Diabetes MILES – The Netherlands: rationale, design and sample characteristics of a national survey examining the psychosocial aspects of living with diabetes in Dutch adults

Background : As the number of people with diabetes is increasing rapidly worldwide, a more thorough understanding of the psychosocial aspects of living with this condition has become an important health care priority. While our knowledge has grown substantially over the past two decades with respect to the physical, emotional and social difficulties that people with diabetes may encounter, many important issues remain to be elucidated. Under the umbrella of the Diabetes MILES (Management and Impact for Long-term Empowerment and Success) Study International Collaborative, Diabetes MILES – The Netherlands aims to examine how Dutch adults with diabetes manage their condition and how it affects their lives. Topics of special interest in Diabetes MILES - The Netherlands include subtypes of depression, Type D personality, mindfulness, sleep and sexual functioning.

Methods/design : Diabetes MILES – The Netherlands was designed as a national online observational study among adults with diabetes. In addition to a main set of self-report measures, the survey consisted of five complementary modules to which participants were allocated randomly. From September to October 2011, a total of 3,960 individuals with diabetes (40% type 1, 53% type 2) completed the battery of questionnaires covering a broad range of topics, including general health, self-management, emotional well-being and contact with health care providers. People with self-reported type 1 diabetes (specifically those on insulin pump therapy) were over-represented, as were those using insulin among respondents with self-reported type 2 diabetes. People from ethnic minorities were under-represented. The sex distribution was fairly equal in the total sample, participants spanned a broad age range (19–90 years), and diabetes duration ranged from recent diagnosis to living with the condition for over fifty years.

Discussion : The Diabetes MILES Study enables detailed investigation of the psychosocial aspects of living with diabetes and an opportunity to put these findings in an international context. With several papers planned resulting from a pooled Australian-Dutch dataset and data collections planned in other countries, the Diabetes MILES Study International Collaborative will contribute substantially to identifying potentially unmet needs of those living with diabetes and to inform clinical research and care across the globe.

Rural living and health-related quality of life in Australians with Parkinson's disease

Introduction: The motor and non-motor symptoms associated with idiopathic Parkinson’s disease (PD) may compromise the health-related quality of life (HRQOL) of some individuals living with this debilitating condition. Although growing evidence suggests that PD may be more prevalent in rural communities, there is little information about the life quality of these individuals. This study examines whether HRQOL ratings vary in relation to rural and metropolitan life settings.
Methods: An analytic cross-sectional study was conducted to compare the HRQOL of two separate samples of people with PD living in metropolitan Melbourne and rural Victoria. The metropolitan sample consisted of 210 individuals who had participated in the baseline assessment for an existing clinical trial. The rural sample comprised 24 participants who attended community-based rehabilitation programs and support groups in rural Victoria. Health-related quality of life was quantified using the Parkinson’s Disease Questionnaire-39 (PDQ-39).
Results: The HRQOL of participants in rural Australia differed from individuals living in a large metropolitan city (p=0.025). Participants in rural Australia reported worse overall HRQOL, after controlling for differences in disease duration. Their overall HRQOL was lower than for city dwellers. Rural living was also found to be a significant negative predictor of HRQOL (β=0.14; 95% CI -1.27 to -0.08; _p=0.027).
Conclusion: The findings of this study suggest that some people with PD living in rural Victoria perceive their HRQOL to be relatively poor. In order to minimise the debilitating consequences of this disease, further studies examining the factors that may contribute to the HRQOL of individuals living in rural and remote areas are required.

The experience of Singapore in raising awareness of natural and cultural resources

The city-state of Singapore has a major role in the urban development. Majority of the innovative projects are initiated by the government agencies. For this paper, I would like to highlight the two distinct themes of innovation that, I believe preoccupied the authority for its urban issues, they are innovation which concern nature and culture. Land in Singapore is scarce. Natural resources are strictly protected. At the same time they are challenged to return the maximum benefit to their own population. The water catchment area and the prime forest on the whole island is the most valuable natural resources to be preserved. The paper will demonstrate how Singapore challenges with its own resources (water and greenery) in which the holistic planning around these themes become more than just spaces of protection but integrated with the public space system and turned into more valuable spaces for the well being of its population. The second theme is the issue related to culture. Singapore's economy is the most advance compare to other Southeast Asian countries, however when it comes to culture and identity, the city state struggles with the over constructed image of branding Singapore's culture. The paper will discuss several examples around the theme of arts and culture, how the city state bench-mark itself with the world class cities. It is one of the most challenging topic in urban planning and policy making. It is worth discussing on its success and failure. We can learn form Singapore that innovation at the level of policy maker can be achieved in some urban aspects such as the management of natural resources and urban design projects related to it. However when it comes to the issue related to art and culture, the top down policy alone cannot assure the achievement of city's identity as it aspired. Tracing the historical development of the environmental and cultural policies of Singapore the paper intends to study and analyze various case studies reflecting these attempts of natural and cultural instillation. In the process of comparison of these two drastically contrasting actors and approaches, the paper will argue that it has mostly been driven by economic aims, and careful thought. The results have been limited and restrictive. Further arguing that 'creativity' is the essential factor of arts and culture, it evaluates the authenticity and the ultimate implications on cultural spirit.

Pharmaceuticals in Australia: developments in regulation and governance

The pharmaceutical domain represents a type of internationalised policy network theorised in recent writings on neo-liberalism, neo-corporatism and governance. This article presents an analysis of developments in prescription drug regulation in Australia. A relatively stable, state-managed pattern of interaction has been superseded by less closed exchange, and the government itself has fragmented into agencies pursuing different objectives. Developments in the three core regulatory areas are described: safety and efficacy controls, social policy (access and equity), and state support for industry (economic) development. Consensus-building occurs within the context of the National Medicines Policy. The pharmaceutical industry, represented by Medicines Australia, has a stake in all aspects of pharmaceutical policy and regulation, and draws upon unique resources (expertise and lobbying capacity). The context for the developments described is Australia's abandonment of a protectionist version of the Keynesian welfare national state in favour of the model of the competition state, which is oriented towards support for the growth of high technology industries such as pharmaceuticals, premised on partnerships with business.

Finding voices: authentic learning online in the field of public communication and citizenship

A creative re-acculturation of teachers and students is occurring in virtual classrooms as traditional learning resources, pedagogy, and technology intersect in unexpected ways. This paper reports on a case of authentic, experiential, and constructivist learning developed for tertiary public relations  students. A subject titled ‘Public Communication and Citizenship’ (PCC) at  Deakin University in Australia asked students to examine the problematic and contentious areas of self interest, persuasion, power, and ethics in  contemporary contexts of mass media and globalisation. Feedback from  those students suggests that, in this case, online teaching strategies  successfully integrated with the total learning environment to achieve  higher-order learning. PCC is one example of PR pedagogy combining  theory and technology to move beyond ‘skilling for jobs’.

The comparative energetics and growth strategies of sympatric Antarctic and subantarctic fur seal pups at Iles Crozet

The period of maternal dependence is a time during which mammalian infants must optimise both their growth and the development of behavioural skills in order to successfully meet the demands of independent living. The rate and duration of maternal provisioning, post-weaning food availability and climatic conditions are all factors likely to influence the growth strategies of infants. While numerous studies have documented differences in growth strategies at high taxonomic levels, few have investigated those of closely related species inhabiting similar environments. The present study examined the body composition, metabolism and indices of physiological development in pups of Antarctic fur seals (Arctocephalus gazella) and subantarctic fur seals (Arctocephalus tropicalis), congeneric species with different weaning ages (4 months and 10 months, respectively), during their overlap in lactation at a sympatric breeding site in the Iles Crozet. Body lipid reserves in pre-moult pups were significantly greater (t₂₈=2.73, P<0.01) in subantarctic (26%) than Antarctic fur seals (22%). Antarctic fur seal pups, however, had significantly higher (t₂₆=3.82, P<0.001) in-air resting metabolic rates (RMR; 17.1±0.6 ml O₂ kg^-1 min^-1) than subantarctic fur seal pups (14.1±0.5 ml O2 kg^-1 min^-1). While in-water standard metabolic rate (SMR; 22.9±2.5 ml O2 kg^-1 min^-1) was greater than in-air RMR for Antarctic fur seal pups (t₉=2.59, P<0.03), there were no significant differences between in-air RMR and in-water SMR for subantarctic fur seal pups (t₁₂=0.82, P>0.4), although this is unlikely to reflect a greater ability for pre-moult pups of the latter species to thermoregulate in water. Pup daily energy expenditure was also significantly greater (t₂₇=2.36, P<0.03) in Antarctic fur seals (638±33 kJ kg^-1 day^-1) than in subantarctic fur seals (533±33 kJ kg^-1 day^-1), which corroborates observations that pups of the former species spend considerably more time actively learning to swim and dive. Consistent with this observation is the finding that blood oxygen storage capacity was significantly greater (t₉=2.81, P<0.03) in Antarctic (11.5%) than subantarctic fur seal (8.9%) pups. These results suggest that, compared with subantarctic fur seals, Antarctic fur seal pups adopt a strategy of faster lean growth and physiological development, coupled with greater amounts of metabolically expensive behavioural activity, in order to acquire the necessary foraging skills in time for their younger weaning age.