Problem and solution trees : a practical approach for identifying potential interventions to improve population nutrition

Population nutrition problems have a diversity of contributory factors and, ideally, multi-sectoral solutions should be developed by the relevant stakeholders, based on a common understanding of these factors. The problem and solution tree approach is a participatory process of working through the layers of determinants and then developing potential interventions for a specific issue, using the available data and expertise. We tailored this approach for non-communicable disease-related nutrition problems in Pacific Islands and applied it in several countries. The process led to the identification of a considerable range of determinants of unhealthy diets and potential interventions to improve the situation. This practical approach also offered the additional benefit of developing stakeholder awareness in the issues. Problem trees are a relatively simple tool to implement, easy to adapt to differing needs, can generate a wealth of information and can be more widely used.

Nutrition screening in long-term care facilities : an evaluation of the methodological quality of available instruments

A variety of nutrition screening instruments have been developed and implemented for identifying the risk of undernutrition among community and hospitalized older adults. Despite the high prevalence of undernutrition amongst older adults in long-term care, few screening instruments have been developed or evaluated in this setting. This review aims to evaluate the validity, reproducibility and feasibility of nutrition screening instruments developed for use, or described as being used, with older adults in long-term care. Ten publications encompassing nine independent nutrition screening tools were identified using electronic databases and manual searches of reference lists. The Mini Nutritional Assessment-Short Form (MNA-SF) was the most widely evaluated nutrition screening instrument and met the requirements for a valid instrument (sensitivity and specificity >0.9) for use in the long-term care setting. Modified versions of the MNA for use in China and South Africa also demonstrated acceptable levels of sensitivity and specificity. Other nutrition screening instruments were found to have variable levels of sensitivity and specificity and while some demonstrated levels consistent with the MNA-SF, only two were evaluated across more than one study population, Body Mass Index (BMI)+weight loss and BMI+albumin. These same instruments reported the highest levels of inter-rater and test-retest reproducibility, although this was only tested in one other instrument (Chinese Nutrition Screen -modified MNA). In conclusion, it is evident from this review that further work in this area is needed. Based on validity, reproducibility and feasibility it appears that BMI+weight loss is the most suitable nutrition screening instrument for use in the long-term care setting at this time. MNA-SF is promising; however, there is currently no data for inter-rater or test-retest reproducibility in the long-term care setting.

Newbs vs. geeks : encouraging creativity in an online learning community

This article explores the development and creative practices of an online  community within an Australian university. The authors argue that creativity can be enhanced and supported by the development and implementation of purpose-specific learning environments, such as an online learning community. Within such a community the participants are exposed to a number of requisite elements designed to support the exploration of their own learning process and the development of creativity. The following study discusses the establishment of such a community and the social, cultural and learning practices of the student participants.

Evaluation of the implementation of a state government community design policy aimed at increasing local walking : design issues and baseline results from RESIDE, Perth Western Australia

Objectives.
To describe the design and baseline results of an evaluation of the Western Australian government's pedestrian-friendly subdivision design code (Liveable Neighborhood (LN) Guidelines).
Methods.

Baseline results (2003–2005) from a longitudinal study of people (n = 1813) moving into new housing developments: 18 Liveable, 11 Hybrid and 45 Conventional (i.e., LDs, HDs and CDs respectively) are presented including usual recreational and transport-related walking undertaken within and outside the neighborhood, and 7-day pedometer steps.
Results.

At baseline, more participants walked for recreation and transport within the neighborhood (52.6%; 36.1% respectively), than outside the neighborhood (17.7%; 13.2% respectively). Notably, only 20% of average total duration of walking (128.4 min/week (SD159.8)) was transport related and within the neighborhood. There were few differences between the groups' demographic, psychosocial and perceived neighborhood environmental characteristics, pedometer steps, or the type, amount and location of self-reported walking (p > 0.05). However, asked what factors influenced their choice of housing development, more participants moving into LDs reported aspects of their new neighborhood's walkability as important (p < 0.05).
Conclusions.

The baseline results underscore the desirability of incorporating behavior and context-specific measures and value of longitudinal designs to enable changes in behavior, attitudes, and urban form to be monitored, while adjusting for baseline residential location preferences.

Socioeconomic variations in women's diets : what is the role of perceptions of the local food environment

Objectives : To test the contribution of perceived environmental factors (food availability, accessibility and affordability) to mediating socioeconomic variations in women’s fruit, vegetable and fast food consumption.

Methods : A community sample of 1580 women from 45 neighbourhoods provided survey data on their socioeconomic position (SEP) (education and income); diet (fruit, vegetable and fast food consumption); and the perceived availability of, access to and cost of healthy food in their local area.

Results : Once perceived environmental variables were considered, the associations between SEP and diet were weak and non-significant, suggesting that socioeconomic differences in diet were almost wholly explained by perceptions of food availability, accessibility and affordability.

Conclusions : Strategies to decrease socioeconomic inequalities in diet could involve promoting inexpensive ways to increase fruit and vegetable consumption, and ensuring that people of low SEP are aware that many healthy foods are available at relatively low cost. Future research should also confirm if perceptions match objective measures of food availability, accessibility and affordability, in order to address the real and/or perceived lack of healthy options in low SEP neighbourhoods.

Entropy-based collaborative detection of DDOS attacks on community networks

A community network often operates with the same Internet service provider domain or the virtual network of different entities who are cooperating with each other. In such a federated network environment, routers can work closely to raise early warning of DDoS attacks to void catastrophic damages. However, the attackers simulate the normal network behaviors, e.g. pumping the attack packages as poisson distribution, to disable detection algorithms. It is an open question: how to discriminate DDoS attacks from surge legitimate accessing. We noticed that the attackers use the same mathematical functions to control the speed of attack package pumping to the victim. Based on this observation, the different attack flows of a DDoS attack share the same regularities, which is different from the real surging accessing in a short time period. We apply information theory parameter, entropy rate, to discriminate the DDoS attack from the surge legitimate accessing. We proved the effectiveness of our method in theory, and the simulations are the work in the near future. We also point out the future directions that worth to explore in the future.

Community development and environmentalism : the dilemmas of being a good ecological citizen

This paper explores some of the dilemmas in operating as both a good community development practitioner and a good ecological citizen. It begins with a brief casestudy of an experience of community development engagement with nongovernment organisations (NGOs) concerned about illegal logging in a South East Asian country. This is followed by a discussion of the different ways of understanding and evaluating the threats to the natural environment today and the various strategies that might be invoked. The paper then considers why operating as a 'good ecological citizen' can be a challenging task for community development practitioners and it discusses some ways forward.

Sea search : a community-based citizen science monitoring program for Victoria, Australia, Marine National Parks and Marine Sanctuaries

Community involvement in monitoring Victoria’s Marine Protected Areas (MPAs) engages coastal volunteers in looking after their marine ‘front yards”. The Management Strategy for Victoria’s System of Marine National Parks and Marine Sanctuaries dedicates an entire theme to community engagement with core key performance areas. This includes community participation. The Sea Search community based monitoring program was developed in 2003 to engage volunteers in meaningful ecological data collection for future sustainability of Victoria’s MPAs. Deakin University, an academic institute, and Parks Victoria, the management agency for Victoria’s MPAs, through a research partner program, trialled three different habitat monitoring methodologies. The trails assessed volunteer ability to collect scientific data, and social science aspects for their involvement in a community-based monitoring program. Information collected by volunteers, feeds directly into their local MPA management strategies to address issues such as climate change, introduced pests and human impacts and natural ecological variation.

The Sea Search program addresses the two action programmes, Agenda 21 and the Rio Declaration on Environment and Development, created at the United Nations Earth Summit, held in 1992. Both documents highlight the need for community engagement and capacity building for sustainability, health and integrity of the earth. Involvement in the Sea Search program builds the volunteer’s capacity by learning scientific skills, interacting with other like minded community members, and creating relationships with all organisations involved in the delivery of the program. In this regard, Sea Search is a citizen science program involving all sectors in society by promoting public-interest and research for decision making and planning of Victoria’s system of Marine National Parks and Marine Sanctuaries.

Building a connected community of learners : the postgraduate peer mentor program

Student peer mentor programs are recognised as a valid component of a multi-faceted strategy to improve student engagement within higher education. This paper reports some preliminary results from research investigating how such programs help support diverse student needs in a multicultural environment. Our results are from a study of a pilot postgraduate student peer mentoring program set up to support new students in the Faculty of Business and Law at Deakin University, Australia. The postgraduate student body at Deakin is quite diverse and includes a large proportion of international students. We present examples to show how a peer mentoring program can improve the social engagement of students, help overcome cross-cultural communication barriers and contribute to the development of academic skills.

Community development and ecology : exploring the links

This paper will explore connections between the concepts of community development and ecology. Initially the tendency was to think there should be a total melding of the principles and practices of community development with those of an ecological understanding but on reflection this has not and indeed is not necessarily the case. The relative epistemological positioning of two different groups, one strongly associating with social justice and the need for people to be at the centre of our economic, environmental and social understanding; and the other clearly seeing the plant and ecology/environment being paramount. While there are a myriad of connections the focus of much community development has been around human welfare based on principles of social, political and economic justice. This has at times been to the detriment of ecological sustainability. Conversely ecology and particularly aspects of deep ecology have focussed on the 'other than human' aspects of the planet and at times seemed almost 'anti 'human and overlooking the need to work with the social almost entirely. This paper briefly outlines the historical separation of the social from the ecological then goes on to explore alternative understandings that bring together principles of community development and ecology. Three examples are used to highlight the principles and practices that are being used across diverse contexts but all informed by common norms and values that are consistent with both community development and ecology. Concepts such as subsidiarity, participation and empowerment that form the basis of community development praxis are critical to the development of local sustainability. The combination of these aspects is evidenced in the three examples. Each is very clearly located in the local context and is built on sound ecological and community development understandings but each is also well aware that the need for a broader perspective is imperative to achieving global goals.

Moving beyond 'rates, roads and rubbish' : how do local governments make choices about healthy public policy to prevent obesity?

While the causes of obesity are well known traditional education and treatment strategies do not appear to be making an impact. One solution as part of a broader complimentary set of strategies may be regulatory intervention at local government level to create environments for healthy nutrition and increased physical activity. Semi structured interviews were conducted with representatives of local government in Australia. Factors most likely to facilitate policy change were those supported by external funding, developed from an evidence base and sensitive to community and market forces. Barriers to change included a perceived or real lack of power to make change and the complexity of the legislative framework. The development of a systematic evidence base to provide clear feedback on the size and scope of the obesity epidemic at a local level, coupled with cost benefit analysis for any potential regulatory intervention, are crucial to developing a regulatory environment which creates the physical and social environment required to prevent obesity.

Associations between the physical and social environment and depressive symptomology among Australian adolescents

Depression is a significant public health issue among Australian adolescents. A number of family, school and community level factors have been identified as important determinants of adolescent's health and well-being, including depression. This study examines associations between measures of the social and physical environment and adolescent mental health, specifically depressive symptomotology using data from the Healthy Neighbourhoods study, a large observational study carried out in 231 Australian schools stratified by socioeconomic quartiles and urban/non-urban geography, which focuses on adolescent health and well-being. Participants were 8256 year 6 and 8
students (48% male), aged 11-16 years (M = 11.6, SD = 0.8 years) from schools across Victoria,Queensland and Western Australia who completed a comprehensive on-line survey. Data collected included the Short Mood and Feeling Questionnaire (SMFQL a tool for assessing depressive symptomotology in adolescents. Results showed that the mean total depression score (possible range 0-26 with total scores;:: 8 used as the cutoff for depression symptomotology) was 6.4 (SD = 5.9), with scores for females (M = 6.8, SD = 6.3) higher than those for males (M = 5.9, SD = 5.5), and scores for year 8 students (M = 6.7,SD = 6.1) higher than those for year 6 students (M = 6.2, SD = 5.8) (p < .001). Greater access to sporting and play equipment, local parks, and more functional neighbourhoods for walking and jogging reduced the odds for depressive symptomotology (p < .05L while increased levels of abandoned homes, and higher levels of fighting within the neighbourhood, and fewer scout/guide clubs, local teams to play sport, and adults in the neighbourhood to talk with, as well as reduced neighbourhood safety increased the odds for depressive symptomotology (p < .05). These findings support the important role of physical and social environments in influencing adolescent health and well-being. Modifications to particular aspects of these environments at the community level may assist in providing adolescents some protection from depression.

"Tell us something new!" : the response of planning and transport professionals to public health guidance on the built environment and physical activity

A large proportion of non-communicable disease can be attributed to modifiable risk factors such as poor nutrition and physical inactivity. We present data on planning and transport practitioners' perceptions and responses to government public health guidance aimed at modifying environmental factors to promote physical activity. This study was informed by questions on the role of evidence-based guidance, the views of professionals towards the guidance, the links between guidance and existing legislation and policy and the practicality of guidelines. A key informant 'snowball' sampling technique was used to recruit participants from the main professional planning organisations across England. Seventy-six people were interviewed in eight focus groups. We found that evidence-based public health guidance is a new voice in urban and town planning, although much of the advice is already reflected by the 'accepted wisdom' of these professions. Evidence-based health guidance could be a powerful driver affecting planning practice, but other legislated planning guidance may take priority for planning and transport professionals.

Physical activity and environment programme guidance : fieldwork report

This quick reference guide presents the recommendations on ‘Promoting and creating built or natural environments that encourage and support physical activity’. It is for NHS and other professionals who have a direct or indirect role in – and responsibility for – the built or natural environment. This includes those working in local authorities and the education, community, voluntary and private sectors. It may also be of interest to members of the public. The guidance offers the first national, evidence-based recommendations on how to improve the physical environment to encourage physical activity. It demonstrates the importance of such improvements and the need to evaluate how they impact on the public’s health.

Community center-based resistance training for the maintenance of glycemic control in adults with type 2 diabetes

OBJECTIVE--The purpose of this study Was to determine whether beneficial effects on glycemic control of an initial laboratory-supervised resistance training program could be sustained through a community center-based maintenance program.

RESEARCH DESIGN AND METHODS--We studied 57 overweight (BMI [greater than or equal to] 27 kg/[m.sup.2]) sedentary men and women aged 40-80 years with established (>6 months) type 2 diabetes. Initially, all participants attended a twice-weekly 2-month supervised resistance training program conducted in the exercise laboratory. Thereafter, participants undertook a resistance training maintenance program (2 times/week) for 12 months and were randomly assigned to carry this out either in a community fitness and recreation center (center) or in their domestic environment (home). Glycemic control ([HbA.sub.1c] [A1C]) was assessed at 0, 2, and 14 months.

RESULTS--Pooling data from the two groups for the 2-month supervised resistance training program showed that compared with baseline, mean A1C fell by -0.4% [95% CI -0.6 to -0.2]. Within-group comparisons showed that A1C remained lower than baseline values at 14 months in the center group (-0.4% [-0.7 to -0.03]) but not in the home group (-0.1% [-0.4 to 0.3]). However, no between-group differences were observed at each time point. Changes in A1C during the maintenance period were positively associated with exercise adherence in the center group only.

CONCLUSIONS--Center-based but not home-based resistance training was associated with the maintenance of modestly improved glycemic control from baseline, which was proportional to program adherence. Our findings emphasize the need to develop and test behavioral methods to promote healthy lifestyles including increased physical activity in adults with type 2 diabetes.