Enhancing patient engagement in chronic disease self-management support initiatives in Australia : the need for an integrated approach

♦ Although emphasis on the prevention of chronic disease is important, governments in Australia need to balance this with continued assistance to the 77% of Australians reported to have at least one long-term medical condition.

♦ Self-management support is provided by health care and community services to enhance patients’ ability to care for their chronic conditions in a cooperative framework.

♦ In Australia, there is a range of self-management support initiatives that have targeted patients (most notably, chronic disease self-management education programs) and health professionals (financial incentives, education and training).

♦ To date, there has been little coordination or integration of these self-management initiatives to enhance the patient–health professional clinical encounter.

♦ If self-management support is to work, there is a need to better understand the infrastructure, systems and training that are required to engage the key stakeholders — patients, carers, health professionals, and health care organisations.

♦ A coordinated approach is required in implementing these elements within existing and new health service models to enhance uptake and sustainability.

Assessing the burden of overweight and obesity : an example from the United Kingdom

Introduction: In this paper I review previous cost studies for overweight and obesity in the UK. I propose a method for estimating the economic and health costs of overweight and obesity in the UK which could also be used in other countries.

Methods: Costs of obesity studies were identified via a systematic search of electronic databases. Information from the WHO Burden of Disease Project was used to calculate the mortality and morbidity cost of overweight and obesity.
Population attributable fractions for diseases attributable
to overweight and obesity were applied to National Health Service (NHS) cost data to estimate direct financial costs.

Results: We estimate the direct cost of overweight and obesity to the NHS at £3.2 billion. Other estimates range between £480 million in 1998 and £1.1 billion in 2004. There is wide variation in methods and estimates for the cost of overweight and obesity to the health systems of developed countries.

Conclusion: The method presented here could be used to calculate the costs of overweight and obesity in other countries. Public health initiatives are required to address the increasing prevalence of overweight and obesity and reduce associated healthcare costs.

Scale matters : the need for a Bipolar Depression Rating Scale (BDRS)

Objective: To briefly review the clinical and biological distinctions between unipolar and bipolar depression critiquing in particular currently available depression rating scales and discuss the need for a new observer-rated scale tailored to bipolar depression.

Method: Relevant literature pertaining to the symptomatic differences between bipolar disorder and unipolar disorder as well as their measurement using existing assessment scales was identified by computerized searches and reviews of scientific journals known to the authors.

Results: Bipolar depression is distinct from unipolar depression in terms of phenomenology and clinical characteristics. These distinguishing features can be used to identify bipolarity in patients that present with recurrent depressive episodes. This is important because current self-report and observer-rated scales are optimized for unipolar depression, and hence limited in their ability to accurately assess bipolar depression.

Conclusion: The development of a specific bipolar depression rating scale will improve the assessment of bipolar depression in both research and clinical settings and assist the development of better treatments and interventions.

Too little exercise and too much sitting : inactivity physiology and the need for new recommendations on sedentary behaviour

Moderate-to vigorous-intensity physical activity has an established preventive role in cardiovascular disease, type 2 diabetes, obesity, and some cancers. However, recent epidemiologic evidence suggests that sitting time has deleterious cardiovascular and metabolic effects that are independent of whether adults meet physical activity guidelines. Evidence from “inactivity physiology” laboratory studies has identified unique mechanisms that are distinct from the biologic bases of exercising. Opportunities for sedentary behaviors are ubiquitous and are likely to increase with further innovations in technologies. We present a compelling selection of emerging evidence on the deleterious effects of sedentary behavior, as it is underpinned by the unique physiology of inactivity. It is time to consider excessive sitting a serious health hazard, with the potential for ultimately giving consideration to the inclusion of too much sitting (or too few breaks from sitting) in physical activity and health guidelines.

A comprehensive framework for assessing the life cycle energy of building construction assemblies

Environmental decision making during the building design process has typically focused on improvements to operational efficiencies. Improvements to thermal performance and efficiency of appliances and systems within buildings both aim to reduce resource consumption and environmental impacts associated with the operation of buildings. Significant reductions in building energy and water consumption are possible; however often the impacts occurring across the other stages of a building‘s life are not considered or are seen as insignificant in comparison.

Previous research shows that embodied impacts (raw material extraction, processing, manufacture, transportation and construction) can be as significant as those related to building operation. There is, however, limited consistent and comprehensive information available for building designers to make informed decisions in this area. Often the information that is available is from disparate sources, which makes comparison of alternative solutions unreliable and risky. lt is also important that decisions are made from a life cycle perspective, ensuring that strategies to reduce environmental impacts from one life cycle stage do not come at the expense of an increase in overall life cycle impacts

A consistent and comprehensive framework for assessing and specifying building assemblies for enhanced environmental outcomes does not currently exist. This paper presents the initial findings of a project that aims to establish a database of the life cycle energy requirements of a broad range of construction assemblies, based on a comprehensive assessment framework. Life cycle energy requirements have been calculated for eight standard residential construction assemblies integrating an innovative embodied energy assessment technique with thermal performance simulation modelling and ranked according to their performance.

Australian property investment advice : an unregulated industry and the need for better consumer protection laws

Currently, consumers have no means of protecting themselves when they are looking for property investment advice in Australia. There is no uniform national or State regulation in the property investment advice and marketeering industry. The only protection and remedies currently available are those under the general consumer protection laws scattered in various Acts, and even so, these have numerous problems. This paper highlights what those problems are under the general consumer protection laws and suggests some changes to the current system. The paper also argues that a national co-operative approach is the only way to move forward in this area and suggests that the constitutional difficulty can be overcome by using the legislative conferral of state powers provision, which has often been overlooked. The paper also argues that a new regulator be set up to administer and enforce the new proposed laws on property investment advice.

Assessing the efficacy and standardization potential of five competing venture capital investment evaluation approaches

The research objective behind this article was to perform a critical evaluation and comparison of five representative business plan evaluation aids (BPEAs) to facilitate constructive discussion of the proposition that greater standardization of venture capital decision-making might be both desirable and possible. The five BPEAs were systematically compared using a structured, taxonomic process. The evidence of this investigation suggests a clear superiority of BPEAs that are based on the researched attributes of successful ventures and use actuarial modeling. Discussion centered on the importance of using BPEAs in a quest for greater consistency during venture capital investment decision-making.

Trade commitments in education services : the need to move out of the current impasse

Education services is included as part of the General Agreement on Trade in Services (GATS). This inclusion, however, has not gone without its critics, and discussions about the liberalization of education remain distinctly polarized. This article seeks to bring a more balanced debate to the mix by presenting the case of New Zealand, one of the most liberalized World Trade Organization (WTO) Members in trade in education services. Through this case study, it is discussed how New Zealand has chosen to shape the growth of the education market and steer its developments by including controlled mechanisms as part of its regulatory framework.

Assessing the risk of suicide at triage

Mental health related presentations to Australian emergency departments are steadily increasing. There is a growing incidence of depression, substance abuse, and other mental illnesses in the Australian population. Mental health problems will contribute 15% of the total world disease burden by 2020. Triage nurses are pivotal to the early detection and management of mental health problems.

The rapid assessment of mental health presentations at triage requires skill, knowledge, experience and confidence. One of the more complex aspects of triage is suicide risk assessment.

An ABC approach to assessing the risk of violence at triage

There is evidence to suggest that the incidence of violent behaviour in the emergency department by patients toward staff is on the rise. As part of the process of determining urgency, triage nurses must assess the risk of violence at point of entry. The risk of violence, that is, behaviour that either involves a threat of physical or psychological harm to one's self or to others, is considered a critical predictor of urgency in mental health triage. A rapid violence risk assessment strategy will be described which can be utilised in emergency department triage.