Health beliefs - what role do they play in outcomes research?

Lay beliefs about health and illness are individual and social, influenced by prevailing social and medical ideologies. Health beliefs clearly influence self-care motivation and have an effect on health-promoting behaviour (e.g. attendance at a screening program, food choices, adherence to prescribed medication). Further, the beliefs and attributions that people hold can directly affect physiological systems (e.g. the immune system). Health beliefs have been shown to influence a variety of patient-reported outcomes, including medication adherence, satisfaction and health-related quality of life. It is widely acknowledged that when the patient's beliefs are acknowledged and incorporated, rather than ignored, optimal biomedical patient-reported outcomes are more likely to be achieved. Several psychological models have been developed to predict health behaviours and may be utilised to identify the beliefs that inform such behaviours. These models consider the social milieu, personality, demographic, political and economic predictors of health beliefs. They demonstrate the impact of beliefs such as the causes of illness, effectiveness of healthcare and acceptability of health services, and how manipulating these can result in actual or intended behaviour change. This workshop will introduce health beliefs and discuss the psychological models that underpin the translation of belief into behaviour. The session is interactive, with participants defining health beliefs and their impact on behaviour. Participants will be invited to critique the models and apply their chosen model to a health indication of their choice.

The role of religiosity as a coping resource for relatives of critically ill patients in Greece

Critical care hospitalisation is emotionally overwhelming for the relatives of patients. Research has shown that religiosity is an effective coping resource for people with health related problems and has been correlated with better health outcomes. However the processes by which religiosity is utilized and its ejfocts on relatives of critically ill patients have not been adequately explored. This article presents relatives' experiences and processes of religiosity; it is part of a wider grounded theory study on the experiences of critically ill patients'relatives in Greece. T wenty-jive relatives of patients in the intensive care units of three public general district hospitals in Athens, Greece, participated in 19 interviews. Religiosity was found tv be the main source of hope, strength and courage for relatives and was expressed with church/monastery attendance, belief in God, praying. and performing religious rituals. Health care professionals should pay attention and understand these aspects of coping.

Understanding exercise uptake and adherence for people with chronic conditions : a new model demonstrating the importance of exercise identity, benefits of attending and support

Understanding the factors influencing uptake and adherence to exercise for people with chronic conditions from different ages, genders and ethnicities is important for planning exercise services. This paper presents evidence supporting a new model of exercise uptake and adherence applicable to people with chronic conditions from diverse socio-demographic backgrounds. The study is based on 130 semistructured interviews with people with chronic conditions, including both those who did and those who did not attend exercise services, and supporters of those who attended. Analysis followed the guidelines of ‘framework analysis’. Results show that three factors were particularly important in influencing adherence behavior: (i) exercise identity, (ii) support and (iii) perceived benefits of attending. Social and cultural identities impacted on willingness to exercise, importance of exercise and perceived appropriateness of exercising. Having at least one supporter providing different types of support was associated with high levels of attendance. Those people who valued the social and psychological benefits of attending were more likely to be high attenders. The new model illustrates interaction between these three factors and discusses how these can be taken into account when planning exercise services for people with chronic conditions drawn from diverse socio-demographic groups.

Harem size and oviposition behaviour in a polygynous bark beetle

1. Harem polygyny can have fitness benefits and costs on females. In bark beetles of the genus Ips the latter may include within-harem competition between larvae. However, earlier competition between females for male care and mating opportunities may also influence oviposition behaviour. There has been relatively little investigation into the relationship between harem size and initial egg output. The present study investigated this relationship in the bark beetle Ips grandicollis.
2. The measure of egg output used was the number of eggs in the gallery with the most eggs in each harem. Mean ( ± SE) harem size of 242 observed harems was 3.25 ± 0.10. A curvilinear relationship was found between egg output and harem size, with females in smaller harems (one to four females) laying more eggs with increased harem size. However, females in larger harems (five to seven females) laid fewer eggs as harem size increased. The optimal harem size (in terms of number of eggs laid) was close to four females.
3. We found no evidence from a behavioural assay that females could preferentially choose unmated males over mated males with harems of two females. Additionally, the distribution of harem sizes suggests that females distribute themselves among males randomly.
4. The results suggest that harem size has effects on female reproduction that extend beyond larval competition and influence patterns of oviposition. The mechanism that determines why egg laying is greatest at intermediate levels is unknown. There is no evidence that smaller harems belong to lower quality males, but females may adjust egglaying behaviour in large harems as a result of reduced male attendance or anticipated larval competition.

Staff perspectives of drug use issues among sex-on-premises attendees

Aims: Sex on premises venues (SOPV) have been given considerable attention, in particular when exploring the relationship between SOPV attendance and risk behaviours such as drug use and unsafe sex. Little attention has been given to the perspectives of those who work in these venues.

Methods: Semi-structured interviews were conducted with staff recruited from four SOPV in Sydney, Australia. Content analysis was performed to identify common themes.

Findings: Several themes emerged from the staff interviews. These themes concentrated on particular drugs of concern; interventions in place to deal with substance use and those under the influence; and that drug use among SOP patrons occurred at venues prior to attending SOPV.

Conclusions: Interviews with SOP workers showed that these venues face unique challenges that may not be encountered by other settings. SOPV staff has a detailed understanding of their clientele and their perspectives may be important not only when informing trends in substance use but also the development and distribution of harm reduction materials.

Talking with their feet : student absenteeism and compulsory schooling

Universal access to elementary schooling is a goal that was largely achieved in western democracies by the mid twentieth century. Yet, at the beginning of the twenty-first century, students’ access to schooling appears to be back on the agenda; this time, students themselves rather than our social systems are regulating their access to school. Increasingly, schools throughout Australia and in several other OECD countries are recording a worrying decline in student attendance in the compulsory years, prompting a certain amount of societal ‘fear’, ‘anxiety’ and ‘moral panic’. This paper reviews the literature on student attendance and absenteeism as a feature of contemporary schooling. It begins with an account of how this literature variously defines absenteeism – its discursive categories – and where it locates the ‘problem’. The ‘solutions’ that flow from these accounts are also explicated, specifically in relation to their regulatory effects on students and on the education they are offered. The paper’s critical reading of these problems of and solutions for student absenteeism seeks to highlight the institutional authoring of such student behaviour and of students as ‘other’. It also uncovers the silences in the literature, particularly in relation to cultural difference, student subjectivity and teacher pedagogy – what teachers are doing (and not doing) to/with students. The paper concludes that issues of low socio-economic status do not feature very loudly in the literature (and, we suspect, in practice), despite being strongly associated with students who respond to the demands and relevance of schooling by ‘talking with their feet’.

Battlefield tourism - Anzac day commemorations at Gallipoli : an empirical analysis

This thesis used theoretical constructs of personal values, emotions, motives, event components of ceremony, transport and amenities to develop an empirical model that provided an understanding of the experiential components of the event and the antecedents associated with attendance, satisfaction and recommending behaviour of the Anzac Day Ceremonies at Gallipoli.

Pre- and posttrip factors influencing the visitor experience at a battlefield commemorative event : Gallipoli, a case study

Battlefield tourism is a major component of national and international tourism. This article sets out to provide a holistic understanding of the preevent factors influencing attendance at an event commemorating a famous World War I battle and to follow the cycle through to gain an understanding of what postevent factors influence event satisfaction and how this translates into recommending behavior. The Anzac Day commemorative event at Gallipoli, Turkey, provides the backdrop for this study. A two-step process was used to gather information from Australians partaking in the Gallipoli commemorations in 2007. A preevent questionnaire was distributed to a convenience sample of respondents while they were in transit from Istanbul to Gallipoli for the commemoration. In total, 482 preevent questionnaires were obtained. Step two of this process saw an exit questionnaire administered to a convenience sample of participants on the return journey to Istanbul, resulting in 331 completed postevent questionnaires. The pre- and postevent datasets were separately analyzed using factor analysis and structural equation modeling (SEM) where appropriate. The findings highlight the role of various event attributes, most prominently the ceremonial and experiential aspects of the Anzac Day commemorations, in encouraging visitor satisfaction and further flow-on effects for recommending behavior.

Engaging with Asia : the Chifley government and the New Delhi conferences of 1947 and 1949

This article is a study of the Chifley government's foreign policy towards Asia, in particular India and Indonesia, as evidenced by Australia's attendance at the 1947 Asian Relations Conference and the 1949 New Delhi Conference on the Indonesian-Dutch conflict. Australia's presence at these two conferences provides an ideal opportunity to examine the Chifley government's response to the momentous changes that occurred in post-war Asia as a result of the dismantling of the European colonial world order. Through detailed examination of the archival material and contemporary accounts generated from Australia's involvement in the New Delhi conferences, this article will argue that despite significant political constraints, the Chifley government did adopt a distinctive and innovative policy towards the emergent nations of Asia in the immediate post-war years.

The CDM-Net project : the development, implementation and evaluation of a broadband-based network for managing chronic disease

Background. In Australia most chronic disease management is funded by Medicare Australia through General Practitioner Management Plans (GPMPs) and Team Care Arrangements (TCAs). Identified barriers may be reduced effectively using a broadband-based network known as the Chronic Disease Management Service (CDMS).

Aims. To measure the uptake and adherence to CDMS, test CDMS, and assess the adherence of health providers and patients to GPMPs and TCAs generated through CDMS.

Methods. A single cohort before and after study.

Results. GPMPs and TCAs increased. There was no change to prescribed medicines or psychological quality of life. Attendance at allied health professionals increased, but decreased at pharmacies. Overall satisfaction with CDMS was high among GPs, allied health professionals, and patients.

Conclusion. This study demonstrates proof of concept, but replication or continuation of the study is desirable to enable the impact of CDMS on diabetes outcomes to be determined.

Rates of common communicable illnesses in non-anaemic 12-24 month old South Island, New Zealand children

Aims : To describe the incidence of parentally reported illness in otherwise healthy South Island toddlers; characterise the predictors of illness; and determine whether there was a relationship between teething and illness in this population.

Methods : A 20-week randomised controlled trial was conducted on 1-year-old children (n=225) from Otago and Southland between February 2004 and December 2005. Information on symptoms of morbidity, occurrence of teething, and childcare attendance were recorded daily throughout the intervention period. Morbidity symptoms were categorised into respiratory illness (RI), gastrointestinal illness (GII), ear infection, and total illness, and the number and duration of events were determined.

Results : The mean (SD) number of total illnesses was 3.4 (2.3) per 20 weeks, with an average duration of 4.5 days. Episodes of RI were most common (50% of total illness events), and tended to be the longest in duration (mean of 3.7 days). Having siblings aged less than 5 years (23% increase, 95%CI 6%–42%, p=0.007) and attending childcare (72% increase, 95%CI 38%–113%, p<0.001)), were positively associated with the number of total illness events but not duration. In addition, teething was positively associated with total events (OR 1.94, 95%CI 1.45–2.60, p<0.001), RI events (OR 2.03, 95%CI 1.41–2.93, p<0.001) and GII events (OR 1.90, 95%CI 1.36–2.67, p<0.001).

Conclusion : This study has shown that illness (particularly RI) is common in the second year of life. It has also confirmed that attending childcare and having siblings aged under 5 years increases the number of illness events. An association between teething and the occurrence of illness was also seen but the exact nature of this relationship requires verification.

A prospective study of the effect of education on non-compliant behaviour in contact lens wear

The contact lens practitioner and patient present a specific case for the study of non-compliance in areas such as hygiene, solution use, appointment attendance and wearing times. Education is one of the factors thought to influence compliance among patients in general health care situations and contact lens practitioners are encouraged to educate patients in the care and maintenance of contact lenses. A prospective, randomized, controlled and double masked study was performed to assess the effect of a‘compliance enhancement strategy’ on levels of compliance among contact lens wearers over twelve months. Eighty experienced contact lens patients were randomly allocated to two experimental groups. A standard level of contact lens instruction was applied to the first group and in addition the compliance enhancement strategy was applied to patients assigned to the second group. The strategy consisted of extra education for patients using a video, booklets, posters, a checklist and a health care contract. Patients were given free supplies of RelMu multipurpose solution and Medalist 38 soft contact lenses IBausch and Lomb, Rochester. New York). Compliance levels were assessed at a twelve month aftercare appointment by demonstration and questionnaire. The results indicate that the compliance enhancement strategy had little significant effect on the compliance levels of the patients to whom it was applied. The population of contact lens wearers were generally very compliant and the contact lenses and care regimen were clinically successful. The possibility that the assessment of non–compliance was not adequately sensitive to highlight small differences in non-compliant, behaviour is discussed. The standard level of eduction applied to this sample of contact lens patients was adequate to ensure generally high levels of compliance with the simple care and maintenance regimen recommended.

Impact of personalized recommendation and social comparison on learning behaviours and outcomes

ELearning suffers from the lack of face-to-face interaction and can deprive learners from the benefits of social interaction and comparison. In this paper we present the results of a study conducted for the impact of social comparison. The study was conducted by collecting students’ engagement with an eLearning tool, the attendance, and grades scored by students at specific milestones and presented these metrics to students as feedback using Kiviat charts. The charts were complemented with appropriate recommendations to allow them to adapt their study strategy and behaviour. The study spanned over 4 semesters (2 with and 2 without the Kiviats) and the results were analysed using paired T tests to test the pre and post results on topics covered by the eLearning tool. Survey questionnaires were also administered at the end for qualitative analysis. The results indicated that the Kiviat feedback with recommendation had positive impact on learning outcomes and attitudes.

Hormonal responses to extreme fasting in subantarctic fur seal (Arctocephalus tropicalis) pups

Surviving prolonged fasting implies closely regulated alterations in fuel provisioning to meet metabolic requirements, while preserving homeostasis. Little is known, however, of the endocrine regulations governing such metabolic adaptations in naturally fasting free-ranging animals. The hormonal responses to natural prolonged fasting and how they correlate to the metabolic adaptations observed, were investigated in subantarctic fur seal (Arctocephalus tropicalis) pups, which, because of the intermittent pattern of maternal attendance, repeatedly endure exceptionally long fasting episodes throughout their development (1–3 mo). Phase I fasting was characterized by a dramatic decrease in plasma insulin, glucagon, leptin, and total L-thyroxine (T4) associated with reductions in mass-specific resting metabolic rate (RMR), plasma triglycerides, glycerol, and urea-to-creatine ratio, while nonesterified fatty acids (NEFA) and β-OHB increased. In contrast, the metabolic steady-state of phase II fasting reached within 6 days was associated with minimal concentrations of insulin, glucagon, and leptin; unchanged cortisol and triiodothyronine (T3); and moderately increased T4. The early fall in insulin and leptin may mediate the shift to the strategy of energy conservation, protein sparing, and primary reliance on body lipids observed in response to the cessation of feeding. In contrast to the typical mammalian starvation response, nonelevated cortisol and minimal glucagon levels may contribute to body protein preservation and downregulation of catabolic pathways, in general. Furthermore, thyroid hormones may be involved in a process of energy conservation, independent of pups' nutritional state. These original hormonal settings might reflect an adaptation to the otariid repeated fasting pattern and emphasize the crucial importance of a tight physiological control over metabolism to survive extreme energetic constraints.