The impact of interventions to prevent obesity or improve obesity related behaviours in children (0-5 years) from socioeconomically disadvantaged and/or indigenous families: a systematic review

Background
Children from disadvantaged families including those from low socioeconomic backgrounds and Indigenous families have higher rates of obesity, making early intervention a priority. The aim of this study was to systematically review the literature to examine the effectiveness of interventions to prevent obesity or improve obesity related behaviours in children 0-5 years from socioeconomically disadvantaged or Indigenous families.

Methods
Searches of major electronic databases identified articles published from 1993–2013 targeting feeding practices, anthropometric, diet, activity or sedentary behaviour outcomes. This was supplemented with snowballing from existing reviews and primary studies. Data extraction was undertaken by one author and cross checked by another. Quality assessments included both internal and external validity.

Results
Thirty-two studies were identified, with only two (both low quality) in Indigenous groups. Fourteen studies had a primary aim to prevent obesity. Mean differences between intervention and control groups ranged from -0.29 kg/m2 to -0.54 kg/m2 for body mass index (BMI) and -2.9 to -25.6% for the prevalence of overweight/obesity. Interventions initiated in infancy (under two years) had a positive impact on obesity related behaviours (e.g. diet quality) but few measured the longer-term impact on healthy weight gain. Findings amongst pre-schoolers (3–5 years) were mixed, with the more successful interventions requiring high levels of parental engagement, use of behaviour change techniques, a focus on skill building and links to community resources. Less than 10% of studies were high quality. Future studies should focus on improving study quality, including follow-up of longer-term anthropometric outcomes, assessments of cost effectiveness, acceptability in target populations and potential for implementation in routine service delivery.

Conclusion
There is an urgent need for further research on effective obesity prevention interventions for Indigenous children. The findings from the growing body of intervention research focusing on obesity prevention amongst young children from socioeconomically disadvantaged families suggest intervention effects are modest but promising. Further high quality studies with longer term follow up are required.

Families' experiences of their interactions with staff in an Australian intensive care unit (ICU): a qualitative study

Nursing is characterised as a profession that provides holistic, person-centred care. Due to the condition of the critically ill, a family-centred care model is more applicable in this context. Furthermore, families are at risk of emotional and psychological distress, as a result of the admission of their relative to intensive care. The families' experiences of their interactions in intensive care have the potential to enhance or minimise this risk. This paper presents a subset of findings from a broader study exploring families of critically ill patients' experiences of their interactions with staff, their environment, the patient and other families, when their relative is admitted to an Australian intensive care unit. By developing an understanding of their experience, nurses are able to implement interventions to minimise the families' distress, while providing more holistic, person- and family-centred care.

"I feel I can no longer endure": Families and the limits of Commitment in Australia, 1914-1919

Civilian endurance has again become a significant issue in understanding the nature of the First World War, especially since so much emphasis has returned to questions of consent and commitment in making and sustaining the conflict. Fundamental to that enquiry is an acknowledgement of the reality and legitimacy of the sentiments that drove individuals and communities to support the war. By extension, this also implies a need to understand the limits of that commitment, and of the capacity to endure the strains of war. This chapter probes civilian endurance through an examination of Australian families’ experiences of war and separation. It argues that persistent anxiety over loved ones at the front consumed individuals’ emotional resources and, even among the most patriotic Australians, tested commitment to the war.

Economic impact of advanced pediatric cancer on families

Despite emerging evidence of substantial financial distress in families of children with complex illness, little is known about economic hardship in families of children with advanced cancer.

Influence functions of two families of robust estimators under proportional scatter matrices

In this paper, under a proportional model, two families of robust estimates for the proportionality constants, the common principal axes and their size are discussed. The first approach is obtained by plugging robust scatter matrices on the maximum likelihood equations for normal data. A projection- pursuit and a modified projection-pursuit approach, adapted to the proportional setting, are also considered. For all families of estimates, partial influence functions are obtained and asymptotic variances are derived from them. The performance of the estimates is compared through a Monte Carlo study. © 2006 Springer-Verlag.

The Healthy Migrant Families Initiative: Development of a culturally competent obesity prevention intervention for African migrants Disease epidemiology - Chronic

Background: Although obesity among immigrants remains an important area of study given the increasing migrant population in Australia and other developed countries, research on factors amenable to intervention is sparse. The aim of the study was to develop a culturally-competent obesity prevention program for sub-Saharan African (SSA) families with children aged 12-17 years using a community-partnered participatory approach. Methods: A community-partnered participatory approach that allowed the intervention to be developed in collaborative partnership with communities was used. Three pilot studies were carried out in 2008 and 2009 which included focus groups, interviews, and workshops with SSA parents, teenagers and health professionals, and emerging themes were used to inform the intervention content. A cultural competence framework containing 10 strategies was developed to inform the development of the program. Using findings from our scoping research, together with community consultations through the African Review Panel, a draft program outline (skeleton) was developed and presented in two separate community forums with SSA community members and health professionals working with SSA communities in Melbourne. Results: The 'Healthy Migrant Families Initiative (HMFI): Challenges and Choices' program was developed and designed to assist African families in their transition to life in a new country. The program consists of nine sessions, each approximately 1 1/2 hours in length, which are divided into two modules based on the topic. The first module 'Healthy lifestyles in a new culture' (5 sessions) focuses on healthy eating, active living and healthy body weight. The second module 'Healthy families in a new culture' (4 sessions) focuses on parenting, communication and problem solving. The sessions are designed for a group setting (6-12 people per group), as many of the program activities are discussion-based, supported by session materials and program resources. Conclusion: Strong partnerships and participation by SSA migrant communities enabled the design of a culturally competent and evidence-based intervention that addresses obesity prevention through a focus on healthy lifestyles and healthy families. Program implementation and evaluation will further inform obesity prevention interventions for ethnic minorities and disadvantaged communities.

Stakeholders' perceptions of the benefit of introducing an Australian intermediary system for vulnerable witnesses

Vulnerable witnesses (e.g. children and adults with communication impairment) face many barriers to testifying and achieving justice when participating in the criminal justice system. To date, reforms have been implemented in Australia to address these, yet the barriers remain. Several other countries have implemented an intermediary scheme, whereby an independent third party assists vulnerable witnesses to understand the questions and processes encountered during interviews and trials, and helps witnesses to be understood. This study provides a qualitative analysis of stakeholders' (N = 25 professionals) perceptions regarding the potential benefits of implementing an intermediary scheme in Australia. While all participants demonstrated an open-minded attitude to new reform in this area, their perspectives did not support the introduction of an intermediary scheme at this time. Stakeholders highlighted the need for improved use and effectiveness of current measures, and expressed concern about adding further complication to the system.

Parents' perspectives on tele-AAC support for families with a new speech generating device: results from an Australian pilot study

Telepractice is rapidly gaining popularity as a cost-effective and convenient alternative to in-person services for a range of speech-language pathology (SLP) applications. To date, there has been little research investigating the use of telepractice to support families with a new speech generating device (SGD). This paper reports on the outcomes of a novel online training and support program, trialed with 4 underserviced Australian families of children with a new SGD. The program consisted of 6 video-narrated lessons on SGD use, along with an online supervision and practice component conducted via videoconference. Semistructured interviews were undertaken with parents following their completion of the program. Parents noted the telepractice support model offered a range of benefits, including convenient service access and flexible learning options. Challenges included technology limitations and increased pressure on parents to coordinate home practice. Overall, parents reported that the telepractice program was a positive experience for them and their children. Findings indicated that telepractice is a promising mode of service delivery for those learning to use a new SGD. Further research in this area is warranted.

Building healthcare workers' confidence to work with same-sex parented families.

This article reports on a qualitative study of barriers and access to healthcare for same-sex attracted parents and their children. Focus groups were held with same-sex attracted parents to explore their experiences with healthcare providers and identify barriers and facilitators to access. Parents reported experiencing uncomfortable or anxiety-provoking encounters with healthcare workers who struggled to adopt inclusive or appropriate language to engage their family. Parents valued healthcare workers who were able to be open and honest and comfortably ask questions about their relationships and family. A separate set of focus groups were held with mainstream healthcare workers to identity their experiences and concerns about delivering equitable and quality care for same-sex parented families. Healthcare workers reported lacking confidence to actively engage with same-sex attracted parents and their children. This lack of confidence related to workers' unfamiliarity with same-sex parents, or lesbian, gay and bisexual culture, and limited opportunities to gain information or training in this area. Workers were seeking training and resources that offered information about appropriate language and terminology as well as concrete strategies for engaging with same-sex parented families. For instance, workers suggested they would find it useful to have a set of 'door opening' questions they could utilize to ask clients about their sexuality, relationship status or family make-up. This article outlines a set of guidelines for healthcare providers for working with same-sex parented families which was a key outcome of this study.

Alternative service delivery models for families with a new speech generating device: perspectives of parents and therapists

Purpose: Research has revealed limitations in the provision of in-person services to families with a new speech generating device (SGD), both in Australia and overseas. Alternative service models such as parent training, peer support and telepractice may offer a solution, but their use with this population has not been researched to date.

Method: Using interviews and focus groups, this study explored the experiences and opinions of 13 speech-language pathologists and seven parents regarding alternatives to in-person support and training for families with a new SGD. Data were analysed using grounded theory. Themes explored in this paper include the benefits and drawbacks of alternative service models as well as participants’ suggestions for the optimal implementation of these approaches.

Result: Participants confirmed the utility of alternative service models, particularly for rural/remote and underserviced clients. Benefits of these models included reduced travel time for families and therapists, as well as enhanced information access, support and advocacy for parents.

Conclusion: Participants viewed the provision of ongoing professional support to families as critical, regardless of service modality. Additional issues arising from this study include the need for development of organizational policies, resources and training infrastructure to support the implementation of these alternative service models.

The Australian middle class and education: a small-scale study of the school choice experience as framed by ‘My School’ within inner city families

With the launch of the ‘My School’ website in 2010, Australia became a relative latecomer to the publication of national school performance comparisons. This paper primarily seeks to explore the school choice experience as framed by ‘My School’ website, for participating middle-class families. We will draw on Bourdieusian theory of cultural capital and relationship networks and Australian-based school choice research in order to contribute to understandings regarding the application of ‘My School’ data within participating families. Data collection consisted of qualitative, semi-structured, in-depth interviews with five families, each based within inner-city suburbs of Melbourne, Victoria. The findings of this small-scale study indicate that participating middle-class families possessed highly developed strategies for locating and achieving enrolment in school-of-choice and therefore did not seek to apply available data on ‘My School’ to decision-making, despite each participant reviewing the available data.