Statistical approaches used to assess the equity of access to food outlets: a systematic review

Abstract: Background Inequalities in eating behaviours are often linked to the types of food retailers accessible in neighbourhood environments. Numerous studies have aimed to identify if access to healthy and unhealthy food retailers is socioeconomically patterned across neighbourhoods, and thus a potential risk factor for dietary inequalities. Existing reviews have examined differences between methodologies, particularly focussing on neighbourhood and food outlet access measure definitions. However, no review has informatively discussed the suitability of the statistical methodologies employed; a key issue determining the validity of study findings. Our aim was to examine the suitability of statistical approaches adopted in these analyses.
Methods: Searches were conducted for articles published from 2000–2014. Eligible studies included objective measures of the neighbourhood food environment and neighbourhood-level socio-economic status, with a statistical analysis of the association between food outlet access and socio-economic status.
Results Fifty four papers were included. Outlet accessibility was typically defined as the distance to the nearest outlet from the neighbourhood centroid, or as the numberof food outlets within a neighbourhood (or buffer). To assess if these measures were linked to neighbourhood disadvantage, common statistical methods included ANOVA, correlation, and Poisson or negative binomial regression. Although all studies involved spatial data, few considered spatial analysis techniques or spatial autocorrelation.
Conclusions: With advances in GIS software, sophisticated measures of neighbourhood outlet accessibility can be considered. However, approaches to statistical analysis often appear less sophisticated. Care should be taken to consider assumptions underlying the analysis and the possibility of spatially correlated residuals which could affect the results.

The National Perinatal Depression Initiative: An evaluation of access to general practitioners, psychologists and psychiatrists through the Medicare Benefits Schedule

OBJECTIVE: To evaluate the impact of the National Perinatal Depression Initiative on access to Medicare services for women at risk of perinatal mental illness. METHOD: Retrospective cohort study using difference-in-difference analytical methods to quantify the impact of the National Perinatal Depression Initiative policies on Medicare Benefits Schedule mental health usage by Australian women giving birth between 2006 and 2010. A random sample of women of reproductive age enrolled in Medicare who had not given birth where used as controls. The main outcome measures were the proportions of women giving birth each month who accessed a Medicare Benefits Schedule mental health items during the perinatal period (pregnancy through to the end of the first postnatal year) before and after the introduction of the National Perinatal Depression Initiative. RESULTS: The proportion of women giving birth who accessed at least one mental health item during the perinatal period increased from 88 to 141 per 1000 between 2007 and 2010. The difference-in-difference analysis showed that while there was an overall increase in Medicare Benefits Schedule mental health item access as a result of the National Perinatal Depression Initiative, this did not reach statistical significance. However, the National Perinatal Depression Initiative was found to significantly increase access in subpopulations of women, particularly those aged under 25 and over 34 years living in major cities. CONCLUSION: In the 2 years following its introduction, the National Perinatal Depression Initiative was found to have increased access to Medicare funded mental health services in particular groups of women. However, an overall increase across all groups did not reach statistical significance. Further studies are needed to assess the impact of the National Perinatal Depression Initiative on women during childbearing years, including access to tertiary care, the cost-effectiveness of the initiative, and mental health outcomes. It is recommended that new mental health policy initiatives incorporate a planned strategic approach to evaluation, which includes sufficient follow-up to assess the impact of public health strategies.

Restricting access to invasion hubs enables sustained control of an invasive vertebrate

Biological invasions often occur through expansion of satellite populations that become established at 'invasion hubs'. Invasion hubs can result from random dispersal events, but frequently arise when invading individuals actively choose habitats using cues that signify high-quality environments where the fitness consequences are positive. Theoretical studies suggest that targeted control at invasion hubs can effectively suppress the populations and impacts of invaders. In arid Australia, small dams that provide water for livestock function as invasion hubs by providing an invasive vertebrate, the cane toad Rhinella marina, with refuge from extreme aridity during the annual dry season. Toads are attracted to dams and use them as stepping stone habitats from which they disperse during rainy periods. Here, we ask whether sustained control of this invasive vertebrate can be achieved by converting invasion hubs into ecological traps. We did this by manipulating invasion hub habitats to induce a mismatch between toads' habitat preference and the fitness consequences of their habitat choice to cause high mortality. We constructed fences to exclude toads from dams and maintained these fences for 1 year. This period encompassed periods of dry and wet seasonal climatic conditions. Our manipulation did not alter the attractive cues for invading toads which died en masse while attempting to settle at fenced dams that prevented toads from reaching water. Toad populations at the fenced dams were suppressed by 1-2 orders of magnitude compared to unfenced controls and procedural controls. Toad populations remained suppressed for a year after exclusion. By excluding toads from dams, we converted invasion hubs into ecological traps and effectively thwarted the reinvasion of cane toads. Our research suggests that water exclusion devices could be used to prevent toad invasion or to control cane toad populations in arid landscapes colonized by toads. Synthesis and applications. Our study demonstrates that sustained control of invader populations can be achieved by restricting their access to invasion hubs. Control of invasive species via elimination of invasion hubs could be conducted reactively, to control established populations of invaders, or conducted strategically, by rendering invasion hubs unsuitable for colonization ahead of the invasion front to prevent further population spread.

Responding to the widening participation agenda through improved access to and within 3D virtual learning environments

The Australian Government's widening participation agenda - also referred to as the social inclusion agenda - considers equity through the triple focus of access, participation and outcomes. These foci are catalysts for re-examining teaching and learning approaches in formal education. This article considers this national refocus and the possibilities for addressing access and equity issues through and within threedimensional virtual learning environments (3DVLEs). The findings of an Australian Learning and Teaching Council (ALTC)-funded project that investigated the potential of an accessible 3DVLE for increasing access and participation of students with disabilities are reported, and strategies for improving outcomes (i.e. retention, success and completion) proposed. The article also highlights some of the remaining challenges with regard to the goal of improving outcomes for under-represented learner groups. The final section of the article identifies areas for further research.

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 < 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 = 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.

The regulation of research by funding bodies : an emerging ethical issue for the alcohol and other drug sector?

The degree to which funding bodies can and do control the content and dissemination of research products raises important issues which need to be openly debated by the alcohol and other drug (AOD) sector. Current policies relating to censorship and other means of controlling research topics or output are explored alongside an examination of how some institutions, particularly some academic journals, deal with such issues. We argue that regulation of research by funding bodies clearly contravenes the scientific ideal of freedom of information and open access to knowledge. Using international ethical guidelines, we also demonstrate that regulation raises concerns in relation to the ethical concept of beneficence. A number of examples specific to harm reduction strategies are presented in order to demonstrate how censorship might conceivably increase the harms associated with drug use. The commentary closes with recommendations concerning the establishment the prevalence of censorship and other forms of control over research in the AOD sector, and the role that ethics committees, journal editorial boards and professional societies might play in resisting the imposition of unacceptable conditions on publication of findings.

Education for a new 'museology'

This article provides a critical reading of a curriculum initiative in tertiary education designed to address students who are traditionally marginalised in the Australian tertiary sector. An argument is made that this curriculum approach with its emphases on authenticity, identity, agency and embodied learning addresses issues of the disjunct between access to knowledge, museums and cultural capital. The political work of this curriculum is situated in the new museology. The author draws on Ellsworth's sensation of learning to elaborate the contributions made possible by the curriculum Learning and teaching in public spaces to museum education and tertiary education.

Supporting athlete selection and strategic planning in track cycling omnium: A statistical and machine learning approach

This article describes the implementation of machine learning techniques that assist cycling experts in the crucial decision-making processes for athlete selection and strategic planning in the track cycling omnium. The omnium is a multi-event competition that was included in the Olympic Games for the first time in 2012. Presently, selectors and cycling coaches make decisions based on experience and opinion. They rarely have access to knowledge that helps predict athletic performances. The omnium presents a unique and complex decision-making challenge as it is not clear what type of athlete is best suited to the omnium (e.g., sprint or endurance specialist) and tactical decisions made by the coach and athlete during the event will have significant effects on the overall performance of the athlete. In the present work, a variety of machine learning techniques were used to analyze omnium competition data from the World Championships since 2007. The analysis indicates that sprint events have slightly more influence in determining the medalists, than endurance-based events. Using a probabilistic analysis, we created a model of performance prediction that provides an unprecedented level of supporting information that assists coaches with strategic and tactical decisions during the omnium.

Narratives and landscapes : their capacity to serve indigenous knowledge interests

The thesis is a culmination of my research which drew on tyangi wedi tjan Rak Mak Mak Marranunggu and Marrithiel knowledge systems. These awa mirr spiritual knowledge systems have guided our Pilu for millennium and have powerful spiritual affiliation to the land and our continued presences. The understandings of the spiritual connectedness and our practices of relatedness have drawn on Pulitj, our deep awa mirr spiritual philosophy that nourishes us on our country. This philosophy gave us our voice and our presence to act in our own ways of knowing and being on the landscapes created by the Western bureaucratic systems of higher education in Australia to bring forth our Tyikim knowledge systems to serve our own educational interests. From this spiritual ‘Puliyana kunun’ philosophical position the thesis examines colonising constructions of Tyikim peoples, Tyikim knowledge systems in education, Tyikim research and access to higher education for Tyikim students. From the research, it is argued that the paradigm, within which the enclave-derived approach to Indigenous higher education is located, is compatible with the normalising imperialistic ideology of higher education. The analysis of the Mirrwana/Wurrkama participatory action research project, central to the research, supported an argument for the Mirrwana/Wurrkama model of Indigenous higher education. Further analysis identified five key pedagogical principles embedded within this new model as metaphorically equivalent to wilan~bu of the pelangu. The thesis identifies the elements of the spirituality of the narrative exposed in the research-in-action through the “Marri kubin mi thit wa!”. This is a new paradigm for Tyikim participation in higher education within which the Mirrwana/Wurrkama model is located. Finally, the thesis identifies the scope for Tyikim knowledge use in the construction of contemporary ‘bureaucratic and institutionalised’ higher education ngun nimbil thit thit teaching and learning experiences of Tyikim for the advancement of Tyikim interests. Here the tyangi yigin tjan spiritual concepts of narrative and landscape are drawn upon both awa mirr metaphorically and in marri kubin mi thit wa Tyikim pedagogical practice.

An exploratory cluster randomised controlled trial of knowledge translation strategies to support evidence-informed decision-making in local governments (The KT4LG study)

Background: Childhood overweight and obesity is the most prevalent and, arguably, politically complex child health problem internationally. Governments, communities and industry have important roles to play, and are increasingly expected to deliver an evidence-informed system-wide prevention program. However, efforts are impeded by a lack of organisational access to and use of research evidence. This study aims to identify feasible, acceptable and ideally, effective knowledge translation (KT) strategies to increase evidence-informed decision making in local governments, within the context of childhood obesity prevention as a national policy priority.
Methods/Design: This paper describes the methods for KT4LG, a cluster randomised controlled trial which is exploratory in nature, given the limited evidence base and methodological advances. KT4LG aims to examine a program of KT strategies to increase the use of research evidence in informing public health decisions in local governments. KT4LG will also assess the feasibility and acceptability of the intervention. The intervention program comprises a facilitated program of evidence awareness, access to tailored research evidence, critical appraisal skills development, networking and evidence summaries and will be compared to provision of evidence summaries alone in the control program. 28 local governments were randomised to intervention or control, using computer generated numbers, stratified by budget tertile (high, medium or low). Questionnaires will be used to measure impact, costs, and outcomes, and key informant interviews will be used to examine processes, feasibility, and experiences. Policy tracer studies will be included to examine impact of intervention on policies within relevant government policy documents.
Discussion: Knowledge translation intervention studies with a focus on public health and prevention are very few in number. Thus, this study will provide essential data on the experience of program implementation and evaluation of a system-integrated intervention program employed within the local government public health context. Standardised programs of system, organisational and individual KT strategies have not been described or rigorously evaluated. As such, the findings will make a significant contribution to understanding whether a facilitated program of KT strategies hold promise for facilitating evidence-informed public health decision making within complex multisectoral government organisations.

Knowledge translation strategies to improve the use of evidence in public health decision making in local government: intervention design and implementation plan

Background: 

Barriers and enablers to healthcare access and use among Arabic-speaking and Caucasian English-speaking patients with type 2 diabetes mellitus: a qualitative comparative study

OBJECTIVE: The objective of this study was to explore the decision-making processes and associated barriers and enablers that determine access and use of healthcare services in Arabic-speaking and English-speaking Caucasian patients with diabetes in Australia. STUDY SETTING AND DESIGN: Face-to-face semistructured individual interviews and group interviews were conducted at various healthcare settings-diabetes outpatient clinics in 2 tertiary referral hospitals, 6 primary care practices and 10 community centres in Melbourne, Australia. PARTICIPANTS: A total of 100 participants with type 2 diabetes mellitus were recruited into 2 groups: 60 Arabic-speaking and 40 English-speaking Caucasian. DATA COLLECTION: Interviews were audio-taped, translated into English when necessary, transcribed and coded thematically. Sociodemographic and clinical information was gathered using a self-completed questionnaire and medical records. PRINCIPAL FINDINGS: Only Arabic-speaking migrants intentionally delayed access to healthcare services when obvious signs of diabetes were experienced, missing opportunities to detect diabetes at an early stage. Four major barriers and enablers to healthcare access and use were identified: influence of significant other(s), unique sociocultural and religious beliefs, experiences with healthcare providers and lack of knowledge about healthcare services. Compared with Arabic-speaking migrants, English-speaking participants had no reluctance to access and use medical services when signs of ill-health appeared; their treatment-seeking behaviours were straightforward. CONCLUSIONS: Arabic-speaking migrants appear to intentionally delay access to medical services even when symptomatic. Four barriers to health services access have been identified. Tailored interventions must be developed for Arabic-speaking migrants to improve access to available health services, facilitate timely diagnosis of diabetes and ultimately to improve glycaemic control.

Spreading the word: using film to share research findings and knowledge about children with disabilities in Vanuatu and Papua New Guinea

While there is increasing international interest in disability inclusive development, people with disability largely remain ‘unseen, unheard and uncounted’ (UN ESCAP 2012:1). Children with disability, particularly, remain excluded from research informing development, and there is a paucity of information that is drawn directly from the self-report of children with disability living in developing countries. This exclusion occurs across all stages of research, including access to research findings. When child research is conducted in such countries, to gain further evidence to support disability inclusive development and advance human rights, researchers must question how findings will be reported back to participants and their communities, and seek a method that is both accessible and culturally relevant. This paper reports on the Voices of Pacific children with disability research project about the human rights of children with disability in Vanuatu and Papua New Guinea (PNG), and focuses on film as a dissemination method. Project researchers developed methods to enhance the participation of children with diverse disabilities as informants, and drew upon community development principles to disseminate research findings via film; a method that resonated with the aural and visual story telling traditions of participants.This medium also included accessibility features that have been utilised by local and international audiences.

Computer-aided design decision support: interfacing knowledge and information

Computer-aided design decision support has proved to be an elusive and intangible project for many researchers as they seek to encapsulate information and knowledge-based systems as useful multifunctional data structures. Definitions of ‘knowledge', ‘information', ‘facts', and ‘data' become semantic footballs in the struggle to identify what designers actually do, and what level of support would suit them best, and how that support might be offered. The Construction Primer is a database-drivable interactive multimedia environment that provides readily updated access to many levels of information aimed to suit students and practitioners alike. This is hardly a novelty in itself. The innovative interface and metadata structures, however, combine with the willingness of national building control legislators, standards authorities, materials producers, building research organisations, and specification services to make the Construction Primer a versatile design decision support vehicle. It is both compatible with most working methodologies while remaining reasonably future-proof. This paper describes the structure of the project and highlights the importance of sound planning and strict adhesion to library-standard metadata protocols as a means to avoid the support becoming too specific or too paradigmatic.