Influence of price discounts and skill-building strategies on purchase and consumption of healthy food and beverages: outcomes of the Supermarket Healthy Eating for Life randomized controlled trial

BACKGROUND: Fiscal strategies are increasingly considered upstream nutrition promotion measures. However, few trials have investigated the effectiveness or cost effectiveness of pricing manipulations on diet in real-world settings. OBJECTIVE: We assessed the effects on fruit, vegetable, and beverage purchasing and consumption of a 20% price-reduction intervention, a tailored skills-based behavior-change intervention, and a combined intervention compared with a control condition. DESIGN: The Supermarket Healthy Eating for Life trial was a randomized controlled trial conducted over 3 mo [baseline (time 1) to postintervention (time 2) with a 6-mo follow-up (time 3)]. Female primary household shoppers in Melbourne, Australia, were randomly assigned to a 1) skill-building (n = 160), 2) price-reduction (n = 161), 3) combined skill-building and price-reduction (n = 160), or 4) control (n = 161) group. Supermarket transaction data and surveys were used to measure the following study outcomes: fruit, vegetable, and beverage purchases and self-reported fruit and vegetable consumption at each time point. RESULTS: At 3 mo (time 2), price reduction-alone participants purchased more total vegetables and frozen vegetables than did controls. Price reduction-alone and price reduction-plus-skill-building participants purchased more fruit than did controls. Relative to controls, in the price-reduction group, total vegetable consumption increased by 233 g/wk (3.1 servings or 15% more than at baseline), and fruit purchases increased by 364 g/wk (2.4 servings; 35% more than at baseline). Increases were not maintained 6 mo postintervention (time 3). Price reduction-alone participants showed a tendency for a slight increase in fruit consumption at time 2 (P = 0.09) that was maintained at time 3 (P = 0.014). No intervention improved purchases of bottled water or low-calorie beverages. CONCLUSIONS: A 20% price reduction in fruit and vegetables resulted in increased purchasing per household of 35% for fruit and 15% for vegetables over the price-reduction period. These findings show that price modifications can directly increase produce purchases. The Supermarket Healthy Eating for Life trial was registered at Current Controlled Trials Registration as ISRCTN39432901.

Interview with Deddy Mulyana

Deddy Mulyana is an Indonesian who studied at Monash University in 1992-1995. Before coming to Australia, he completed his Masters degree in the US on a Fulbright scholarship. He then studied in Melbourne on an Australian International Development Assistance Bureau (AIDAB) Scholarship and completed his PhD in Sociology. The interview was conducted in English on 29 April 2014 by Dr. Jemma Purdey of Deakin University and Dr. Ahmad Suaedy of the Abdurrahman Wahid Centre for Inter-faith Dialogue and Peace at Universitas Indonesia. This set comprises: an interview recording in two parts, a timed summary and a photograph.

Interview with Mulyoto Pangestu

Mulyoto Pangestu is an Indonesian who studied in Melbourne on two occasions; in 1993-1996, and in 1998-2005. During his first period of study he started at the University of Melbourne, but transferred to Monash University in 1994. He completed a Graduate Diploma in Agricultural Science in his one year at Melbourne University, before completing his Masters in Reproductive Science at Monash in 1994-1996. The change in field was the reason for his transferral to Monash. After two and a half years back in Indonesia, he returned to Monash University to complete his PhD in Reproductive Science. He was awarded Australian International Development Assistance Bureau (AIDAB) Scholarships to study in Australia. The interview was conducted in English on 18 August 2014 by Dr. Jemma Purdey of Deakin University. This set comprises: an interview recording, a timed summary and a photograph.

Cross-sectional and longitudinal associations between parents' and preschoolers' physical activity and TV viewing: the HAPPY Study

Background: Parental modelling has been shown to be important for school-aged children’s physical activity (PA) and television (TV) viewing, yet little is known about its impact for younger children. This study examined cross-sectional and three-year longitudinal associations between PA and TV viewing behaviours of parents and their preschool children. Method: In 2008-9 (T1), parents in the HAPPY cohort study (n=450) in Melbourne, Australia self-reported their weekly PA and TV viewing, and proxy-reported their partner’s PA and TV viewing, and their 3-5 year-old preschool child’s TV viewing. Children’s PA was assessed via accelerometers. Repeat data collection occurred in 2011-12 (T2). Results: Mothers’ and fathers’ PA were associated with PA among preschool girls at T1, but not boys. Parents’ TV viewing times were significant correlates of girls’ and boys’ TV viewing at T1. Longitudinally, mothers’ PA at baseline predicted boys’ PA at T2, while sex-specific associations were found for TV viewing, with mothers’ and fathers’ TV viewing at T1 associated with girls’ and boys’ TV viewing respectively at T2. Conclusions: The PA and TV viewing of both parents are significantly associated with these behaviours in preschool children. The influence of the sex-matched parent appears to be important longitudinally for children’s TV viewing&period.

Restorative care for palliative patients: a retrospective clinical audit of outcomes for patients admitted to an inpatient palliative care unit

BACKGROUND: Restorative care in palliative care is a subset of rehabilitation that aims to improve quality of life through restoration or maintenance of physical functions. Outcomes for restorative care programmes delivered by palliative care units have not adequately been assessed. OBJECTIVES: The objectives are to examine the outcomes of a restorative care programme in an inpatient palliative care unit, including discharge destination, performance status changes and length of stay. METHODS: Retrospective clinical audit of consecutive patients admitted to Calvary Health Care Bethlehem in Melbourne, Australia, principally for restorative care from July 2010 to December 2011. RESULTS: 79 admissions met inclusion criteria. Mean age was 76.5 years (SD=11.14) and 43 (54%) were men. 75 (95%) patients had a malignant diagnosis; of these, the majority had lung cancer (24%). 16 patients (20%) were discharged home, 51 (65%) died and 12 (15%) were transferred. Of the patients discharged home, only 6 (38% of those discharged home) improved their performance status. Those discharged home had a significantly shorter length of stay (17 days compared to 39 days; p<0.05). Patients discharged home also had significantly better Australia-modified Karnofsky Performance Status (AKPS) and Resource Utilisation Groups-Activities of Daily Living (RUG-ADL) scores on admission than others (both p<0.05). CONCLUSIONS: The majority of patients referred for restorative care died during admission, with only a minority discharged home. Patients discharged most commonly experienced maintenance and not improvement in performance status. A successful discharge home following restorative care was associated with a shorter length of stay. Implications and recommendations for successful restorative care will be discussed.

Gestational weight gain information: seeking and sources among pregnant women

BACKGROUND: Promoting healthy gestational weight gain (GWG) is important for preventing obstetric and perinatal morbidity, along with obesity in both mother and child. Provision of GWG guidelines by health professionals predicts women meeting GWG guidelines. Research concerning women's GWG information sources is limited. This study assessed pregnant women's sources of GWG information and how, where and which women seek GWG information. METHODS: Consecutive women (n&thinsp;=&thinsp;1032) received a mailed questionnaire after their first antenatal visit to a public maternity hospital in Melbourne, Australia. Recalled provision of GWG guidelines by doctors and midwives, recalled provided GWG goals, and the obtaining of GWG information and information sources were assessed. RESULTS: Participants (n&thinsp;=&thinsp;368; 35.7 % response) averaged 32.5 years of age and 20.8 weeks gestation, with 33.7 % speaking a language other than English. One in ten women recalled receiving GWG guidelines from doctors or midwives, of which half were consistent with Institute of Medicine guidelines. More than half the women (55.4 %) had actively sought GWG information. Nulliparous (OR 7.07, 95 % CI&thinsp;=&thinsp;3.91-12.81) and obese (OR 1.96, 95 % CI&thinsp;=&thinsp;1.05-3.65) women were more likely to seek information. Underweight (OR 0.29, 95 % CI&thinsp;=&thinsp;0.09-0.97) women and those working part time (OR 0.52, 95 % CI&thinsp;=&thinsp;0.28-0.97) were less likely to seek information. Most frequently reported GWG sources included the internet (82.7 %), books (55.4 %) and friends (51.5 %). The single most important sources were identified as the internet (32.8 %), general practitioners (16.9 %) and books (14.9 %). CONCLUSION: More than half of women were seeking GWG guidance and were more likely to consult non-clinician sources. The small numbers given GWG targets, and the dominance of non-clinical information sources, reinforces that an important opportunity to provide evidence based advice and guidance in the antenatal care setting is currently being missed.

Our Sherlockian eyes: the surveillance of vision

or this inter-disciplinary article, we undertook a pilot case study that eye-tracked the ‘Holmes Saves Mrs. Hudson’ sequence from the episode, A Scandal in Belgravia (Sherlock, BBC, 2012). This small-scale empirical study involved a total of 13 participants (3 males and 10 females, mean age was: 27 years), comprised of a mixture of academics and undergraduate students at La Trobe University in Melbourne, Australia. The article examines its findings through a range of threaded frames – neuroscience, forensics, surveillance, haptics, memory, performance-movement, and relationality – and uniquely draws upon the interests of the authors to set the examination in context. The article is both a reading of Sherlock and a dialogue between its authors. We discover that the codes and conventions of Sherlock have a direct impact on where viewers look but we also discover eyes emerging in the periphery of the frame, and we account for these ways of seeing in different ways.

Within-and between-day associations between children's sitting and physical activity time

Background: The objective of this study was to examine whether increased levels of sitting time and physical activity in one period (within-day) or on one day (between-day) were predictive of lower levels in these behaviours in the following period or day among children. Methods: Children aged 8-11 years from 8 primary schools located in Melbourne, Australia, wore an activPAL for 7 consecutive days (n = 235; 53 % boys). Sitting, standing and stepping time were derived for each day and for specific periods on weekdays and weekend days. Multilevel analyses were conducted using generalised linear latent and mixed models to estimate associations between temporally adjacent values (i.e. pairs of days; pairs of periods within-days) between the outcome variables. Results: Significant associations were observed between temporally adjacent days and periods of the day. On any given day, an additional 10 min of stepping was associated with fewer minutes of stepping (~9 min; 95 % CI: -11.5 to -6.2 min) and standing (15 min; 95 % CI: -18.8 to -11.1 min) the following day. Greater time spent sitting during one period, regardless of being a weekday or weekend day, was associated with less time sitting and more time standing and stepping in the following period. Conclusions: The direction of the results suggest that children appeared to compensate for increased sitting, standing, and stepping time both within- and between-days. The implications of such associations for the design and delivery of interventions require consideration.

All around

All Around is a collaborative video art piece created by Twin Peetz, Bob Brass and Renata Lemos Morais. Renata's spoken word performance was recorded and mixed to the music of Bob Brass, which was synthezised by Twin Peetz as the soundtrack to one of his Glitch Art videos. A series of GIFs was also created as a rection to the concepts.This work was developed online and simultaneously in Melbourne, New Paltz and Berlin by the three artists. The video piece, All Around, is their combined artistic interpretation of the conceptual challenges presented by Renata in her forthcoming article Sky High, Skin Deep: dark technologies of mediation, to be published by CTheory.net.

Clinical review criteria and medical emergency teams: evaluating a two-tier rapid response system

OBJECTIVES: To assess the prevalence of patients fulfilling clinical review criteria (CRC), to determine activation rates for CRC assessments, to compare baseline characteristics and outcomes of patients who fulfilled CRC with patients who did not, and to identify the documented nursing actions in response to CRC values. DESIGN, SETTING AND PARTICIPANTS: A cross-sectional study using a retrospective medical record audit, in a universityaffiliated, tertiary referral hospital with a two-tier rapid response system in Melbourne, Australia. We used a convenience sample of hospital inpatients on general medical, surgical and specialist service wards admitted during a 24-hour period in 2013. MAIN OUTCOME MEASURES: Medical emergency team (MET) or code blue activation, unplanned intensive care unit admissions, hospital length of stay and inhospital mortality. For patients who fulfilled CRC or MET criteria during the 24- hour period, the specific criteria fulfilled, escalation treatments and outcomes were collected. RESULTS: Of the sample (N = 422), 81 patients (19%) fulfilled CRC on 109 occasions. From 109 CRC events, 66 patients (81%) had at least one observation fulfilling CRC, and 15 patients (18%) met CRC on multiple occasions. The documented escalation rate was 58 of 109 events (53%). The number of patients who fulfilled CRC and subsequent MET call activation criteria within 24 hours was significantly greater than the number who did not meet CRC (P < 0.001). CONCLUSIONS: About one in five patients reached CRC during the study period; these patients were about four times more likely to also fulfil MET call criteria. Contrary to hospital policy, escalation was not documented for about half the patients meeting CRC values. Despite the clarity of escalation procedures on the graphic observation chart, escalation remains an ongoing problem. Further research is needed on the impact on patient outcomes over time and to understand factors influencing staff response.

Stillness and movement: a bodily approach to photography

My paper will address both Duration and temporality of the ‘still’ imageand Sensorial and bodily experience of photography through a discussion of a recent body of work ‘Fly Rhythm’, a series of photographs and video works exhibited in a gallery context.By acknowledging the inter-relationship between the body and the camera my project seeks to challenge a perceived separation between performance and photography. Fly Rhythm was conceived through a performative somatic process. Through using a custom made camera I was able to negotiate time and space to create a visual drawing of movement and stillness together in photography. The resultant images are discussed as a notation of body movement – a record of bodily history enabled through a self imposed discipline of learning to read light.I initially constructed a human size camera to understand how photography works. Spending time inside observing the way light moves and affects the formation of sight is also a way of embodying the act of photography. I responded by making a bespoke camera that enabled light to be captured during extended periods while moving. My project is dependent upon a self-imposed discipline of intuiting light’s strength and erratic changes, a skill developed by making analogue prints while inside a camera obscura. Once I had developed an ability to read light’s changes and gain an understanding of camera mechanics I made durational recordings moving through the landscape on Bruny Island Tasmania and industrial sites in Melbourne, photographs exhibited as part of Fly Rhythm. I will discuss these prints in context with the idea that light is a conduit through which past and present fuse together in a bodily act of photographing and processing images.I will explore durational aspects of photography by discussing light’s relative motion while taking photographs without using the viewfinder or composing images in the traditional way. Rather, the camera at the end of my arm is directed through how I read light therefore a choreography notated in the prints – a kind of body signatureMy practice enables a new the way of seeing, in a spontaneous hand held process creating a sense of embodiment. By analyzing process my paper will consider how the body together with analogue and 21st century digital technology coalesce cross-disciplinary practice combining visual art, performance and photographic disciplines.I also explored limitations of digital light in contrast with ‘natural’ light by a making a gamut of dissolving colour determined by the software based on two pixels. Projected into the ambient light ‘Glide’ is an 11minute durational work installed at the Substation Contemporary Art Space in Melbourne Australia.

The relationship between problem gambling and attention deficit hyperactivity disorder

Recent studies indicate that treatment-seeking problem gamblers display elevated rates of ADHD and that adolescents who screen positive for ADHD are more likely to engage in gambling, develop gambling problems, and experience a greater severity in gambling problems. This study aimed to (a) compare the prevalence of ADHD in treatment-seeking problem gamblers to the general population; (b) investigate the relationships between ADHD and problem gambling severity, cluster B personality disorders, motor impulsivity, alcohol use, substance use, gender, and age; and (c) investigate the degree to which these factors moderate the relationship between ADHD and problem gambling severity. Participants included 214 adults (154 males, 58 females, 2 unspecified) who sought treatment for their gambling problems at a specialist gambling agency in Melbourne, Australia. Almost one-quarter (24.9 %) of treatment-seeking problem gamblers screened positively for ADHD, which was significantly higher than the 14 % prevalence in a community sample. ADHD was significantly positively correlated with problem gambling severity, motor impulsivity, and cluster B personality disorders, but was not associated with alcohol and substance use, gender or age. None of the factors significantly moderated the relationship between ADHD and problem gambling severity. These findings suggest that a considerable proportion of treatment-seeking problem gamblers report ADHD and that their clinical profile is complicated by the presence of high impulsivity and cluster B personality disorders. They highlight the need for specialist gambling agencies to develop screening, assessment, and management protocols for co-occurring ADHD to enhance the effectiveness of treatment.

Challenges and opportunities of undertaking a video ethnographic study to understand medication communication

AIMS AND OBJECTIVES: To examine the challenges and opportunities of undertaking a video ethnographic study on medication communication among nurses, doctors, pharmacists and patients. BACKGROUND: Video ethnography has proved to be a dynamic and useful method to explore clinical communication activities. This approach involves filming actual behaviours and activities of clinicians to develop new knowledge and to stimulate reflections of clinicians on their behaviours and activities. However, there is limited information about the complex negotiations required to use video ethnography in actual clinical practice. DESIGN: Discursive paper. METHOD: A video ethnographic approach was used to gain better understanding of medication communication processes in two general medical wards of a metropolitan hospital in Melbourne, Australia. This paper presents the arduous and delicate process of gaining access into hospital wards to video-record actual clinical practice and the methodological and ethical issues associated with video-recording. CONCLUSIONS: Obtaining access to clinical settings and clinician consent are the first hurdles of conducting a video ethnographic study. Clinicians may still feel intimidated or self-conscious in being video recorded about their medication communication practices, which they could perceive as judgements being passed about their clinical competence. By thoughtful and strategic planning, video ethnography can provide in-depth understandings of medication communication in acute care hospital settings. Ethical issues of informed consent, patient safety and respect for the confidentiality of patients and clinicians need to be carefully addressed to build up and maintain trusting relationships between researchers and participants in the clinical environment. RELEVANCE TO CLINICAL PRACTICE: By prudently considering the complex ethical and methodological concerns of using video ethnography, this approach can help to reveal the unpredictability and messiness of clinical practice. The visual data generated can stimulate clinicians' reflexivity about their norms of practice and bring about improved communication about managing medications.

The effect of a staged, emergency department specific rapid response system on reporting of clinical deterioration

BACKGROUND: Despite emerging evidence regarding clinical deterioration in emergency department (ED) patients, the widespread uptake of rapid response systems (RRS) in EDs has been limited. AIMS: To evaluate the effect of an ED RRS on reporting of clinical deterioration and determine if there were differences between patients who did, and did not, deteriorate during ED care. METHODS: A retrospective cross sectional design was used to conduct this single site study in Melbourne, Australia. Stratified random sampling identified 50 patients with shortness of breath, chest pain or abdominal pain per each year studied (2009-2012) giving a total of 600 patients. The intervention was an ED RRS implemented in stages. RESULTS: The frequency of clinical deterioration was 14.8% (318 episodes/89 patients). Unreported deterioration decreased each year (86.7%; 68.8%; 55.3%; 54.0%, p=0.141). Patients who deteriorated during ED care had a longer median ED length of stay (2.8h; p<0.001), were 31.9% more likely to need hospital admission (p<0.001) and 4.9% more likely to die in hospital (p=0.044). CONCLUSIONS: A staged ED specific RRS decreased the frequency of unreported clinical deterioration. Controlled multi-site studies of ED specific RRSs are needed to examine the effect of formal ED RRSs on patient outcomes.

The impact on family functioning of social media use by depressed adolescents: a qualitative analysis of the family options study

BACKGROUND: Adolescent depression is a prevalent mental health problem, which can have a major impact on family cohesion. In such circumstances, excessive use of the Internet by adolescents may exacerbate family conflict and lack of cohesion. The current study aims to explore these patterns within an intervention study for depressed adolescents.

METHOD: The current study draws upon data collected from parents within the family options randomized controlled trial that examined family based interventions for adolescent depression (12-18&thinsp;years old) in Melbourne, Australia (2012-2014). Inclusion in the trial required adolescents to meet diagnostic criteria for a major depressive disorder via the Structured Clinical Interview for DSM-IV Childhood Disorders. The transcripts of sessions were examined using qualitative thematic analysis. The transcribed sessions consisted of 56&thinsp;h of recordings in total from 39 parents who took part in the interventions.

RESULTS: The thematic analysis explored parental perceptions of their adolescent's use of social media (SM) and access to Internet content, focusing on the possible relationship between adolescent Internet use and the adolescent's depressive disorder. Two overarching themes emerged as follows: the sense of loss of parental control over the family environment and parents' perceived inability to protect their adolescent from material encountered on the Internet and social interactions via SM.

CONCLUSION: Parents within the context of family based treatments felt that prolonged exposure to SM exposed their already vulnerable child to additional stressors and risks. The thematic analysis uncovered a sense of parental despair and lack of control, which is consistent with their perception of SM and the Internet as relentless and threatening to their parental authority and family cohesion.