Increase in poorer students

Universities have swung open their doors to the country's poor, who are the fastest growing student demographic, Senate estimates has heard.

In the wake of the global financial crisis and publicity over universities' recruitment push, university enrolments are up 10 per cent overall this year, federal education officials have reported.

Does an increase in body mass index over 10 years affect knee structure in a population-based cohort study of adult women?

Introduction : Although obesity is a modifiable risk factor for knee osteoarthritis (OA), the effect of weight gain on knee structure in young and healthy adults has not been examined. The aim of this study was to examine the relationship between body mass index (BMI), and change in BMI over the preceding 10-year period, and knee structure (cartilage defects, cartilage volume and bone marrow lesions (BMLs)) in a population-based sample of young to middle-aged females.

Methods : One hundred and forty-two healthy, asymptomatic females (range 30 to 49 years) in the Barwon region of Australia, underwent magnetic resonance imaging (MRI) during 2006 to 2008. BMI measured 10 years prior (1994 to 1997), current BMI and change in BMI (accounting for baseline BMI) over this period, was assessed for an association with cartilage defects and volume, and BMLs.

Results : After adjusting for age and tibial plateau area, the risk of BMLs was associated with every increase in one-unit of baseline BMI (OR 1.14 (95% CI 1.03 to 1.26) P = 0.009), current BMI (OR 1.13 (95% CI 1.04 to 1.23) P = 0.005), and per one unit increase in BMI (OR 1.14 (95% CI 1.03 to 1.26) P = 0.01). There was a trend for a one-unit increase in current BMI to be associated with increased risk of cartilage defects (OR 1.06 (95% CI 1.00 to 1.13) P = 0.05), and a suggestion that a one-unit increase in BMI over 10 years may be associated with reduced cartilage volume (-17.8 ml (95% CI -39.4 to 3.9] P = 0.10). Results remained similar after excluding those with osteophytes.

Conclusions : This study provides longitudinal evidence for the importance of avoiding weight gain in women during early to middle adulthood as this is associated with increased risk of BMLs, and trend toward increased tibiofemoral cartilage defects. These changes have been shown to precede increased cartilage loss. Longitudinal studies will show whether avoiding weight gain in early adulthood may play an important role in diminishing the risk of knee OA.

A pilot study of a telephone-based parental intervention to increase fruit and vegetable consumption in 3-5 year old children

Objective : To examine the potential efficacy of a brief telephone-based parental intervention in increasing fruit and vegetable consumption in children aged 3–5 years and to examine the feasibility of intervention delivery and acceptability to parents.

Design : A pre–post study design with no comparison group. Telephone surveys were conducted approximately 1 week before and following intervention delivery.
Setting Participants were recruited through pre-schools in the Hunter region, New South Wales, Australia.

Subjects : Thirty-four parents of 3–5-year-olds received four 30-min interventional telephone calls over 4 weeks administered by trained telephone interviewers. The scripted support calls focused on fruit and vegetable availability and accessibility within the home, parental role modelling of fruit and vegetable consumption and on implementing supportive family eating routines.

Results : Following the intervention, the frequency and variety of fruit and vegetable consumption increased (P = 0·027), as measured by a subscale of the children's dietary questionnaire. The intervention was feasible to be delivered to parents, as all participants who started the intervention completed all four calls, and all aspects of the interventional calls, including the number, length, content, format and relevance, were considered acceptable by more than 90 % of parents.

Conclusions : A brief telephone-based parental intervention to encourage fruit and vegetable consumption in pre-school-aged children may be effective, feasible and acceptable. Further investigation is warranted in a randomised controlled trial.

A cluster randomized controlled trial of a telephone-based parent intervention to increase preschoolers’ fruit and vegetable consumption

Background: Inadequate fruit and vegetable consumption is associated with increased chronic disease risk and represents a considerable global health burden. Despite evidence that dietary habits track from early childhood, there are few published trials of interventions attempting to increase preschoolers’ fruit and vegetable consumption.

Objective: The Healthy Habits trial aimed to assess the efficacy of a telephone-based intervention for parents to increase the fruit and vegetable consumption in their 3–5-y-old children.

Design: A cluster randomized controlled trial was conducted involving 394 parents of children aged 3–5 y recruited through local preschools. Parents allocated to the intervention received printed resources plus four 30-min telephone calls targeting aspects of the home food environment associated with children's fruit and vegetable consumption. Parents allocated to the control group received generic printed nutrition information. Children's fruit and vegetable consumption was assessed by using the Fruit and Vegetable Subscale of the Children's Dietary Questionnaire, which was administered via telephone interview at baseline and 2 and 6 mo later.

Results: Analysis of all available data showed that children's fruit and vegetable scores were significantly higher in the intervention group than in the control group at 2 mo (P < 0.001) and at 6 mo (P = 0.021). Sensitivity analysis using baseline observation carried forward showed an intervention effect at 2 mo (P = 0.008) but not at 6 mo (P = 0.069).

Conclusions: Telephone-delivered parent interventions may be an effective way of increasing children's fruit and vegetable consumption in the short term. Further investigation to determine whether the intervention effect is maintained in the longer term is recommended.

Using e-learning to increase the preparedness and confidence of nurses to perform buttonhole cannulation

Arteriovenous fistulae are considered the gold standard for haemodialysis vascular access. Their use can be fraught with complications for both the patient and cannulator, with knowledge, expertise and skills being key factors in reducing access associated morbidity. There is mounting evidence demonstrating the efficacy of the buttonhole technique. One disturbing problem noted with the buttonhole experience has been an increased rate in site infections, anecdotally attributed to poor buttonhole site preparation. Enhanced knowledge and skills for nurses are crucial in increasing patient comfort and improving outcomes.

Although knowledge and skill acquisition related to vascular access are often the focus of individual institutional educational initiatives, a national evidence based program that provides free equitable access to all nurses does not exist in Australasia. A survey of Australasian Nephrology Educators’ identified the need for more effective and consistent delivery of clinical education for nurses using innovative, web‐based approaches that support the tenets of e-learning methodologies. This paper will discuss the development and implementation of an e-learning program for buttonhole cannulation. The preparedness of participants to professionally engage with buttonhole cannulation and their self-efficacy (estimates) in undertaking learning about the clinical procedure using e-learning will be evaluated. In addition it will highlight the benefits of inter‐organizational partnerships and how they can facilitate positive change in teaching and learning practices aimed at improving patient outcomes. This project has unique characteristics that collectively provide value, distinction and innovation to patients, nurses, and renal departments across Australasia. As the e-learning program is founded on evidence based practice this project is easily transferable to an international context.

Modeling a dynamic data replication strategy to increase system availability in cloud computing environments

Failures are normal rather than exceptional in the cloud computing environments. To improve system avai-lability, replicating the popular data to multiple suitable locations is an advisable choice, as users can access the data from a nearby site. This is, however, not the case for replicas which must have a fixed number of copies on several locations. How to decide a reasonable number and right locations for replicas has become a challenge in the cloud computing. In this paper, a dynamic data replication strategy is put forward with a brief survey of replication strategy suitable for distributed computing environments. It includes: 1) analyzing and modeling the relationship between system availability and the number of replicas; 2) evaluating and identifying the popular data and triggering a replication operation when the popularity data passes a dynamic threshold; 3) calculating a suitable number of copies to meet a reasonable system byte effective rate requirement and placing replicas among data nodes in a balanced way; 4) designing the dynamic data replication algorithm in a cloud. Experimental results demonstrate the efficiency and effectiveness of the improved system brought by the proposed strategy in a cloud.

Annual feedback is an effective tool for a sustained increase in calcium intake among older women

We aimed to optimize calcium intake among the 2,000+ older women taking part in the Vital D study. Calcium supplementation was not included in the study protocol. Our hypothesis was that annual feedback of calcium intake and informing women of strategies to improve calcium intake can lead to a sustained increase in the proportion of women who consume adequate levels of the mineral. Calcium intake was assessed on an annual basis using a validated short food frequency questionnaire (FFQ). Supplemental calcium intake was added to the dietary estimate. Participants and their nominated doctor were sent a letter that the participant’s estimated daily calcium intake was adequate or inadequate based on a cutoff threshold of 800 mg/day. General brief statements outlining the importance of an adequate calcium intake and bone health were included in all letters. At baseline, the median daily consumption of calcium was 980 mg/day and 67 percent of 1,951 participants had calcium intake of at least 800 mg per day. Of the 644 older women advised of an inadequate calcium intake at baseline (< 800 mg/day), 386 (60%) had increased their intake by at least 100 mg/day when re-assessed twelve months later. This desirable change was sustained at 24 months after baseline with almost half of these women (303/644) consuming over 800 mg calcium per day. This study devised an efficient method to provide feedback on calcium intake to over 2,000 older women. The improvements were modest but significant and most apparent in those with a low intake at baseline. The decreased proportion of these women with an inadequate intake of calcium 12- and 24-months later, suggests this might be a practical, low cost strategy to maintain an adequate calcium intake among older women.

MAKINGtheLINK : a school-based health promotion programme to increase help-seeking for cannabis and mental health issues among adolescents

Aim: There is increasing concern regarding the use of cannabis among adolescents, especially given recent evidence highlighting its link with later mental disorders. Encouraging young people with mental health or drug issues to seek professional help is an important early intervention strategy; however, adolescents are typically reluctant to do so and instead turn to their peers for help. Peers may not have the skills or knowledge required to assist their friends to access professional help. This paper describes the development and evaluation of MAKINGtheLINK, a school-based health promotion programme that promotes help-seeking behaviour for mental health and cannabis use issues among young people.

Methods: The MAKINGtheLINK programme was piloted with 182 Year 10 students at a secondary school in Melbourne, Australia. Forty teachers received the MAKINGtheLINK staff professional development session.

Results: The delivery of the MAKINGtheLINK programme was found to be both acceptable and feasible within a school setting. Students and teachers described it as a fun, engaging, helpful and important programme. Students reported increased confidence and awareness of how to seek help for themselves or a friend, and teachers indicated increased confidence and awareness of how to assist students to seek help for cannabis use and/or mental health problems.

Conclusions: MAKINGtheLINK was successfully implemented within the school curriculum. We believe this is the first school-based programme that specifically focuses on facilitating professional help-seeking for cannabis use and mental health problems among young people, and demonstrates that utilizing peer models for help-seeking is a valuable resource for early intervention initiatives.