Introducing health information systems to aged care in Vietnam

Similar to many other countries worldwide, Vietnam is facing a challenge of an ageing population. This challenge is even more difficult to overcome because Vietnam is a developing country lacking an established aged care infrastructure and system. Many aspects of aged care have largely been relied on families of aged people due to a strong influence of Confucian philosophy. Looking after aged parents has always been seen as a responsibility and filial piety of children and their extended families. Therefore, providing healthcare for aged people in their family and community context is important. The paper offers a rich description and an analysis of the current situation of the health state of and healthcare for aged people in Vietnam. The paper also suggests directions for integrating information communication technology into aged care in Vietnam.

A cluster-randomized controlled trial to reduce sedentary behavior and promote physical activity and health of 8-9 year olds : the transform-us! study

Background: Physical activity (PA) is associated with positive cardio-metabolic health and emerging evidence suggests sedentary behavior (SB) may be detrimental to children’s health independent of PA. The primary aim of the Transform-Us! study is to determine whether an 18-month, behavioral and environmental intervention in the school and family settings results in higher levels of PA and lower rates of SB among 8-9 year old children compared with usual practice (post-intervention and 12-months follow-up). The secondary aims are to determine the independent and combined effects of PA and SB on children’s cardio-metabolic health risk factors; identify the factors that mediate the success of the intervention; and determine whether the intervention is cost-effective.
Methods/design: A four-arm cluster-randomized controlled trial (RCT) with a 2 × 2 factorial design, with schools as the unit of randomization. Twenty schools will be allocated to one of four intervention groups, sedentary behavior (SB-I), physical activity (PA-I), combined SB and PA (SB+PA-I) or current practice control (C), which will be evaluated among approximately 600 children aged 8-9 years in school year 3 living in Melbourne, Australia. All children in year 3 at intervention schools in 2010 (8-9 years) will receive the intervention over an 18-month period with a maintenance ‘booster’ delivered in 2012 and children at all schools will be invited to participate in the evaluation assessments. To maximize the sample and to capture new students arriving at intervention and control schools, recruitment will be on-going up to the post-intervention time point. Primary outcomes are time spent sitting and in PA assessed via accelerometers and inclinometers and survey.
Discussion: To our knowledge, Transform-Us! is the first RCT to examine the effectiveness of intervention strategies for reducing children’s overall sedentary time, promoting PA and optimizing health outcomes. The integration of consistent strategies and messages to children from teachers and parents in both school and family settings is a critical component of this study, and if shown to be effective, may have a significant impact on educational policies as well as on pedagogical and parenting practices.

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.

Health system costs of diseases and injury in Australia 1993-94 : an analysis of costs, service use and mortality for major disease and injury groups

Provides a systematic analysis of the health system use and costs associated with specific disease and injury groups in Australia in 1993-94. The estimates are presented in a consistent format and are derived using a methodology that ensures the results add across disease, age and sex groups to total Australian health expenditures for 1993-94.