies 2 and 3 investigated the relationship between rhythms of sleep-wake and core temperature in CFS patients and healthy controls. The major finding from these studies was that sleep-wake and core temperature rhythms appear to be less effectively synchronised. Further evidence was collected that suggested that there was a relationship between circadian parameters and symptom measures in the CFS group. While this indicated that circadian dysregulation is linked in some way to the symptoms of CFS, assessment of the actual clinical significance of circadian disturbances required the use of a prospective methodology. The final two studies, therefore, report on a placebo-controlled trial of clinical interventions that were designed to restore circadian integrity to CFS patients, in order to see whether this would lead to a reduction in symptom number or severity. Results indicated that, although patients experienced improvements across a range of measures of symptoms and functional capacity, these were small in magnitude, of unlikely clinical significance, and no greater, in general, to improvements reported by patients who underwent placebo treatment. These results, along with those of the earlier studies, are discussed with respect to their implications regarding the presence and significance of circadian dysregulation. It is concluded that, while they provide evidence that CFS is associated with a degree of both internal and external circadian desynchrony, these findings suggest that circadian dysregulation is likely to be only a peripheral, contributor to the processes that generate and maintain the symptom complex. These findings are discussed with respect to how they contribute to our overall understanding of this multi-dimensional condition, and the implications they have for the continuing effort to investigate the causes and treatment of CFS.

Australia and Japan in the South Pacific island countries : a general appraisal through the concepts of structural power

This study examines several specific fields of activity of Australia and Japan in the areas of security, production, finance, development assistance, information, education and regional organization. Using the concept of structural power, it observes the sources of Australian and Japanese strenght in the region, the growing imbalance in the bilateral Australia-Japan relationship, and also the coexistence of affinities and differences in the development opportunities opened to the South Pacific Island Countries.

Patient recall of receiving lifestyle advice for overweight and hypertension from their general practitioner

Background
Overweight, obesity and hypertension can be prevented through improvements in lifestyle including nutrition and physical activity. General practitioners (GPs) in Australia have access to over 90% of the population in the course of a year and therefore, the general practice setting may be ideal to assist patients with lifestyle change for weight management and hypertension. The present study aimed to determine the proportion of overweight/obese patients that recalled receiving advice by their GP to make lifestyle changes for weight loss. Recall of advice received by hypertensive patients to reduce salt intake was also measured.

Methods
A face to face survey was conducted on a representative sample (urban, suburban and rural) of South Australian residents. Respondents provided information on height and weight (self-report), whether they had received lifestyle advice from their GP for weight loss, and for those with self reported hypertension if they had received advice to reduce dietary salt.

Results
The sample included 2947 South Australian adult residents (58% female; BMI (mean (SD)), 26.6 (5.3) kg/m2; age, 50.7 (18.0) years). Ninety-six percent had visited their GP in the past 12 months. Forty-one percent of males and 25% of females were overweight and 19% of males and 20% of females were obese. Twenty-seven percent of overweight/obese respondents reported receiving lifestyle advice for weight loss purposes. Of the 33% who reported they had hypertension, 34% reported receiving advice to reduce salt intake.

Conclusions
Less than 1/3 of overweight/obese patients reported that they had received lifestyle advice that could assist with weight loss from their GP. About a third of respondents with hypertension reported that they received advice to reduce salt intake. There are potentially missed opportunities in which GPs could provide re-enforcement of benefits of lifestyle changes with respect to weight and blood pressure control.

Is dietary management a responsibility of general practitioners? The views of Victorian general practitioners

Rationale : Australia is experiencing an evolving healthcare system, resulting in an aim of systematic managed care for patients with chronic disease. One outcome has been debate on doctors' dietary management responsibilities.
Aim : To identify general practitioners' perceptions of their dietary management responsibilities for adult cardiac patients.
Methods : A Two phase study was conducted. First, semi-structured interviews with 30 Melbourne general practitioners were conducted to gather preliminary information about dietary management. The results informed a questionnaire for the second phase. This was completed by 248 general practitioners (30%) in Victoria.
Principal findings : Themes arising in interviews, and also supported by cross-sectional survey showed that doctors perceive themselves as filling one or more of three roles. The majority (87.4%) endorsed an 'Influencing' role, 27.4% endorsed 'Dietary Educator' and 44.0% a 'Coordinator' role. The Influencer role was characterised by encouragement of dietary behaviour change, such as discussing benefits and consequences of inaction to dietary change. The Educator role was characterised by the provision of a range of behaviour change strategies- 'how to' achieve change. 'Coordinators' reported the provision of dietary counselling belonged to dietitians alone.
Implications : The results indicate doctors' awareness of need for patients' dietary education should be increased. This could be accomplished by one-on-one education. Patients' access to dietary education should also be facilitated by doctors' referring on. Embedding dietary management protocols in doctors' managed care templates could improve patients' access to dietary education and enhance doctor's collaborative roles.
Presentation type : Paper
Session theme : Getting Evidence into Practice 2

An evaluation of a mental health screening and referral pathway for community nursing care : nurses' and general practitioners' perspectives

Aims and objectives. To evaluate a feasible, best practice mental health screening and referral clinical pathway for generalist community nursing care of war veterans and war widow(er)s in Australia.
Background. War veterans commonly experience mental health difficulties and do not always receive required treatment, as can also occur for war widow(er)s. Whenever opportunity arises, such as during community nursing care, it is vital to identify mental health problems in a health promotion framework.
Design. A clinical pathway was developed by literature review and consultation and then trialled and evaluated using mixed methods – quantitative and qualitative.
Methods. Community nurses who trialled the pathway completed an evaluation survey and attended focus groups. General practitioners responded to an evaluation survey.
Results. Most nurses found the pathway clear and easy to understand but not always easy to use. They emphasised the need to establish trust and rapport with clients prior to implementing the pathway. It was sometimes difficult to ensure effective referral to general practitioners for clients who screened positive for a mental health problem. When referral was accomplished, general practitioners reported adequate and useful information was provided. Some general practitioners also commented on the difficulty of achieving effective communication between general practitioners and nurses.
Conclusions. Nurses and some general practitioners found the pathway useful for their practice. They offered several suggestions for improvement by simplifying the trialled pathway and accompanying guidelines and strategies to improve communication between nurses and general practitioners. This study adds understanding of how community nurses might productively screen for mental health difficulties.
Relevance to clinical practice. The trialled pathway, which was modified and refined following the study, is an evidence-based
resource for community nurses in Australia and similar contexts to guide practise and maximise holistic care for war veterans and war widow(er)s and possibly other client groups.