Treatment of depression in low-level residential care facilities for the elderly

Background: The rate of recognition and treatment of depressed older people in nursing homes is low. Data from the low-level residential care population have not been reported. This study aimed to collect information about the treatment of depression among older persons living in low-level residential care (hostels).

Method: The participants comprised 300 elderly residents from ten low-level residential care facilities from various suburbs in metropolitan Melbourne. The participants were interviewed by a trained clinical psychologist to determine the presence or absence of major or minor depressive disorder using the Structured Clinical Interview for DSM-IV Axis I Disorder (SCID-I). Each participant was also administered the Standardized Mini-mental State Examination (SMMSE) to determine level of cognitive function. The clinical psychologist then reviewed all cases in consultation with a geropsychiatrist experienced in the diagnosis of depression among older people, prior to assigning a diagnosis of depression.

Results: An important finding in this study was the low treatment for currently depressed residents, with less than half of those in the sample who were depressed receiving treatment. However, 61 of the 96 residents out of the sample of 300 who were on antidepressants were not currently depressed.

Conclusion: There is an under recognition and under treatment of currently depressed older people in low-level residential care facilities (hostels) just as has been reported in studies in nursing homes. However, there are high numbers receiving antidepressants who are not currently depressed.

The prevalence and recognition of major depression among low-level aged care residents with and without cognitive impairment

Previous research has demonstrated a high level of depression in nursing homes. The current study was designed to determine the prevalence of depression, using a structured diagnostic interview, among older people with and without mild-moderate cognitive impairment residing in low-level care facilities. The results demonstrated that, consistent with previous research in nursing homes, 16.9% of older people were diagnosed with major depressive disorder. Less than half of these cases had been detected or treated. Individuals with moderate cognitive impairment were more likely to be depressed, but cognitive impairment did not appear to act as a strong impediment to the detection of depression by general practitioners. A low awareness of their use of antidepressant medications was demonstrated among older people prescribed this treatment, including those with normal cognitive function. Reasons for the poor recognition of depression among older people are discussed.

Key stakeholders' expectations of educational outcomes from Australian critical care nursing courses: a Delphi study

Background
Educational preparation for critical care nursing in Australia varies considerably in terms of the level of qualification resulting in a lack of clarity for key stakeholders about student outcomes.

Objectives
The study aim was to identify and reach consensus regarding the desired learning outcomes from Australian post-registration critical care education programs as demonstrated through the graduate's knowledge, skills and attitudes.

Design
A Delphi technique was used to establish consensus between educators, managers, clinicians and students regarding learning outcomes expected of graduates with a Graduate Certificate, Graduate Diploma and Master level qualification in critical care nursing.

Participants
A total of 164 critical care nurses (66 clinicians, 48 educators, 32 managers and 18 students) participated and 99 questionnaires were returned in the first round (response rate 60%). Fifty-seven questionnaires were returned for Round 2 (response rate 58%).

Methods
Learning outcomes were obtained from the Australian College of Critical Care Nurses Competency Standards for Specialist Critical Care Nurses. Some statements included more than one characteristic, and these were split to create learning outcomes with one characteristic per item. A survey of Australian higher education providers of critical care education provided additional learning outcomes, for a total of 73 learning outcomes for the first Delphi round.

Results
Findings suggest that patient comfort, safety, professional responsibility and ethical conduct are deemed most important for all three levels of educational preparation. There was a lack of emphasis on clinical practice issues for all levels. Participants placed higher emphasis on learning outcomes related to complex decision-making, leadership, supervision, policy development and research for Graduate Diploma and Master level programs.

Conclusion
The findings have implications for curriculum development and the profession with regards to the level of educational preparation required of critical care nurses and suggest that further work is required before clear recommendations can be made for desired educational outcomes from critical care nursing programs in Australia.

Designing the future in wound care: the role of the nurse practitioner

The nurse practitioner is emerging as a new level and type of health care. Increasing specialisation and advanced educational opportunities in nursing and the inequality in access to health care for sectors of the community have established the conditions under which the nurse practitioner movement has strengthened both nationally and internationally. The boundaries of responsibility for nurses are changing, not only because of increased demands but also because nurses have demonstrated their competence in varied extended and expanded practice roles. The nurse practitioner role reflects the continuing development of the nursing profession and substantially extends the career path for clinical nurses.

This paper describes an aspect of a large-scale investigation into the feasibility of the role of the nurse practitioner in the Australian Capital Territory (ACT) health care system. The paper reports on the trial of practice for a wound care nurse practitioner model in a tertiary institution. In the trial the wound care nurse practitioner worked in an extended practice role for 10 months. The nurse practitioner practice was supported, monitored and mentored by a clinical support team. Data were collected relating to a range of outcomes including definition of the scope of practice for the model, description of patient demographics and outcomes and the efficacy of the nurse practitioner service.

The findings informed the development of clinical protocols that define the scope of practice and the parameters of the wound care nurse practitioner model and provided information on the efficacy of this model of health care for the tertiary care environment. The findings further suggest that this model brings expert wound care and case management to an at-risk patient population. Recommendations are made relating to ongoing research into the role of the wound care nurse practitioner model in the ACT health care system.

Evaluating the social value of charitable organizations : a conceptual foundation

Charities are becoming more businesslike in their quest to address competitive pressures and funding reductions. However, this shift may have unintended consequences. For example, the best-marketed charities are not necessarily the ones with the greatest potential for social benefit. There is currently no mechanism that attempts to evaluate the social value of charities. Borrowing from social investing and corporate social responsibility literature, the authors argue that despite the difficulties inherent in this task, there are several issues that must be considered to assess a charity's social value, and each stakeholder will consider some dimensions of social value differently. Assessing a charity's social value has several ethical and policy implications, especially given the level of governmental and foundational support for charity organizations.

Assurance of sustainability reports : impact on report users' perceptions of reliability

This study examined whether (1) assurance, (2) the level of assurance (reasonable vs. limited), and (3) the type of assurance provider (accountant vs. specialist consultant) affect users’ perceptions of reliability of sustainability reports. Based on an experimental questionnaire, we find that the provision of assurance improves report users’ perceived reliability of the environmental and social information. There were no significant main effects between the two experimental factors; level of assurance and type of assurance provider, and report users’ perceptions of the reliability of sustainability reports. However, a significant interaction was found between the two experimental factors and report users’ perceptions of reliability of such reports. More specifically, report users placed more confidence in the sustainability reports where the level of assurance provided is reasonable (high), and when such assurance is provided by a top tier accountancy firm, rather than when the assurance is provided by a specialist consultant. No such difference was found when the level of assurance provided was limited (low) for either type of assurance provider group. The results of this study thus highlight the relevance of assurance for sustainability reporting.

Tennis Australia : a case study of financial management for sport development at the club level

There has been substantial work that examines financial management in professional sport which has assisted scholars and practitioners to better understand processes and policies to ensure teams and leagues are sustainable (Andreff & Staudohar, 2000; Howard & Crompton, 2004; Kraekel, 2007; Lewis, Sexton, & Lock, 2007; Li, Hofacre, & Mahony, 2001). However, there has been a paucity of scholarly research that examines financial management at the grass roots levels of sport, and how this integrates with national sport organisation strategic planning, with the exception of the recent work by Havaris and Danylchuk (2007). This study aims to add to this gap in knowledge by examining financial management at the club level of tennis in Australia.

Consideration of corporate social orientation in managing sport organisations' internal stakeholders

Increasing pressure from the public has raised the expectations on corporations to be better citizens of their communities and society as a whole (Bennet 2002; Carroll 1999; Epstein 1989; Van Marrewijk 2003; Wood 1991). As a result, corporations have engaged in corporate social responsibility efforts with most of the subsequent research focused on its impact on consumer response (e.g., attitudes, behaviours, etc.) (Bhattacharya & Sen 2001, 2004; Porter & Kramer 2002). Similarly, research interest on corporate social responsibility in the sport industry has risen, yet no research studies have explored the influence and perceptions about corporate social responsibility of important internal constituents (employees and volunteers) of sport organisations. Particular interest would be in uncovering what employees and volunteers specifically believe are important among CSR elements (ethical, discretionary, legal, economic) and what impact a sense of 'shared CSR values' with the respective sport organisation would have on employee and volunteer response. Will understanding how shared social values influence organisational commitment provide insight on recruitment, retention and/or development strategies of employees and volunteers? Further, assessing any difference in sensemaking between these two groups would be of additional value to this line of enquiry, as the perceptions of the organisation are understood as "tantamount to reality, since organisations are social constructions made up of and acting in accordance with shared perceptions," (Brickson 2007, p. 865) particularly those of employees and volunteers of sport organisations. With increasing academic and industry interest of corporate social responsibility in sport and to address the obvious gap on CSR and employees and volunteers in the literature, the present study will explore how CSR impacts internal constituents (employees and volunteers) of sport organisations. Specifically, the main purpose of the present study is to assess the level of perceived shared values as they related to CSR (measured as corporate social orientation) between employees- organisation and volunteers- organisation. Further, the influence of the level of perceived shared corporate social orientation (CSO) on organisational identification will be evaluated in the context of a proposed model, which includes the relationship of perceived shared corporate social orientation>organisational identification> attitudinal and behavioural outcomes (i.e., commitment, satisfaction, and organisational behaviour). Using a sample of employees and volunteers of a sport organisation, the respondents will be asked to complete an online survey composed of demographic items, the corporate social orientation scale, and items that measure organisational identification, value commitment, job/ volunteer satisfaction, and organisational citizenship behaviours. Discussion of how other stakeholder (e.g., sponsors, consumers, etc.) perceptions on CSR potentially impacts the model and outcomes (e.g., corporate reputation, consumer behaviour) will be addressed. Analyses and results will support discussion and conclusions made to provide evidence for practitioner and researcher implications.

Encouraging governments to enhance the happiness of their nation : Step 1: understand subjective wellbeing

This article considers the issue of facilitating policies that enhance population happiness. An impediment to such action is the failure of most policy makers to understand that subjective wellbeing can be measured and understood within the framework of science. Additionally, they fail to realize that enhancing the subjective wellbeing of populations enhances not only the functioning of individuals but that of the population as a whole. A framework for understanding calls on the Theory of Subjective Wellbeing Homeostasis and data from the Australian Unity Wellbeing Index. This Index has been used to monitor the subjective wellbeing of the Australian population over the 6-year period 2001–2006. The article begins by a description of the subjective wellbeing construct and the theory that it is homeostatically managed. The operation of homeostasis makes very determined predictions as to the kinds of relationships that should be found in association with various environmental challenges and resources. These predictions will be examined in the light of the data from our surveys and the benefits of population happiness will be discussed. Finally, consideration will be given as to and how such understanding may be conveyed to politicians, in order to assist the development of policies aimed at enhancing the level of happiness in society.

Family food environments as determinants of children's eating : implications for obesity prevention

The prevalence of childhood obesity is escalating rapidly and it considered to be a major public health problem. Diet is a recognised precursor of fatness, and current evidence supports the premise that in Westernised countries, the dietary intakes of children are likely to be important in obesity genesis. However, we have a relatively poor understanding of the environments in which a child’s eating is learnt and maintained. Much of the existing work in this area is based on small-scale or experimental studies, or has been derived from homogeneous populations within the USA. Despite these limitations, there is evidence that aspects of the child’s family environment are likely to be important in determining obesity risk in children. This thesis examines the impact of the family food environment on a child’s eating through two related studies. The first study, titled the Children and Family Eating (CAFÉ) study comprised three phases. Phase one involved qualitative interviews with 17 parents of 5-6 year-old children to explore parental perceptions regarding those factors in a child’s environment believed to influence the development of their child’s eating habits. These interviews were used to inform the development of quantitative measures of the family food environment. The second phase involved the development of a Food Frequency Questionnaire (FFQ) to assess dietary intake in 5-6 year-olds. The FFQ was informed by analysis of 1995 Australian National Nutrition Survey data. In the final phase the relationships between dietary intakes of 5-6 year-old children, and potential predictors of dietary intake were examined in a cross-sectional study of 560 families. Predictors included measures of: parental perceptions of the adequacy of their child’s diet; food availability and accessibility; child-feeding; the opportunities for parental modelling of food intake; a child’s television exposure; maternal Body Mass Index; and maternal education. Analysis of the CAFÉ data provides unique information regarding the relationships between a child’s family food environment and their food consumption. Models developed for a range of dietary outcomes considered to be predictive of increased risk for obesity, including total energy and fat intakes, vegetable variety, vegetable consumption, and high-energy (non-dairy) fluid consumption, explained between 11 and 20 percent of the variance in dietary intake. Two aspects of the family food environment, parental perception of a child’s dietary adequacy, and the total minutes of television viewed per day, were frequently found to be predictive of dietary outcomes likely to promote fatness in these children. The second study, titled the Parent Education and Support (PEAS) Feeding Intervention Study, was a prospective pre/post non-randomised intervention trial that assessed the impact of a feeding intervention to 240 first-time mothers of one-year-old children. This intervention focused on one aspect of the family food environment, child-feeding, which has been proposed as influential in the development of obesogenic eating behaviours. In this study, Maternal and Child Health Nurses (MCHNs), using a ‘Division of Responsibility’ model of feeding, taught parents to provide nutritious food at regular intervals and to let children decide if to eat and how much to eat. Thus parents were encourages to food their child without exerting pressure, or employing coercion or rewards (controlling behaviours). The aim was to influence parental attitudes and beliefs regarding child-feeding. Through the use of these feeding techniques, this intervention also aimed to increase the variety of fruits and vegetables a child consumed by teaching parents to persist with offering these foods, over the year of the intervention, in non-emotive environments. Fruits and vegetables were chosen in this intervention because they are likely to be protective in the development of obesity. Analysis of the PEAS data suggests that this low-level feeding intervention, delivered through existing Maternal and Child Health services, was modestly effective in changing parental attitudes and beliefs regarding the feeding of young children. Further, the validity of fruits offered to intervention group children increased. This thesis expands the existing knowledge base by providing a comprehensive analysis of the relative impact of aspects of the family environment on dietary intakes of 5-6 year-olds. Further, the analysis of a feeding intervention in first-time parents provides important insights regarding the potential to influence child-feeding and the impact this may have on the promotion of eating behaviours protective against obesity.

Corporate sustainability reporting of major commercial banks in line with GRI : Bangladesh evidence

Purpose – This paper aims to examine the tendencies of sustainability reporting by major commercial banks in Bangladesh in comparison with global sustainability reporting indicators outlined in the GRI framework together with banks' predilection toward reporting 16 GRI financial service sector (FSS) specific performance indicators.

Design/methodology/approach – Based on the GRI G3 guidelines, the paper investigated banks' reporting in five broad areas of sustainability, such as environment, labour practices and decent works, product responsibility, human rights and society. The 2008/2009 annual reports of 12 major commercial banks listed on Dhaka stock exchange were analysed and coded using a content-based technique.

Findings – The results show that information on society is addressed most extensively with regard to extent of reporting. This is followed by the disclosures prepared on decent works and labour practices and environmental issues. Furthermore, the disclosures of product responsibility information and the information for human rights are rather scarce in banks' reporting; on the subject of FSS-specific disclosures, only seven items out of 16 are disclosed by all sample banks.

Research limitations/implications – The findings of the study indicate that Bangladeshi commercial banks' social disclosures could develop in this style to become more holistic and over time (in association with the country's central bank involvement) to resemble a type of structured reporting to the point where they are properly labelled per se.

Originality/value – The study contributes to the social disclosure literature, in particular in a developing countries banking sector context, seeing as it disseminates evidence of the standing on social disclosures practices at the level of GRI with developing countries' banks data.

Involvement of young Australian adults in meal preparation : cross-sectional associations with abdominal obesity and body mass index

Previous research has shown that involvement in meal preparation is positively associated with better diet quality. However, it is unclear whether there is an association between involvement in meal preparation and being overweight or obese. This study investigated whether the level of involvement in meal preparation was associated with objectively measured weight status in young adults. During 2004-2006, a national sample of 1,996 Australian adults aged 26 to 36 years completed a self-administered questionnaire including questions on sociodemographic characteristics, diet, and physical activity. Participants were asked to report who usually prepared the main meal on working days and responses were categorized as “myself,” “shared,” or “someone else.” Waist circumference, weight, and height were measured by trained staff. Moderate abdominal obesity was defined as waist circumference >94 cm for men and >80 cm for women. Overweight was defined as body mass index (calculated as kg/m2) >25. Prevalence ratios were calculated using log binomial regression. After adjusting for age, education, and leisure time physical activity, men who shared the meal preparation had a slightly lower prevalence of moderate abdominal obesity (prevalence ratio=0.92; 95% confidence interval [CI]: 0.86 to 0.99) than those whose meals were usually prepared by someone else. There was no association with having sole responsibility (prevalence ratio=0.99; 95% CI: 0.92 to 1.06). There were no associations between level of involvement in meal preparation and being overweight (shared responsibility prevalence ratio=0.99; 95% CI: 0.92 to 1.07; sole responsibility prevalence ratio=0.98; 95% CI: 0.91 to 1.05). For women, level of involvement was not associated with moderate abdominal obesity (shared responsibility prevalence ratio=0.93; 95% CI: 0.84 to 1.03; sole responsibility prevalence ratio=0.94; 95% CI: 0.86 to 1.03) or being overweight (shared responsibility prevalence ratio=0.93; 95% CI: 0.84 to 1.02; sole responsibility prevalence ratio=0.93; 95% CI: 0.85 to 1.02). In this sample of young adults, level of involvement in meal preparation was not strongly related to weight status.

Incidence of cardiovascular risk factors by education level 2000-2005 : the Australian diabetes, obesity and lifestyle (AusDiab) cohort study

Lower socioeconomic status (SES) is associated with a higher prevalence of major risk factors for cardiovascular disease (CVD). However, few longitudinal studies have examined the association between SES and CVD risk factors over time. We aimed to determine whether SES, using education as a proxy, is associated with the onset of CVD risk factors over 5 years in an Australian adult cohort study.

Participants in the Australian Diabetes, Obesity and Lifestyle study (AusDiab) study aged 25 years and over who attended both baseline and 5-year follow-up examinations (n=5 967) were categorised according to educational attainment. Cardiovascular risk factor data at both time points were ascertained through questionnaire and physical measurement.

Women with lower education had a greater risk of progressing from normal weight to overweight or obesity than those with higher education (age-adjusted OR 1.57, 95% CI 1.06-2.31). Both men and women with lower education were more likely to develop diabetes (age-adjusted OR from higher education 1.75, 95% CI 1.14-2.71 and 3.01, 95% CI 1.26-7.20, respectively). A lower level of education was associated with a greater number of risk factors accumulated over time in women (OR of progressing from having two or less risk factors at baseline to three or more at follow up, 2.04, 95% 1.32-3.14).

In this Australian population-based study, lower educational attainment was associated with an increased risk of developing both individual and total CVD risk factors over a 5-year period. These findings suggest that SES inequalities in CVD will persist into the future.

Enhancement of user level controls in cloud databases

Industries in developed countries are moving quickly to ensure the rapid adoption of cloud computing. At this stage, several outstanding issues exist, particularly related to Service Level Agreements (SLAs), security and privacy. Consumers and businesses are willing to use cloud computing only if they can trust that their data will remain private and secure. Our review of research literature indicates the level of control that a user has on their data is directly correlated to the level of data privacy provided by the cloud service. We considered several privacy factors from the industry perspective, namely data loss, data storage location being unknown to the client, vendor lock-in, unauthorized secondary use of user's data for advertising, targeting secured backup and easy restoration. The level of user control in database models were identified according to the level of existence in these privacy factors. Finally, we focused on a novel logical model that might help to bring the level of user control of privacy in cloud databases into a higher level.

Quality of service-based service level agreement management framework for hydrocarbon exploration and discovery operation

 The major contributions presented in this thesis are twofold. Firstly, it presents the research towards a unique services-based Hydrocarbon Exploration and Discovery Model that demonstrates the feasibility of using advanced ICT technologies in the reproduction of stages involved in an oil and gas discovery, processing and analysis process. Secondly, the research demonstrated a solution of the problems in providing agreed level of quality of service (QoS) and formalizing of appropriate Service Level Agreements (SLA) within such complex environment where different services within the model can be delivered by a variety of service providers