The effectiveness of nutrition interventions on dietary outcomes by relative social disadvantage : a systematic review

Objective: To determine whether nutrition interventions widen dietary inequalities across socioeconomic status groups.

Design: Systematic review of interventions that aim to promote healthy eating.

Data sources: CINAHL and MEDLINE were searched between 1990 and 2007.

Review methods: Studies were included if they were randomised controlled trials or concurrent controlled trials of interventions to promote healthy eating delivered at a group level to low socioeconomic status groups or studies where it was possible to disaggregate data by socioeconomic status.

Results: Six studies met the inclusion criteria. Four were set in educational setting (three elementary schools, one vocational training). The first found greater increases in fruit and vegetable consumption in children from high-income families after 1 year (mean difference 2.4 portions per day, p<0.0001) than in children in low-income families (mean difference 1.3 portions per day, p<0.0003). The second did not report effect sizes but reported the nutrition intervention to be less effective in disadvantaged areas (p<0.01). The third found that 24-h fruit juice and vegetable consumption increased more in children born outside the Netherlands ("non-native") after a nutrition intervention (beta coefficient = 1.30, p<0.01) than in "native" children (beta coefficient = 0.24, p<0.05). The vocational training study found that the group with better educated participants achieved 34% of dietary goals compared with the group who had more non-US born and non-English speakers, which achieved 60% of dietary goals. Two studies were conducted in primary care settings. The first found that, as a result of the intervention, the difference in consumption of added fat between the intervention and the control group was –8.9 g/day for blacks and –12.0 g/day for whites (p<0.05). In the second study, there was greater attrition among the ethnic minority participants than among the white participants (p<0.04).

Conclusions: Nutrition interventions have differential effects by socioeconomic status, although in this review we found only limited evidence that nutrition interventions widen dietary inequalities. Due to small numbers of included studies, the possibility that nutrition interventions widen inequalities cannot be excluded. This needs to be considered when formulating public health policy.

MammoSapiens: eResearch of the lactation program.

Delivering bioinformatics power to life science researchers inevitably runs into problems of limited computing resources in the context of exponentially increasing data sources, access time, costs, lack of skills and, rapidly evolving technology and software tools with poorly defined standards. In this context the development of e-facilities to best enable collaborative research often needs to be customized to specific project applications in close cooperation with the experimentalist users and, to be concerned with the storage and management of results to allow more consistency and traceability of e-results on a broad access data mining platform.

Here we showcase an internet based eResearch platform using the PHP/MySQL paradigm for the collaborative, integrative and comparative analysis of lactation related gene sequences and gene expression experiments to support lactation research. We also illustrate how these resources are used, how they enable research by allowing meta-analysis of data and results and, how the bottom-up development of customized eResearch components can lead to the production of more generic functional software tools and eResearch environments for deployment to a larger number of biological research users working on other bio-systems.

The effect of tai chi on psychosocial well-being : a systematic review of randomized controlled trials

Objective : This systematic review aimed to critically appraise published clinical trials designed to assess the effect of Tai Chi on psychosocial well-being.

Data Sources : Databases searched included MEDLINE, CINAHL, EMBASE, HEALT, PsycINFO, CISCOM, the Cochrane Central Register of Controlled Trials of the Cochrane Library, and dissertations and conference proceedings from inception to August 2008.

Review Methods : Methodological quality was assessed using a modified Jadad scale. A total of 15 studies met the inclusion criteria (i.e. English publications of randomized controlled trials with Tai Chi as an intervention and psychological well-being as an outcome measure), of which eight were high quality trials. The psychosocial outcomes measured included anxiety (eight studies), depression (eight studies), mood (four studies), stress (two studies), general mental health three studies), anger, positive and negative effect, self-esteem, life satisfaction, social interaction and self-rated health (one study each).

Results : Tai Chi intervention was found to have a significant effect in 13 studies, especially in the management of depression and anxiety. Although the results seemed to suggest Tai Chi is effective, they should be interpreted cautiously as the quality of the trials varied substantially. Furthermore, significant findings were shown in only six high quality studies. Moreover, significant between group differences after Tai Chi intervention was demonstrated in only one high quality study (the other three significant results were observed in non-high quality studies). Two high quality studies in fact found no significant Tai Chi effects.

Conclusion : It is still premature to make any conclusive remarks on the effect of Tai Chi on psychosocial well-being.

An exploration of the pedagogies employed to integrate knowledge in work-integrated learning

This article describes a three-sector, national research project that investigated the integration aspect of work-integrated learning (WIL). The context for this study is three sectors of New Zealand higher education: business and management, sport, and science and engineering, and a cohort of higher educational institutions that offer WIL/cooperative education in variety of ways. The aims of this study were to investigate the pedagogical approaches in WIL programs that are currently used by WIL practitioners in terms of learning, and the integration of academic-workplace learning. The research constituted a series of collective case studies, and there were two main data sources � interviews with three stakeholder groups (namely employers, students, and co-op practitioners), and analyses of relevant documentation (e.g., course/paper outlines, assignments on reflective practice, portfolio of learning, etc.). The research findings suggest that there is no consistent mechanism by which placement coordinators, off-campus supervisors, or mentors seek to employ or develop pedagogies to foster learning and the integration of knowledge. Learning, it seems, occurs by means of legitimate peripheral participation with off-campus learning occurring as a result of students working alongside professionals in their area via an apprenticeship model of learning. There is no evidence of explicit attempts to integrate on- and off-campus learning, although all parties felt this would and should occur. However, integration is implicitly or indirectly fostered by a variety of means such as the use of reflective journals.

Descriptive epidemiology of Australian football injuries presenting to sports medicine clinics

Sports injury prevention has been the focus of a number of recent public health initiatives due to the acknowledgement that sports injuries are a significant public health problem in Australia Whilst Australian football is one of the most popular participation sports in the country, only very limited data is available about football injuries The majority of sports injury data available for this sport is from hospital emergency departments and elite-level injury surveillance Overall there is a paucity of data from treatment settings other than hospitals In particular, there is a lack of information about the injuries sustained by community-level, junior and recreational Australian football participants. One good potential source of football injury data is sports medicine clinics. Analysis of injury presentations to sports medicine clinics was undertaken to provide a detailed description of the epidemiology of Australian football injuries that present to this treatment setting and to determine the implications for injury prevention in this sport. In addition, the data from sports medicine clinics was compared with existing sources of Australian football injury data to determine how representative sports medicine clinic data is of other football injury data sources and to provide recommendations for future injury surveillance n Australian football. The results contained in this thesis show that Australian football is the sport most associated with injury presentation at sports medicine clinics. The majority of injured Australian football players presenting to sports medicine clinics are community-level or junior participants which suggests that sports medicine clinics are a good source of information on the injuries sustained by sub-elite football participants. Competition is the most common context in which Australian football players presenting to sports medicine clinics are injured. The major causes of injuries to Australian football players are being struck by another player, collisions and overuse. Injuries to Australian football players predominantly involve the lower limb. Adult players, players who stopped participating immediately after noticing their injury and players with overuse injuries are the most likely to sustain a more severe injury (i.e. more than four weeks before a full return to football participation and a moderate/significant amount of treatment expected). The least experienced players (five or less years of participation) are more likely to require a significant amount of treatment than the more experienced players. The prevention of lower limb injuries, injuries caused by body contact and injuries caused by overuse should be a priority for injury prevention research in Australian football due to the predominance of these injury types in the pattern of Australian football injuries Additionally, adult players, as a group, should be a focus of injury prevention activities in Australian football due to the association between age and injury severity. Overall, the pattern of Australian football injuries presenting to sports medicine clinics appears to be different than reported by club-based and hospital emergency department injury surveillance activities. However, detailed comparison of sports medicine clinic Australian football data with other sources of Australian football injury data is difficult due to the variable methods of collecting and reporting injury information used by hospital emergency department and club-based injury surveillance activities. The development of a standardised method for collecting and reporting injury data in Australian football is strongly recommended to overcome the existing limitations of data collection in this sport. In summary, sports medicine clinics provide a rich source of Australian football injury data, especially from the community and junior levels of participation. The inclusion of sports medicine clinic data provides a broader epidemiological picture of Australian football injuries. This broader understanding of the pattern of Australian football injuries provides a better basis for the development of injury prevention measures in this sport.

Retrospective application of remote sensing to the Tasmanian lakeland

This thesis describes the research undertaken for a degree of Master of Science in a retrospective study of airborne remotely sensed data registered in 1990 and 1993, and field captured data of aquatic humus concentrations for ~ 45 lakes in Tasmania. The aim was to investigate and describe the relationship between the remotely sensed data and the field data and to test the hypothesis that the remotely sensed data would establish further evidence of a limnological corridor of change running north-west to south- east. The airborne remotely sensed data consisted of data captured by the CSIRO Ocean Colour Scanner (OCS) and a newly developed Canadian scanner, a compact airborne spectrographic imager (CASI). The thesis investigates the relationship between the two kinds of data sources. The remotely sensed data was collected with the OCS scanner in 1990 (during one day) and with both the OCS and the CASI in 1993 (during three days). The OCS scanner registers data in 9 wavelength bands between 380 nm and 960 nm with a 10-20 nm bandwidth, and the CASI in 288 wavelength bands between 379.57 nm and 893.5 nm (ie. spectral mode) with a spectral resolution of 2.5 nm. The remotely sensed data were extracted from the original tapes with the help of the CSIRO and supplied software and digital sample areas (band value means) for each lake were subsequently extracted for data manipulation and statistical analysis. Field data was captured concurrently with the remotely sensed data in 1993 by lake hopping using a light aircraft with floats. The field data used for analysis with the remotely sensed data were the laboratory determined g440 values from the 1993 water samples collated with g440 values determined from earlier years. No spectro-radiometric data of the lakes, data of incoming irradiance or ancillary climatic data were captured during the remote sensing missions. The sections of the background chapter in the thesis provide a background to the research both in regards to remote sensing of water quality and the relationship between remotely sensed spectral data and water quality parameters, as well as a description of the Tasmanian lakes flown. The lakes were divided into four groups based on results from previous studies and optical parameters, especially aquatic humus concentrations as measured from field captured data. The four groups consist of the ‘green” clear water lakes mostly situated on the Central Plateau, the ‘brown” highly dystrophic lakes in western Tasmania, the ‘corridor” lakes situated along a corridor of change lying approximately between the two lines denoting the Jurassic edge and 1200 mm isohyet, and the ‘eastern, turbid” lakes make up the fourth group. The analytical part of the research work was mostly concerned with manipulating and analysing the CASI data because of its higher spectral resolution. The research explores methods to apply corrections to this data to reduce the disturbing effects of varying illumination and atmospheric conditions. Three different methods were attempted. In the first method two different standardisation formulas are applied to the data as well as ‘day correction” factors calculated from data from one of the lakes, Lake Rolleston, which had data captured for all three days of the remote sensing operations. The standardisation formulas were also applied to the OCS data. In second method an attempt to reduce the effects of the atmosphere was performed using spectro-radiometric captured in 1988 for one of the lakes flown, Great Lake. All the lake sample data were time normalised using general irradiance data obtained from the University of Tasmania and the sky portion as calculated from Great Lake upwelling irradiance data was then subtracted. The last method involved using two different band ratios to eliminate atmospheric effects. Statistical analysis was applied to the data resulting from the three methods to try to describe the relationship between the remotely sensed data and the field captured data. Discriminant analysis, cluster analysis and factor analysis using principal component analysis (pea) were applied to the remotely sensed data and the field data. The factor scores resulting from the pca were regressed against the field collated data of g440 as were the values resulting from last method. The results from the statistical analysis of the data from the first method show that the lakes group well (100%) against the predetermined groups using discriminant analysis applied to the remotely sensed CASI data. Most variance in the data are contained in the first factor resulting from pca regardless of data manipulation method. Regression of the factor scores against g440 field data show a strong non- linear relationship and a one-sided linear regression test is therefore considered an inappropriate analysis method to describe the dataset relationships. The research has shown that with the available data, correction and analysis methods, and within the scope of the Masters study, it was not possible to establish the relationships between the remotely sensed data and the field measured parameters as hoped. The main reason for this was the failure to retrieve remotely sensed lake signatures adequately corrected for atmospheric noise for comparison with the field data. This in turn is a result of the lack of detailed ancillary information needed to apply available established methods for noise reduction - to apply these methods we require field spectroradiometric measurements and environmental information of the varying conditions both within the study area and within the time frame of capture of the remotely sensed data.

Will residential aged care facilities meet long-term demand?

Purpose – This paper aims to provide an invaluable insight into long-term forecasting of demand for aged care facilities. This will ensure the provision of adequate supply by government bodies, stakeholders and developers in order to meet the anticipated level of demand, without creating an over-supply or an under-supply scenario.

Design/methodology/approach – Using an innovative approach, different data sources were collectively used to forecast separate individual supply and demand levels, which were then examined together in order to measure the difference between the two variables between 2009-2020. A case study approach was used for Victoria, Australia.

Findings – The paper finds that, although there is excess supply between 2009-2010 and 2019-2020, the period between 2010 and 2019 will experience an under-supply period which cannot be easily rectified over the short term.

Research limitations/implications – The case study was limited to residential care facilities in Victoria, Australia, although some countries have substantially different age profiles and accommodation supply for older residents. Forecasts are based on information sources from various data suppliers and collectively analysed.

Practical implications – The results are also of direct interest to place managers and planning authorities who are charged with providing medium- and long-term visions and plans for specific locations. This type of research is essential when planning for the eventual aging of the population, where the methodology can be replicated in different areas. Most importantly, this research approach provides a solid basis for decisions regarding the supply of residential aged care facilities as opposed to a simple estimate.

Originality/value – The study adopted a unique approach to analysing the individual supply and demand components for aged care facilities over the long term. This approach is able to accurately determine when there will be an under-supply or over-supply situation and thus provide the opportunity to address the difference before it occurs. This will allow informed decisions about planning aged care facilities in the future to be made as required.

Increasing community capacity to prevent childhood obesity : challenges, lessons learned and results from the Romp & Chomp intervention

Background
Obesity is a major public health issue; however, only limited evidence is available about effective ways to prevent obesity, particularly in early childhood. Romp & Chomp was a community-wide obesity prevention intervention conducted in Geelong Australia with a target group of 12,000 children aged 0-5 years. The intervention had an environmental and capacity building focus and we have recently demonstrated that the prevalence of overweight/obesity was lower in intervention children, post-intervention. Capacity building is defined as the development of knowledge, skills, commitment, structures, systems and leadership to enable effective health promotion and the aim of this study was to determine if the capacity of the Geelong community, represented by key stakeholder organisations, to support healthy eating and physical activity for young children was increased after Romp & Chomp.

Methods
A mixed methods evaluation with three data sources was utilised. 1) Document analysis comprised assessment of the documented formative and intervention activities against a capacity building framework (five domains: Partnerships, Leadership, Resource Allocation, Workforce Development, and Organisational Development); 2) Thematic analysis of key informant interviews (n = 16); and 3) the quantitative Community Capacity Index Survey.

Results
Document analysis showed that the majority of the capacity building activities addressed the Partnerships, Resource Allocation and Organisational Development domains of capacity building, with a lack of activity in the Leadership and Workforce Development domains. The thematic analysis revealed the establishment of sustainable partnerships, use of specialist advice, and integration of activities into ongoing formal training for early childhood workers. Complex issues also emerged from the key informant interviews regarding the challenges of limited funding, high staff turnover, changing governance structures, lack of high level leadership and unclear communication strategies. The Community Capacity Index provided further evidence that the project implementation network achieved a moderate level of capacity.

Conclusions
Romp & Chomp increased the capacity of organisations, settings and services in the Geelong community to support healthy eating and physical activity for young children. Despite this success there are important learnings from this mixed methods evaluation that should inform current and future community-based public health and health promotion initiatives.

Trial Registration Number: ANZCTRN12607000374460

Overweight and obesity in infants and pre-school children in the European Union : a review

The objective of this study was to synthesize available information on prevalence and time trends of overweight and obesity in pre-school children in the European Union. Retrieval and analysis or re-analysis of existing data were carried out. Data sources include WHO databases, Medline and Google, contact with authors of published and unpublished documents. Data were analysed using the International Obesity Task Force reference and cut-offs, and the WHO standard. Data were available from 18/27 countries. Comparisons were problematic because of different definitions and methods of data collection and analysis. The reported prevalence of overweight plus obesity at 4 years ranges from 11.8% in Romania (2004) to 32.3% in Spain (1998–2000). Countries in the Mediterranean region and the British islands report higher rates than those in middle, northern and eastern Europe. Rates are generally higher in girls than in boys. With the possible exception of England, there was no obvious trend towards increasing prevalence in the past 20–30 years in the five countries with data. The use of the WHO standard with cut-offs at 1, 2 and 3 standard deviations yields lower rates and removes gender differences. Data on overweight and obesity in pre-school children are scarce; their interpretation is difficult. Standard methods of surveillance, and research and policies on prevention and treatment, are urgently needed.

A pathway to enhancing professionalism: building a bridge between TAFE and university early childhood qualifications

It has been argued that a key strategy to improve developmental and educational outcomes for young children is to increase the number of childcare staff with early childhood university degrees (Saracho & Spodek, 2007). In order to upgrade the qualifications of staff, a number of Australian universities provide pathways that enable graduates of early childhood diploma programs to complete a degree. Several impediments, including institutional structures and individual contextual and personal factors, may affect these pathways. Although a range of organisations offer diploma programs, TAFE (Tertiary and Further Education) is a major provider. The aim of the present study was to investigate student transition between early childhood programs in TAFE and university. The research drew on several data sources, including a survey of the perceptions of students at various points of undertaking the transition. The current credit arrangement for TAFE Diploma graduates was found to be satisfactory; however, gaps were identified between the TAFE and university teaching and learning arrangements with regard to curriculum structures, teaching styles and assessment. Graduates of both programs considered that the completion of both awards would have a positive effect on their careers.

Mining multi-modal crime patterns at different levels of granularity using hierarchical clustering

The appearance of patterns could be found in different modalities of a domain, where the different modalities refer to the data sources that constitute different aspects of a domain. Particularly, the domain of our discussion refers to crime and the different modalities refer to the different data sources such as offender data, weapon data, etc. in crime domain. In addition, patterns also exist in different levels of granularity for each modality. In order to have a thorough understanding a domain, it is important to reveal the hidden patterns through the data explorations at different levels of granularity and for each modality. Therefore, this paper presents a new model for identifying patterns that exist in different levels of granularity for different modes of crime data. A hierarchical clustering approach - growing self organising maps (GSOM) has been deployed. Furthermore, the model is enhanced with experiments that exhibit the significance of exploring data at different granularities.

Barriers to kidney transplants in Indonesia : a literature review

Background: People living with chronic kidney disease will require renal dialysis or a kidney transplant to maintain life. Although Indonesia has a developing healthcare industry, Indonesia's kidney transplant rates are lower than comparable nations.

Purpose: To explore the healthcare literature to identify barriers to kidney transplants in particular in relation to Indonesia.

Methods: Healthcare databases were searched (CINAHL, Medline, EBSCOhostEJS, Blackwell Synergy, Web of Science, PubMed, Google Scholar and Proquest 5000) using the search terms: transplant, kidney disease, renal, dialysis, haemodialysis, Indonesia and nursing. The search was limited to English and Indonesian language data sources from 1997 to 2007. Reference lists of salient academic articles were hand searched.

Results: The results of our search identified six articles that met our criteria. Costs are the major barrier to kidney transplant in Indonesia, followed by cultural beliefs, perception of the law, lack of information and lack of infrastructure. In addition, kidney disease prevention strategies are required.

Conclusions: There are many complex socio-economic, geographical, legal, cultural and religious factors that contribute to low kidney transplant rates in Indonesia. Although an increase in transplantation rates will require strategies from various agencies, healthcare professionals, including nurses, can play a role in overcoming some barriers. Community education programmes, improving their own education levels and by increasing empowerment in nursing we may contribute to improved kidney transplant rates in Indonesia.

The societal benefits of reducing six behavioural risk factors : an economic modelling study from Australia

Background
A large proportion of disease burden is attributed to behavioural risk factors. However, funding for public health programs in Australia remains limited. Government and non-government organisations are interested in the productivity effects on society from reducing chronic diseases. We aimed to estimate the potential health status and economic benefits to society following a feasible reduction in the prevalence of six behavioural risk factors: tobacco smoking; inadequate fruit and vegetable consumption; high risk alcohol consumption; high body mass index; physical inactivity; and intimate partner violence.
Methods
Simulation models were developed for the 2008 Australian population. A realistic reduction in current risk factor prevalence using best available evidence with expert consensus was determined. Avoidable disease, deaths, Disability Adjusted Life Years (DALYs) and health sector costs were estimated. Productivity gains included workforce (friction cost method), household production and leisure time. Multivariable uncertainty analyses and correction for the joint effects of risk factors on health status were undertaken. Consistent methods and data sources were used.
Results
Over the lifetime of the 2008 Australian adult population, total opportunity cost savings of AUD2,334 million (95% Uncertainty Interval AUD1,395 to AUD3,347; 64% in the health sector) were found if feasible reductions in the risk factors were achieved. There would be 95,000 fewer DALYs (a reduction of about 3.6% in total DALYs for Australia); 161,000 less new cases of disease; 6,000 fewer deaths; a reduction of 5 million days in workforce absenteeism; and 529,000 increased days of leisure time.
Conclusions
Reductions in common behavioural risk factors may provide substantial benefits to society. For example, the total potential annual cost savings in the health sector represent approximately 2% of total annual health expenditure in Australia. Our findings contribute important new knowledge about productivity effects, including the potential for increased household and leisure activities, associated with chronic disease prevention. The selection of targets for risk factor prevalence reduction is an important policy decision and a useful approach for future analyses. Similar approaches could be applied in other countries if the data are available.

A comparative assessment of the information technology services sector in India and China

The purpose of this paper is to assess the nature of competition in the information technology (IT) services sector between India and China. Using primary and secondary data sources, we compare and contrast the strengths and weaknesses of the IT services sector in the two countries along the main dimensions of Porter’s competitive advantage model. The principal findings indicate that the IT services sectors in the two countries are distinctively different, have developed along different paths and are highly complementary to each other. China has a well established hardware sector and its IT services sector focuses mostly on servicing its domestic market. India’s IT services sector is predominantly export orientated with focus on the US and Western European markets. Contrary to popular beliefs, given the complementary characteristics of the IT services sectors in India and China, it is unlikely for the two countries to compete against each other in the near future and greater strategic co-operation between IT service providers in the two countries is a more likely outcome.

A Steinian approach to an empathic understanding of hope among patients and clinicians in the culture of palliative care

Aim. This article presents a discussion of empathy in the context of human person, reason and hopes in the clinical setting.

Background. Empathy was introduced to nursing as part of an ethical and philosophical foundation for caring. It helped to solve the tension and meet the demands that empathy placed upon nursing practice.

Data sources. This article is based on two studies undertaken between 2008 and 2010 to understand the concept of hope and empathy among people with terminal cancer and doctors who care for them. Doctoral dissertations and theses of Edith Stein (1916–1917), Marianne Sawicki [Body, Text and Science. The Literary of Investigative Practices and the Phenomenology of Edith Stein (1997) Kluwer Academic Publisher, Dordrecht], and Sister M. Judith Parsons (2005) have been used to examine: ‘the essence of acts of empathy’, ‘the constitution of the psycho-physical individual’ and ‘empathy as understanding of intellectual persons’. CINAHL, MEDLINE and PROQUEST have provided further supporting data.

Discussion. Steinian empathy requires that we use affective resonance, cognitive understanding and distance, as we grasp another person’s emotional and situational reality while in the caring role as nurses.

Implications for current nursing. Steinian empathy is about recognizing a lived experience and standing side-by-side with that person. Nurses can transmit this knowledge to enable and support courage and wisdom to reduce feelings of helplessness when caring for people with terminal illness.

Conclusion. Not only is empathy a safe and permissible emotion, it is the linchpin to a caring patient–nurse relationship and we must embrace this.