A randomised trial of the Flinders Program to improve patient self-management competencies in a range of chronic conditions : study rationale and protocol

Background: Supporting self management is seen as an important health service strategy in dealing with the large and increasing health burden of chronic conditions. Several types of self-management programs are available. Evidence to date suggests that disease specific and lay-led self management programs provide only part of the support needed for improved outcomes. The Flinders Program is promising as a generic self management intervention, which can be combined with targeted disease specific and lay-led interventions, but it has yet to be evaluated for a range of chronic conditions using a rigorous controlled trial design. This paper gives the rationale for a randomised controlled trial and process evaluation of the Flinders Program of chronic condition self-management in community practice, and details and justifies the design of such a study.Method: The design for a randomised trial and associated process evaluation, suited to evaluation of a complex and behavioural intervention as it is applied in actual practice, is presented and justified.Conclusion: A randomised trial of the Flinders Program is required and a functional design is presented. Results from this trial, currently underway, will test the effectiveness of the Flinders Program in improving patient competencies in self-management of chronic conditions in practice conditions. A process evaluation alongside the trial will explore system, provider and patient factors associated with greater and lesser Program effectiveness.

Developing graduate knowledge and skills for the world of work: The case of the translation curriculum in Vietnam

National and global challenges have given rise to the need to prepare Vietnamese graduates for effective adaptation to the increasingly changing professional field, their community, their society and the globalised world. The tertiary education curriculum thus needs to take into account the employment market, socio-cultural demands and students’ individual needs in order to develop highly educated populations for the world of work and for the current knowledge economy.

Based on a case study of the translation curriculum in a B.A. (Bachelors of Arts) language program, this paper addresses the mismatch between the demands of the translation employment market and the curriculum within the context of Vietnamese tertiary education. It raises a number of important issues related to the tensions between the centralised curriculum, learner-centred education, the actual demands of the employment market as well as the issue of capacity building in response to the socialist-oriented market economy and the changing workplace context in Vietnam. Implications are drawn not only for the translation curriculum, but also for the reform of the Vietnamese tertiary education curriculum as a whole, in order to enhance graduate employability.

Procedural trained, procedural remain : the first report from 'A census of doctors who have been awarded the Graduate Diploma in Rural General Practice (GDRGP)'

Aims & rationale/Objectives : To document the practice of initial cohorts receiving the Graduate Diploma in Rural General Practice
Methods : With the co-operation of the National Rural Faculty (NRF) of Royal Australian College of General Practitioners (RACGP), a census by questionnaire was conducted on 279 graduates. The response rate was 70%.
Principal findings : The target doctors are young (65% < 40 years old). Under half (42.3%) have completed Advanced Rural Skills terms in >1 discipline. Of the total 272 posts recorded from 174 respondents, the most popular advanced skill is anaesthetics, followed by obstetrics. The ARSP increased confidence in 96.3% of respondents. Two thirds of doctors trained in a procedural skill remain practicing procedural General Practice.
Discussion : The GDRGP was the qualification developed to recognise competency gained as a result of a series of rural training initiatives begun within the RACGP Training Program in 1992. Its delivery has continued under the new GPET Training Program. Outcomes from the range of initiatives leading to the GDRGP are currently emerging in an environment which has seen significant changes within vocational training, and within the context of a rising focus on indemnity. Doctors who undertook this training have mostly retained procedural practice. In addition, RACGP rural initiatives successfully achieved increase confidence prior to rural work in advanced areas of practice, with >95% reporting an increase.
Implications : Changes within vocational training were accelerated without analysis of existing initiatives such as the GDRGP. Funding for the GDRGP was, as a result, withdrawn prematurely. These changes also saw the entrant of a second College with an interest in rural procedural practice. This research show that the GDRGP offers, and offered, a clear vocational pathway that will guide a doctor to a career as a rural doctor, and provide them with the advanced skills they need to practice confidently in the bush. It is important to capitalise on past success before deconstructing professional concepts of practice further.
Presentation type : Paper

Achieving 'sustainability education' in primary schools as a result of the Victorian Science in Schools Research Project

The purpose of this paper is to discuss the experiences of primary schools involved in the Victorian Science in Schools Research Project which was concerned with improving science teaching and learning strategies but which also unexpectedly led to more environmental (sustainability) education occurring. The paper also suggests a curriculum strategy for achieving more widespread acceptance and implementation of 'sustainability education' through primary school science curricula.

The major drawbacks to the use of wireless communication products in education

This paper considers the use of wireless devices as an educational facilitator both in the classroom and in a business environment.  There are many characteristics of such devices which are favourable to their use in such settings.  But there are also problems.  We identify the main problematic areas as being security, low speed and reliability, and the lack of interoperability.  In our opinion, the use of wireless devices for educational purposes will grow quickly, and the problems of reliability, speed and standards will be overcome.  However, the issue of security will remain a major problem into the distant future.

Effects of a walking program in the psychiatric in-patient treatment setting: a cohort study.

Issue addressed: To assess the effectiveness of a walking program in a psychiatric in-patient unit. Method: In-patients at a private psychiatric unit were offered the opportunity to participate in a daily morning 40 minute walk led by an activity supervisor. After discharge, outcomes for patients who had regularly participated in the walking group (n=35) and patients who had not participated (n=49) were compared for length of stay during their period of admission and Clinical Global Impression - Severity (CGI-S) and  Depression Anxiety Stress Scales (DASS) scores measured at admission and discharge. This was a retrospective analysis of data collected routinely. Results: There were no significant differences between the two cohorts on most primary outcome measures, including length of stay, DASS scores at admission and at discharge and CGI-S scores at admission. Patients who had not participated in the walking group had a significantly lower score on a single measure, the CGI-S, than patients who had participated (p=0.001). Conclusions: This study showed no evidence that in-patients benefited from participating in the physical activity program. However, this must be  interpreted within the confines of a number of study limitations and, as such, the findings can neither support nor refute the effectiveness of physical activities.

Mediators of the relationship between maternal education and children's TV viewing

Background: Maternal education is consistently found to be inversely related to children’s television viewing and is associated with aspects of the family television environment. This study investigates whether family television environment mediates the relationship between maternal education and children’s television viewing.

Methods: Parents of 1484 children reported maternal education, time their child spends watching television, and 21 aspects of the family television environment (potential mediators) during 2002 and 2003. Separate regression analyses were conducted in 2006 for each potential mediator that met two initial conditions for mediation (associated with both maternal education and children’s television viewing (p<0.10)), to assess whether inclusion reduced the association between maternal education and children’s television viewing. Multivariable regression assessed the combined impact of all mediators.

Results: Twelve of 21 potential mediators met the initial conditions for mediation. Inclusion of each resulted in decreased β values (3.2% to 15.2%) for the association between maternal education and television viewing. Number and placement of televisions in the home appeared to have the greatest mediating effect, followed by frequency of eating dinner in front of the television with the child and rules about television viewing during mealtimes. Together, the 12 mediators accounted for more than one-third of the association between maternal education and children’s television viewing time.

Conclusions: This study suggests the strong inverse relationship between maternal education and children’s television viewing is partly mediated by aspects of the family television environment.

The influence of various aspects of enjoyment on participation in leisure time physical activity

This study examines the direct and indirect influence of various aspects of enjoyment, including activity enjoyment, enjoyment conceptualised as physical/environmental, and enjoyment conceptualised as social interaction, on regular participation in leisure-time physical activity (LTPA). The study was cross-sectional and used self-report questionnaires to collect data from a random sample of 250 people aged 19-87 years living in an Australian city. Questionnaires included demographic items and scales to measure enjoyment of LTPA, prioritisation of LTPA and regularity of participation in LTPA. The findings suggest that the influence of enjoyment on participation in LTPA is complex. Aspects of enjoyment have varying levels of influence on participation in LTPA and this influence is indirect through preference for LTPA, life priority of LTPA and making time for LTPA. Policies, programs and strategies by government and practitioners that aim to increase participation in LTPA should primarily aim to enhance activity enjoyment, rather than focusing on other aspects of participation. Theoretically, this study suggests that enjoyment is a multidimensional concept and that enjoyment is a part of a larger decision-making process influencing participation in LTPA.

Aspects of the interaction between Xanthorrhoea australis and Phytophthora cinnamomi in south-western Victoria, Australia

Diseases in natural ecosystems are often assumed to be less severe than those observed in domestic cropping systems due to the extensive biodiversity exhibited in wild vegetation communities. In Australia, it is this natural biodiversity that is now under threat from Phytophthora cinnamomi. The soilborne Oomycete causes severe decline of native vegetation communities in south-western Victoria, Australia, disrupting the ecological balance of native forest and heathland communities. While the effect of disease caused by P. cinnamomi on native vegetation communities in Victoria has been extensively investigated, little work has focused on the Anglesea healthlands in south-western Victoria. Nothing is known about the population structure of P. cinnamomi at Anglesea. This project was divided into two main components to investigate fundamental issues affecting the management of P. cinnamomi in the Anglesea heathlands. The first component examined the phenotypic characteristics of P. cinnamomi isolates sampled from the population at Anglesea, and compared these with isolates from other regions in Victoria, and also from Western Australia. The second component of the project investigated the effect of the fungicide phosphonate on the host response following infection by P. cinnamomi. Following soil sampling in the Anglesea heathlands, a collection of P, cinnamomi isolates was established. Morphological and physiological traits of each isolate were examined. All isolates were found to be of the A2 mating type. Variation was demonstrated among isolates in the following characteristics: radial growth rate on various nutrient media, sporangial production, and sporangial dimensions. Oogonial dimensions did not differ significantly between isolates. Morphological and physiological variation was rarely dependant on isolate origin. To examine the genetic diversity among isolates and to determine whether phenotypic variation observed was genetically based, Random Amplified Polymorphic DNA (RAPD) analyses were conducted. No significant variation was observed among isolates based on an analysis of molecular variance (AMQVA). The results are discussed in relation to population biology, and the effect of genetic variation on population structure and population dynamics. X australis, an arborescent monocotyledon indigenous to Australia, is highly susceptible to infection by P. cinnamomi. It forms an important component of the heathland vegetation community, providing habitat for native flora and fauna, A cell suspension culture system was developed to investigate the effect of the fungicide phosphonate on the host-pathogen interaction between X. australis and P. cinnamomi. This allowed the interaction between the host and the pathogen to be examined at a cellular level. Subsequently, histological studies using X. australis seedlings were undertaken to support the cellular study. Observations in the cell culture system correlated well with those in the plant. The anatomical structure of X australis roots was examined to assist in the interpretation of results of histopathological studies. The infection of single cells and roots of X. australis, and the effect of phosphonate on the interaction are described. Phosphonate application prior to inoculation with P. cinnamomi reduced the infection of cells in culture and of cells in planta. In particular, phosphonate was found to stimulate the production of phenolic material in roots of X australis seedlings and in cells in suspension cultures. In phosphonate-treated roots of X australis seedlings, the deposition of electron dense material, possibly lignin or cellulose, was observed following infection with P. cinnamomi. It is proposed that this is a significant consequence of the stimulation of plant defence pathways by the fungicide. Results of the study are discussed in terms of the implications of the findings on management of the Anglesea heathlands in Victoria, taking into account variation in pathogen morphology, pathogenicity and genotype. The mode of action of phosphonate in the plant is discussed in relation to plant physiology and biochemistry.