A new approach to assessing the health benefit from obesity interventions in children and adolescents: the assessing cost-effectiveness in obesity project

OBJECTIVE: To report on a new modelling approach developed for the assessing cost-effectiveness in obesity (ACE-Obesity) project and the likely population health benefit and strength of evidence for 13 potential obesity prevention interventions in children and adolescents in Australia. METHODS: We used the best available evidence, including evidence from non-traditional epidemiological study designs, to determine the health benefits as body mass index (BMI) units saved and disability-adjusted life years (DALYs) saved. We developed new methods to model the impact of behaviours on BMI post-intervention where this was not measured and the impacts on DALYs over the child's lifetime (on the assumption that changes in BMI were maintained into adulthood). A working group of stakeholders provided input into decisions on the selection of interventions, the assumptions for modelling and the strength of the evidence. RESULTS: The likely health benefit varied considerably, as did the strength of the evidence from which that health benefit was calculated. The greatest health benefit is likely to be achieved by the 'Reduction of TV advertising of high fat and/or high sugar foods and drinks to children', 'Laparoscopic adjustable gastric banding' and the 'multi-faceted school-based programme with an active physical education component' interventions. CONCLUSIONS: The use of consistent methods and common health outcome measures enables valid comparison of the potential impact of interventions, but comparisons must take into account the strength of the evidence used. Other considerations, including cost-effectiveness and acceptability to stakeholders, will be presented in future ACE-Obesity papers. Information gaps identified include the need for new and more effective initiatives for the prevention of overweight and obesity and for better evaluations of public health interventions.

Second life first hand: a teacher perspective

The professional landscape in public relations is changing as new communication and social networking technologies are integrated into day-to-day professional practice. Whilst adoption of such technologies by public relations practitioners is certainly on the increase, their use can still be regarded as limited and application experimental to some degree. However, few could argue that these technologies will be increasingly important to public relations practice in coming years.
In this context, public relations educators must strive to deliver a contemporary curriculum reflective of industry expectations and best practice principles but which also provides students with exposure to new communication contexts and technologies.

The advent of persistent virtual worlds generated by Massively Multiplayer Online Role Playing Games (MMORPGs) and Collaborative Virtual Environments (CVEs) offer new realms for public relations practitioners and educators alike. Virtual worlds potentially provide public relations educators with novel but relevant training grounds for their students. These 3D worlds offer dynamic and authentic learning environments which have the capability to foster deep learning and engender a sense of community within a student cohort in a way that many computer-mediated classrooms sadly lack.

This paper will present the experiences of two tertiary educators’ journey towards a conceptual understanding of the persistent virtual world, Second Life, from a teacher perspective. The paper argues that the successful adoption of new online technologies like Second Life need not be inhibited by preferences for technology or prior ICT skills as long as teaching staff are given the necessary support and training by their institutions coupled with opportunity for familiarisation and experimentation.

Standardizing anthropometric measures in children and adolescents with new functions for egen

A new function for egen has been developed to allow transformation of child anthropometric data to z-scores using the LMS method and the reference data available from the 1990 British Growth Reference and the 2000 US CDC Growth Reference. An additional function allows for children to be categorized according to body mass index (weight/height ²) using international cutoff points recommended by the Childhood Obesity Working Group of the International Obesity Taskforce. Copyright 2004 by StataCorp LP.

Unhealthy landscapes: policy recommendations on land use change and infectious disease emergence

Anthropogenic land use changes drive a range of infectious disease outbreaks and emergence events and modify the transmission of endemic infections. These drivers include agricultural encroachment, deforestation, road construction, dam building, irrigation, wetland modification, mining, the concentration or expansion of urban environments, coastal zone degradation, and other activities. These changes in turn cause a cascade of factors that exacerbate infectious disease emergence, such as forest fragmentation, disease introduction, pollution, poverty, and human migration. The Working Group on Land Use Change and Disease Emergence grew out of a special colloquium that convened international experts in infectious diseases, ecology, and environmental health to assess the current state of knowledge and to develop recommendations for addressing these environmental health challenges. The group established a systems model approach and priority lists of infectious diseases affected by ecologic degradation. Policy-relevant levels of the model include specific health risk factors, landscape or habitat change, and institutional (economic and behavioral) levels. The group recommended creating Centers of Excellence in Ecology and Health Research and Training, based at regional universities and/or research institutes with close links to the surrounding communities. The centers' objectives would be 3-fold: a) to provide information to local communities about the links between environmental change and public health ; b) to facilitate fully interdisciplinary research from a variety of natural, social, and health sciences and train professionals who can conduct interdisciplinary research ; and c) to engage in science-based communication and assessment for policy making toward sustainable health and ecosystems.

Sydney principles for reducing the commercial promotion of foods and beverages to children

A set of seven principles (the ‘Sydney Principles’) was developed by an International Obesity Taskforce (IOTF) Working Group to guide action on changing food and beverage marketing practices that target children. The aim of the present communication is to present the Sydney Principles and report on feedback received from a global consultation (November 2006 to April 2007) on the Principles.

The Principles state that actions to reduce marketing to children should: (i) support the rights of children; (ii) afford substantial protection to children; (iii) be statutory in nature; (iv) take a wide definition of commercial promotions; (v) guarantee commercial-free childhood settings; (vi) include cross-border media; and (vii) be evaluated, monitored and enforced.

The draft principles were widely disseminated and 220 responses were received from professional and scientific associations, consumer bodies, industry bodies, health professionals and others. There was virtually universal agreement on the need to have a set of principles to guide action in this contentious area of marketing to children. Apart from industry opposition to the third principle calling for a statutory approach and several comments about the implementation challenges, there was strong support for each of the Sydney Principles. Feedback on two specific issues of contention related to the age range to which restrictions should apply (most nominating age 16 or 18 years) and the types of products to be included (31 % nominating all products, 24 % all food and beverages, and 45 % energy-dense, nutrient-poor foods and beverages).

The Sydney Principles, which took a children’s rights-based approach, should be used to benchmark action to reduce marketing to children. The age definition for a child and the types of products which should have marketing restrictions may better suit a risk-based approach at this stage. The Sydney Principles should guide the formation of an International Code on Food and Beverage Marketing to Children.

Would Kitty Genovese have been murdered in Second Life? Researching the "bystander effect" using online technologies

The increasing use of online technologies, including ‘virtual worlds’ such as Second Life, provides sociology with a transformed context within which to ply creative research approaches to ongoing social issues, such as the ‘bystander effect’. While the ‘bystander effect’ was coined following a real-life incident, the concept has been researched primarily through laboratory-based experiments. The relationship between ‘virtual’ and ‘real’ world environments and human behaviours are, however, unclear and warrant careful attention and research.

In this paper we outline existing literature on the applicability of computer-simulated activity to real world contexts. We consider the potential of Second Life as a research environment in which ‘virtual’ and ‘real’ human responses are potentially more blurred than in real-life or a laboratory setting. We describe preliminary research in which unsolicited Second Life participants faced a situation in which they could have intervened. Our findings suggest the existence of a common perception that formal regulators were close at hand, and that this contributed to the hesitation of some people to personally intervene in the fraught situation. In addition to providing another angle on the ‘bystander effect’, this research contributes to our understanding of how new technologies might enable us to conduct social research in creative ways.

Second Life and the role of educators as regulators

Regulation, governance and harms stemming from the use of virtual worlds and other Massive Multi Media Online Role Playing Games (MMMORPGs) in higher education, are poorly understood and under-researched issues. Second Life, developed by Linden Labs, provides users with a series of generic ‘terms of service’ and codes of conduct, yet place the bulk of responsibility on individual users or groups to report misbehaviour or develop their own behavioural codes, enforcement procedures and punishments suited to their particular needs. There is no guidebook to assist users in the processes of risk identification and management. As such, the various benefits of MMMORPG technologies could be offset by the risks to users and user-groups from a range of possible harms, including the impact of actual or perceived violence within teaching and learning settings.

While cautioning against the direct translation of real-world regulatory principles into the governance of virtual worlds, this paper suggests theoretical and practical guidance on these issues can be taken from recent criminological developments. Using Lawrence Lessig’s (1999) landmark work on cyber-regulation as a starting point, this paper examines the literature on video-game violence to illustrate the need for educators show awareness of both real and perceived risks in virtual worlds as a core element of an emerging educational pedagogy. We identify how the multiple roles of the virtual-world educator become useful in framing this pedagogy to improve student learning, to dispel myths about the risks of immersive technologies and advocate for their adoption and acceptance in the educational community.

Poly-Articulate

Poly-Articulate was a series of meditations around the paradoxes of articulation, considered in the heterogeneity of its material, visual, aural and conceptual aspects. Taking form through a collaborative working group of four artists/ designers/writers, the project used different technologies from the most ancient (the voice-box) to the most current (real-time rendering engines). With the utilisation of laser sensors crossing the gallery spaces, 20 digital monitors accompanied by vocal syllables would respond to the viewers? movement. Another piece of technology?a theramin installed below the sculpture of a trachea (inner ear)?mutated the vocal sounds upon its engagement along with a microphone suspended in one of the galleries. The visual and sound aspects of this project made it a compelling spatial experience.

An interactive CDRom accompanied with a text by Justin Clemens was published with this project.

Calcium and bone health : position statement for the Australian and New Zealand Bone and Mineral Society, Osteoporosis Australia and the Endocrine Society of Australia

This position statement was prepared by the Working Group of the Australian and New Zealand Bone and Mineral Society and Osteoporosis Australia. The final statement was endorsed by the Endocrine Society of Australia.

Currently, the balance of evidence remains in favour of fracture prevention from combined calcium and vitamin D supplementation in elderly men and women.

Adequate vitamin D status is essential for active calcium absorption in the gut and for bone development and remodelling.

In adults with a baseline calcium intake of 500–900 mg/day, increasing or supplementing this intake by a further 500–1000 mg/day has a beneficial effect on bone mineral density.

Calcium intake significantly above the recommended level is unlikely to achieve additional benefit for bone health.

Designing collaborative e-learning for the net generation

The designer of higher education programs is on the cusp of some very exciting resource development particularly in the area of postgraduate coursework. Part of this is because of the new learner, a millennial or net generation learner who is time-poor, a networker with strong inclinations towards social or community knowledge pooling and a multiple media literacy which is comfortable in virtual worlds and with visual emphasis. The other element is the perceived changing role of the university or higher education in the transfer of knowledge, moving from a transmission or narrative model to learner-centred and performative approaches. This has been highlighted by greater emphasis on experiential learning methodologies, and the development of action learning practices. The nexus of these two influences, the new learner and the higher education response to delivering learning, may be elaborated further from learning theory which seems to be moving beyond social constructivist approaches, or certainly encompassing what is referred to as connectivism.

This may be a new theoretical approach, or it could simply be an organic growth in meeting the needs of large numbers of higher education student participants who perceive a degree as a skills-based workplace preparation. Whatever the theoretical underpinning may be, the large numbers of learners moving to postgraduate coursework or more workplace oriented programs and subjects has thrown out the challenge to instructional designers to provide just-in-time, relevant and socially transferred learning with strong creative and imaginative engagement.

The case studies incorporated in this paper provide two separate approaches to these challenges - one is a workplace oriented postgraduate team project in a Masters in Communication, the other provides a virtual simulation for developing creative and professional writing skills at postgraduate levels. They both provide perspectives on the net generation learner and collaborative and connected learning models.

The cost-effectiveness of Australia's active after-school communities program

The objective of this study was to assess from a societal perspective the cost-effectiveness of the Active After-school Communities (AASC) program, a key plank of the former Australian Government's obesity prevention program. The intervention was modeled for a 1-year time horizon for Australian primary school children as part of the Assessing Cost-Effectiveness in Obesity (ACE-Obesity) project. Disability-adjusted life year (DALY) benefits (based on calculated effects on BMI post-intervention) and cost-offsets (consequent savings from reductions in obesity-related diseases) were tracked until the cohort reached the age of 100 years or death. The reference year was 2001, and a 3% discount rate was applied. Simulation-modeling techniques were used to present a 95% uncertainty interval around the cost-effectiveness ratio. An assessment of second-stage filter criteria ("equity," "strength of evidence," "acceptability to stakeholders," "feasibility of implementation," "sustainability," and "side-effects") was undertaken by a stakeholder Working Group to incorporate additional factors that impact on resource allocation decisions. The estimated number of children new to physical activity after-school and therefore receiving the intervention benefit was 69,300. For 1 year, the intervention cost is Australian dollars (AUD) 40.3 million (95% uncertainty interval AUD 28.6 million; AUD 56.2 million), and resulted in an incremental saving of 450 (250; 770) DALYs. The resultant cost-offsets were AUD 3.7 million, producing a net cost per DALY saved of AUD 82,000 (95% uncertainty interval AUD 40,000; AUD 165,000). Although the program has intuitive appeal, it was not cost-effective under base-case modeling assumptions. To improve its cost-effectiveness credentials as an obesity prevention measure, a reduction in costs needs to be coupled with increases in the number of participating children and the amount of physical activity undertaken.

The cost-effectiveness of removing television advertising of high-fat and/or high-sugar food and beverages to Australian children

Objective: To model the health benefits and cost-effectiveness of banning television (TV) advertisements in Australia for energy-dense, nutrient-poor food and beverages during children's peak viewing times.

Methods: Benefits were modelled as changes in body mass index (BMI) and disability-adjusted life years (DALYs) saved. Intervention costs (AUD$) were compared with future health-care cost offsets from reduced prevalence of obesity-related health conditions. Changes in BMI were assumed to be maintained through to adulthood. The comparator was current practice, the reference year was 2001, and the discount rate for costs and benefits was 3%. The impact of the withdrawal of non-core food and beverage advertisements on children's actual food consumption was drawn from the best available evidence (a randomized controlled trial of advertisement exposure and food consumption). Supporting evidence was found in ecological relationships between TV advertising and childhood obesity, and from the effects of marketing bans on other products. A Working Group of stakeholders provided input into decisions surrounding the modelling assumptions and second-stage filters of 'strength of evidence', 'equity', 'acceptability to stakeholders', 'feasibility of implementation', 'sustainability' and 'side-effects'.

Results: The intervention had a gross incremental cost-effectiveness ratio of AUD$ 3.70 (95% uncertainty interval (UI) $2.40, $7.70) per DALY. Total DALYs saved were 37 000 (95% UI 16 000, 59 000). When the present value of potential savings in future health-care costs was considered (AUD$ 300m (95% UI $130m, $480m), the intervention was 'dominant', because it resulted in both a health gain and a cost offset compared with current practice.

Conclusions: Although recognizing the limitations of the available evidence, restricting TV food advertising to children would be one of the most cost-effective population-based interventions available to governments today. Despite its economic credentials from a public health perspective, the initiative is strongly opposed by food and advertising industries and is under review by the current Australian government.

Workshop synopses : Pathways for public health education

The Commonwealth introduced the Public Health Education and Research Program (PHERP) initiative to support capacity building within the public health workforce, primarily through investment in Master of Public Health programs. Following the 2005 review of PHERP, a national 'Quality Agenda' was proposed to establish minimum standards in public health competencies of graduates; and Master of Public Health (MPH) graduates in particular. This 'agenda' has triggered renewed discussion on public health workforce needs, public health graduate competencies, and the capacity of the tertiary education sector to deliver these.

The Australian Network of Academic Public Health Institutions (ANAPHI) has worked with the Department of Health and Ageing on the 'Quality Agenda'. In 2008, ANAPHI convened a working group to further open up discussion among academic institutions on the public health education context to the Quality Agenda. The group held a lunchtime workshop at the 2008 Population Health Congress in Brisbane, as one of a themed pair of sessions entitled 'Public Health Professionals - Shaping our Future'. A further aim of the workshop was to identify key themes to shape the next ANAPHI Teaching and Learning Forum (September 23rd to 24th 2008, Canberra, www.anaphi.org.au).

The epidemiology workforce : are we planning for the future?

Epidemiology has a central role in public health practice, education and research, and is arguably the only discipline unique to public health. A strong perception exists among epidemiologists in Australia that there is a substantial shortage in epidemiological capacity within the health workforce and health research, and that there are few graduates with sufficient high-level epidemiological training to fill the educational and leadership roles that will be essential to building this capacity. It was this concern that led the Australasian Epidemiological Association (AEA)--the peak professional body for epidemiologists in Australia and New Zealand--to convene a working group in 2007 to assess and address these concerns. This article summarises the key training challenges and opportunities discussed within this group, and the larger organisation, with the intention of stimulating greater public debate of these issues.

Update of the UNCITRAL arbitration rules revision

The UNCITRAL Rules Revision process began in September 2006 - the first revision in 30 years. The revision process has been a complicated and difficult one. It is a process that cannot be rushed as one might reasonably expect the new edition of the UNCITRAL Rules needs to serve another 30 years. This article provides an insight into the conduct of the 50th session of Working Group II, the Working Group within UNCITRAL that has been charged with preparing draft rules for the Commission to consider and approve. It was a very interesting session in which a number of significant and controversial issues were considered. Our report focuses on three specific issues - the treatment of set-off; witnesses; and interim measures.