Norms and their relationship to behavior in worksite settings : an application of the Jackson Return Potential Model

To measure health norms and assess their influence on behavior among 2541 employees in 16 manufacturing worksites using an adapted Jackson's Return Potential Model (RPM). METHODS: Worksite-level norm intensity, crystallization, and normative power were calculated for several behaviors; linear regression analyses tested whether normative power was related to each health behavior. RESULTS: Norms about safe work practices and smoking were most intense; norms about safe work practices were most crystallized. Safe work practices and smoking held the highest normative power; healthy eating held the least normative power. Comparing norm characteristics across health behaviors leads to important leverage points for intervening to influence norms and improve worker health.

The cost-effectiveness of the Dose Adjustment for Normal Eating (DAFNE) structured education programme: an update using the Sheffield Type 1 Diabetes policy model

AIMS: 
To estimate the cost-effectiveness of training in flexible intensive insulin therapy [as provided in the Dose Adjustment for Normal Eating (DAFNE) structured education programme] compared with no training for adults with Type 1 diabetes mellitus in the UK using the Sheffield Type 1 Diabetes Policy Model.

METHODS: 
The Sheffield Type 1 Diabetes Policy Model was used to simulate the development of long-term microvascular and macrovascular diabetes-related complications and the occurrence of diabetes-related adverse events in 5000 adults with Type 1 diabetes. Total costs and quality-adjusted life years were estimated from a National Health Service perspective over a lifetime horizon, discounted at a rate of 3.5%. The treatment effectiveness of DAFNE was modelled as a reduction in HbA1c that affected the risk of developing long-term diabetes-related complications. Probabilistic and structural sensitivity analyses were conducted.

RESULTS:
DAFNE resulted in greater life expectancy and reduced incidence of some diabetes-related complications compared with no DAFNE. DAFNE was found to generate an average of 0.0294 additional quality-adjusted life years for an additional cost of £426 per patient, leading to an incremental cost-effectiveness ratio of £14 400 compared with no DAFNE. There was a 54% probability that DAFNE would be cost-effective at a willingness-to-pay threshold of £20 000 per quality-adjusted life year.

CONCLUSIONS: 
The results of this study suggest that DAFNE is a cost-effective structured education programme for people with Type 1 diabetes and support its provision by the National Health Service in the UK.

The role of personality in leadership: an application of the five-factor model in the Australian military

This study investigated the relation between the five-factor model (FFM) of personality trait domains and leadership effectiveness. Ninety-nine Australian Army commissioned officers completed the NEO Personality Inventory-Revised (NEO-PI-R; Costa & McCrae, 1992) and were rated by their superior officer on the Australian Army annual leadership effectiveness evaluation schedule. Participants indicated whether they had been selected to attend a leadership promotion course at the Army Command and Staff College, widely regarded within the Army as indicative of an officer's effectiveness. It was hypothesized that leadership effectiveness would be predicted by the personality trait domains of high Conscientiousness, Openness, Agreeableness, and Extraversion and by low Neuroticism. High Conscientiousness and low Extraversion scores predicted high leadership effectiveness and the likelihood of attending the leadership promotion course. High Openness scores also predicted the likelihood of attending the promotion course. The results support the utility of the FFM in exploring the role of personality in leadership effectiveness among military leaders.

Social factors and obesity: an investigation of the role of health behaviours

OBJECTIVES: This study evaluated a behavioural model of the relation between social factors and obesity, in which differences in body mass index (BMI) across sociodemographic groups were hypothesized to be attributable to social group differences in health behaviours affecting energy expenditure (physical activity, diet and alcohol consumption and weight control).

METHODS: A total of 8667 adults who participated in the 1995 Australian National Health and Nutrition Surveys provided data on a range of health factors including objectively measured height and weight, health behaviours, and social factors including family status, employment status, housing situation and migration status.

RESULTS: Social factors remained significant predictors of BMI after controlling for all health behaviours. Neither social factors alone, nor health behaviours alone, adequately explained the variance in BMI. Gender-specific interactions were found between social factors and individual health behaviours.

CONCLUSIONS: These results suggest that social factors moderate the relation between BMI and weight-related behaviours, and that the mechanisms underlying sociodemographic group differences in obesity may vary among men and women. Additional factors are likely to act in conjunction with current health behaviours to explain variation in obesity prevalence across sociodemographic groups.

Providing health services to migrants and refugees settling in Victoria, Australia: an analysis of the complexity, cost and policy implications for public health

The aim of the research was to identify factors related to the increased costs of providing health services to clients from a non-English speaking background (NESB), using a cross-sectional analysis of the administrative records of clients using community health services in the Northern Metropolitan region of Melbourne for the 2001/2002 financial year. The higher cost of providing services to NESB clients was influenced by four factors: increased consultation time, group attendance to an appointment, increased interpreting costs and the type of service provider. Family members and multilingual staff play a significant role in providing informal interpreting services or low-cost support for NESB consultants, and these activities should receive appropriate support. Additional funding is needed to support interpreting requirements when dealing with the health needs of NESB clients.