Role recognition and changes to self-identity in family caregivers of people with advanced cancer: a qualitative study

Purpose : Family caregivers of people with advanced cancer can provide extensive support to the patient. However, the role is not well defined and their experiences are poorly understood. This study aimed to explore how caregivers view their role and the impact of their caregiving.

Methods : A symbolic interactionist framework guided the in-depth individual interviews and grounded theory methodology was used to analyse the data. A total of 17 interviews were conducted: 13 with active caregivers and 4 with bereaved caregivers.

Results : Three dominant codes are presented. Caregivers lacked role recognition, as they struggled to recognise their role existed, even though they took on extensive and challenging tasks. Caregivers reported substantial loss or changes to their self-identity: with some caregivers reporting not being able to stop thinking about caregiving and others having difficulty answering questions about themselves. Caregivers also demonstrated difficulty in taking a break: active caregivers did not consider taking a break, whereas bereaved caregivers retrospectively admitted needing a break but reported an inability to take one.

Conclusions : Caregiving is complex and extensive. People who care for those with advanced cancer are in need of intervention to provide support and assistance to them in their role. However, this needs to be structured with consideration for how caregivers view their role.

The construction of power in family medicine bedside teaching: a video observation study

INTRODUCTION: Bedside teaching is essential for helping students develop skills, reasoning and professionalism, and involves the learning triad of student, patient and clinical teacher. Although current rhetoric espouses the sharing of power, the medical workplace is imbued with power asymmetries. Power is context-specific and although previous research has explored some elements of the enactment and resistance of power within bedside teaching, this exploration has been conducted within hospital rather than general practice settings. Furthermore, previous research has employed audio-recorded rather than video-recorded observation and has therefore focused on language and para-language at the expense of non-verbal communication and human-material interaction. METHODS: A qualitative design was adopted employing video- and audio-recorded observations of seven bedside teaching encounters (BTEs), followed by short individual interviews with students, patients and clinical teachers. Thematic and discourse analyses of BTEs were conducted. RESULTS: Power is constructed by students, patients and clinical teachers throughout different BTE activities through the use of linguistic, para-linguistic and non-verbal communication. In terms of language, participants construct power through the use of questions, orders, advice, pronouns and medical/health belief talk. With reference to para-language, participants construct power through the use of interruption and laughter. In terms of non-verbal communication, participants construct power through physical positioning and the possession or control of medical materials such as the stethoscope. CONCLUSIONS: Using this paper as a trigger for discussion, we encourage students and clinical teachers to reflect critically on how their verbal and non-verbal communication constructs power in bedside teaching. Students and clinical teachers need to develop their awareness of what power is, how it can be constructed and shared, and what it means for the student-patient-doctor relationship within bedside teaching.

A revised Australian dietary guideline index and its association with key sociodemographic factors, health behaviors and body mass index in peri-retirement aged adults

The Dietary Guideline Index, a measure of diet quality, was updated to reflect the 2013 Australian Dietary Guidelines. This paper describes the revision of the index (DGI-2013) and examines its use in older adults. The DGI-2013 consists of 13 components reflecting food-based daily intake recommendations of the Australian Dietary Guidelines. In this cross-sectional study, the DGI-2013 score was calculated using dietary data collected via an 111-item food frequency questionnaire and additional food-related behaviour questions. The DGI-2013 score was examined in Australian adults (aged 55-65 years; n = 1667 men; 1801 women) according to sociodemographics, health-related behaviours and BMI. Women scored higher than men on the total DGI-2013 and all components except for dairy. Those who were from a rural area (men only), working full-time (men only), with lower education, smoked, did not meet physical activity guidelines, and who had a higher BMI, scored lower on the DGI-2013, highlighting a group of older adults at risk of poor health. The DGI-2013 is a tool for assessing compliance with the Australian Dietary Guidelines. We demonstrated associations between diet quality and a range of participant characteristics, consistent with previous literature. This suggests that the DGI-2013 continues to demonstrate convergent validity, consistent with the original Dietary Guideline Index.

Hair cortisol levels, perceived stress and body mass index in women and children living in socioeconomically disadvantaged neighborhoods: the READI study

Disadvantaged communities provide adverse psychosocial exposures that have been linked to high levels of stress, and this may provide one explanatory pathway linking socioeconomic disadvantage to obesity. This study used hair cortisol analysis to quantify associations between stress and body mass index (BMI), and between hair cortisol and perceived psychological stress levels, in women and children living in socioeconomically disadvantaged neighborhoods. Participants were a volunteer sample of 70 women from the Resilience for Eating and Activity Despite Inequality study, including 30 maternal-child pairs. Women self-reported body weight, height and perceived psychological stress using the Perceived Stress Scale (PSS), and provided hair samples for themselves and their child. Children's body weight and height were measured. Following extraction, hair cortisol levels were measured using enzyme-linked immunosorbent assay. Multiple linear regression models examined associations between stress and BMI, and between hair cortisol and perceived stress levels in women and children. Women's hair cortisol levels were not associated with their BMI or PSS scores. Women's PSS scores were positively associated with their BMI (p = 0.015). Within maternal-child pairs, mothers and children's hair cortisol levels were strongly positively associated (p = 0.006). Maternal hair cortisol levels and PSS scores were unrelated to their child's zBMI. Children's hair cortisol levels were not associated with their zBMI or with their mother's PSS score. Findings suggest that cortisol-based and perceived psychological measures of stress may be distinct among women and children living in disadvantaged neighborhoods. Perceived psychological measures may be more important predictors of weight-related risk.

How has alcohol advertising in traditional and online media in Australia changed? Trends in advertising expenditure 1997-2011

Introduction and Aims The aim of this study was to determine changes in advertising expenditures across eight media channels for the four main alcohol beverage types and alcohol retailers in Australia. Design and Methods Yearly advertising expenditures between January 1997 and December 2011 obtained from a leading media-monitoring company. Media channels assessed were: free-to-air television, newspapers, magazines, radio, outdoors (billboards), cinema, direct mail (from 2005) and online (from 2008). Data were categorised into alcohol retailers (e.g. supermarkets, off-licences) or four alcoholic beverage types (beer, wine, spirits, premixed spirits/cider). Regression analyses examined associations between year and expenditure. Results Total alcohol advertising expenditure peaked in 2007, then declined to 2011 (P&thinsp;=&thinsp;0.02). Television advertising expenditure declined between 2000 and 2011 (P&thinsp;<&thinsp;0.001), while outdoor advertising expenditure increased between 1997 and 2007. Alcohol retailers' advertising expenditure increased over time (P&thinsp;<&thinsp;0.001), and from the mid-2000s exceeded expenditure for any single beverage category. For both beer and spirits, television advertising expenditure declined over time (beer: P&thinsp;<&thinsp;0.001; spirits: P&thinsp;<&thinsp;0.001) while outdoor advertising expenditure increased (beer: P&thinsp;<&thinsp;0.001; spirits: P&thinsp;=&thinsp;0.02). However, the number of advertised beer (P&thinsp;<&thinsp;0.001), spirits (P&thinsp;<&thinsp;0.001) and wine (P&thinsp;=&thinsp;0.01) products increased over time. Discussion and Conclusions Retailers are playing an increasing role in advertising alcohol. As our study excluded non-traditional advertising media (e.g. sponsorships, in-store) we cannot determine whether declines in television advertising have been offset by increases in advertising in newer media channels. However, our findings that media channels used for alcohol advertising have changed over time highlights the need for adequate controls on alcohol advertising in all media channels.

Social media bodies : revealing the entanglement of sexual well-being, mental health, and social media in education

While media and youth research reveal the intersectionality of young people’s sexual well-being, mental health, and social media practices, little attention has been paid to how this entanglement is addressed in education. Pedagogy that is not informed by a nuanced and interconnected understanding of young people’s everyday experiences of sexual well-being, mental health, and social media is likely to be ineffective and inadequate. I describe a workshop activity with young people experiencing mental ill health that uses bodies as a metaphor for social media, allowing participants to reveal and discuss their experiences, attitudes, and values through dressing up and illustrating “social media bodies.” I outline three themes that arose from the workshops: revealing and destabilising affordances, the spatial and temporal affordances of social media, and young people’s affective relationships through and with social media, and advocate for an intersectional approach to sexuality education, one that is necessarily complex and ambivalent.

Proliferation of MISS-related microbial mats following the end-Permian mass extinction in the northern Paleo-Tethys: evidence from southern Qilianshan region, western China

As a consequence of the end-Permian mass extinction, microbes proliferated in the post-extinction shallow marine ecosystems, in which they grew as various microbially induced sedimentary structures (MISSs) in siliciclastic settings. This paper reports, for the first time, the discovery of abundant MISSs from the lowest Triassic sandstones of shallow-water margin origin in the Zhihema sections of the southern Qilianshan region, West China. The sandstones are characterized by well-developed cross-beddings and ripple marks, and a Claraia-dominated bivalve assemblage of middle-late Griesbachian age. These sedimentary structures, together with the bivalves, suggest a high-energy peritidal zone of a shoreface setting in a clastic shallow sea environment. Seven types of MISSs are recognized and described here: pictograph-like sand cracks/crack-fills, polygonal sand crack-fills, erosional remnants, multidirectional linear grooves, sinuous crack-fills, fusiform sand cracks/crack-fills, and leveled ripple marks. Most of the newly found MISSs are morphologically comparable with their ancient and modern counterparts. Detailed optical microscope and scanning electron microscope (SEM) analyses reveal that thin clayey laminae and filamentous mica grains are aligned parallel to bedding plane, and that the matrix-supported quartz grains, overall, are oriented; both of which are interpreted to indicate biogenic origin. The biogenic origin of these MISSs is reinforced by the presence of copious putative nanoglobules and filamentous biofilm-like organic objects in the interspaces of clay minerals in laminated layers. These nanometer-scale objects are interpreted as bacterial bodies or remains that have been replaced with inorganic minerals upon fossilization. The presence of MISSs on the northern margins of Paleo-Tethys indicates that the post-extinction microbial mats had expanded their distributions from low-latitude to moderate-high latitude regions. Moreover, unlike some previously reported microbial mats that contain very rare body and trace fossils, the southern Qilianshan MISSs were found in association with abundant vertical burrows and bivalves, suggesting that the MISS-forming microbial mats may have served as oases for trace-making organisms and opportunistic bivalves to flourish in shallow-marine habitats immediately after the end-Permian mass extinction.

Associations between access to recreational physical activity facilities and body mass index in Scottish adults

BACKGROUND: The aim of this country-wide study was to link individual health and behavioural data with area-level spatial data to examine whether the body mass index (BMI) of adults was associated with access to recreational physical activity (PA) facilities by different modes of transport (bus, car, walking, cycling) and the extent to which any associations were mediated by PA participation. METHODS: Data on individual objectively-measured BMI, PA (number of days of (a) ≥20 min of moderate-to-vigorous PA, and (b) ≥15 min of sport or exercise, in previous 4 weeks), and socio-demographic characteristics were obtained from a nationally representative sample of 6365 adults. The number of accessible PA facilities per 1,000 individuals in each small area (data zones) was obtained by mapping a representative list of all fixed PA facilities throughout mainland Scotland. A novel transport network was developed for the whole country, and routes on foot, by bike, by car and by bus from the weighted population centroid of each data zone to each facility were calculated. Separate multilevel models were fitted to examine associations between BMI and each of the 24 measures of accessibility of PA facilities and BMI, adjusting for age, gender, longstanding illness, car availability, social class, dietary quality and urban/rural classification. RESULTS: We found associations (p&thinsp;<&thinsp;0.05) between BMI and 7 of the 24 accessibility measures, with mean BMI decreasing with increasing accessibility of facilities-for example, an estimated decrease of 0.015 BMI units per additional facility within a 20-min walk (p&thinsp;=&thinsp;0.02). None of these accessibility measures were found to be associated with PA participation. CONCLUSIONS: Our national study has shown that some measures of the accessibility of PA facilities by different modes of transport (particularly by walking and cycling) were associated with BMI; but PA participation, as measured here, did not appear to play a part in this relationship. Understanding the multi-factorial environmental influences upon obesity is key to developing effective interventions to reduce it.

Educating for designing in and planning for country: Empowering built environment students with Indigenous protocols and knowledge

Increasingly, built environment professionals in Australia, including architect, landscape architect and planner practitioners, are becoming involved in planning and design of projects for, and in direct consultation with Indigenous communities and their proponents. Critically, built environment professionals must be able to plan and design, and demonstrate respect for Indigenous protocols, cultural issues and their community values. Yet many students graduate with little or no comprehension of Indigenous knowledge systems or the protocols for engagement with Australian or international Indigenous communities in which they are required to work. This paper reports on a recently completed Office of Learning & Teaching funded project that was designed to improve the knowledge and skills of tertiary students in the built environment professions including proposing strategies and processes to expose students in the built environment professions to Australian Indigenous knowledge systems. This is a positive beginning in a long-term decolonising project.

Planning practices in Australian family businesses

Australian family businesses have a poor track record of undertaking formal business planning. This paper reports on the business planning behaviour of
Australian family businesses from a survey of 5,000 businesses across all types and sizes of industries. Our survey found that around one-third of family
businesses undertake formal planning activities. Thus, there has been no improvement in family business planning practices from that reported in 2003. The reluctance of Australian family businesses to undertake contingency and risk planning, as well as human resources planning, leaves Australian family businesses highly exposed in these difficult economic times.

A good place to raise a family? Comparing parents, service-providers', and media perspectives of the inner and outer suburban areas of Melbourne

In Australia, the suburbs have historically been the favoured place to raise children. However this is being challenged both by social change and government policy encouraging innerurban renewal. We examined how inner-urban areas compare with more traditional suburban locations as places to raise a family. Recognising that there are many influences on perceptions of place, we included the opinions of parents, service-providers and the media in the two locations.

Research focused on two municipalities in Melbourne, one located >25km and the other <10km from the CBD. Themes were obtained and compared from in-depth interviews with parents, serviceproviders and analysis of municipality-specific and state-wide newspaper articles.

Service provision was the only theme common at all levels of analysis. For all other themes, differences occurred between perspectives of service-providers, media and parents, as well as between the two residential locations. These in-depth snapshots on the challenges and rewards of raising children in different urban locations can help inform government in planning healthy neighbourhoods that better serve the needs of contemporary Australian families.

Stability of television viewing and electronic game/computer use in a prospective cohort study of Australian children: relationship with body mass index

Background
While much cross-sectional data is available, there have been few longitudinal investigations of patterns of electronic media use in children. Further, the possibility of a bi-directional relationship between electronic media use and body mass index in children has not been considered. This study aimed to describe longitudinal patterns of television viewing and electronic game/computer use, and investigate relationships with body mass index (BMI).
Methods
This prospective cohort study was conducted in elementary schools in Victoria, Australia. 1278 children aged 5–10 years at baseline and 8–13 years at follow-up had their BMI calculated, from measured height and weight, and transformed to z-scores based on US 2000 growth data. Weight status (non-overweight, overweight and obese) was based on international BMI cut-off points. Weekly television viewing and electronic game/computer use were reported by parents, these were summed to generate total weekly screen time. Children were classified as meeting electronic media use guidelines if their total screen time was ≤14 hrs/wk.
Results
Electronic media use increased over the course of the study; 40% met guidelines at baseline but only 18% three years later. Television viewing and electronic game/computer use tracked moderately and total screen time was positively associated with adiposity cross-sectionally. While weaker relationships with adiposity were observed longitudinally, baseline z-BMI and weight status were positively associated with follow-up screen time and baseline screen time was positively associated with z-BMI and weight status at follow-up. Children who did not meet guidelines at baseline had significantly higher z-BMI and were more likely to be classified as overweight/obese at follow-up.

Conclusion
Electronic media use in Australian elementary school children is high, increases with age and tracks over time. There appears to be a bi-directional association suggesting that interventions targeting reductions in either screen time or adiposity may have a positive effect on both screen time and adiposity.

The influence of cultural attributes on intergenerational succession in the Chinese-Australian family business

Research on succession in family business has been traditionally concentrated on planning and strategies in terms of management, ownership and governance. There is an increasing concern on the family influence on the process of succession. This paper discusses the role that the family culture plays in sustaining a family's commitment to its business. In particular, the family business is a prominent form of organisation among the ethnic Chinese expatriate business families. Since the I 980s, under the business migration programme, the increase of Chinese migrants has contributed significantly to the cultural landscape of Australian. This paper chooses Chinese-Australian family businesses to explore their cultural characteristics as a strong family influence on the practices of pas sing on the business to the next generation.

Exploring the relationship between media coverage and participation in entrepreneurship : initial global evidence and research implications

Using a set of variables measured in the Global Entrepreneurship Monitor (GEM) study, our empirical investigation explored the influence of mass media through national culture on national entrepreneurial participation rates in 37 countries over 4 years (2000 to 2003). We found that stories about successful entrepreneurs, conveyed in mass media, were not significantly associated with the rate of nascent (opportunity searching) or the rate of actual (business activities commenced up to 3 months old) start-up activity, but that there was a significant positive association between the volume of entrepreneurship media stories and a nation’s volume of people running a young business (that is in GEM terminology, a business aged greater than 3 but less than 42 months old). More particularly, such stories had strong positive association with opportunity oriented operators of young businesses. Together, these findings are compatible with what in the mass communications theory literature may be called the ‘reinforcement model’. This argues that mass media are only capable of reinforcing their audience’s existing values and choice propensities but are not capable of shaping or changing those values and choices. In the area covered by this paper, policy-makers are committing public resources to media campaigns of doubtful utility in the absence of an evidence base. A main implication drawn from this study is the need for further and more sophisticated investigation into the relationship between media coverage of entrepreneurship, national culture and the rates and nature of people’s participation in the various stages of the entrepreneurial process.