A compilation of consumers' stories: the development of a video to enhance medication adherence in newly transplanted kidney recipients

AIM: To describe the design, development and evaluation of a consumer-centred video, which was underpinned by the Theory of Planned Behaviour and it was created to educate newly transplanted kidney recipients about the importance of medication adherence. BACKGROUND: Kidney transplantation is a treatment whereby medication adherence is critical to ensure long-term kidney graft success. To date, many interventions aimed to improve medication adherence in kidney transplantation have been conducted but consumers remain largely uninvolved in the interventional design. DESIGN: Qualitative sequential design. METHODS: Twenty-two participants who had maintained their kidney transplant for at least 8 months and three participants who had experienced a kidney graft loss due to non-adherence were interviewed from March-May 2014 in Victoria, Australia. These interviews were independently reviewed by two researchers and were used to guide the design of the story plot and to identify storytellers for the video. The first draft of the video was evaluated by a panel of seven experts in the field, one independent educational expert and two consumers using Lynn's content validity questionnaire. The content of the video was regarded as highly relevant and comprehensive, which achieved a score of >3·7 out of a possible 4. RESULTS/FINDINGS: The final 18-minute video comprised 15 sections. Topics included medication management, the factors affecting medication adherence and the absolute necessity of adherence to immunosuppressive medications for graft survival. CONCLUSION: This paper has demonstrated the feasibility of creating a consumer-driven video that supports medication adherence in an engaging way.

Urban amphibian assemblages as metacommunities

1. Urban ecosystems are expanding throughout the world, and urban ecology is attracting increasing research interest. Some authors have questioned the value of existing ecological theories for understanding the processes and consequences of urbanization.
2. In order to assess the applicability of metacommunity theory to urban systems, I evaluated three assumptions that underlie the theory – the effect of patch area, the effect of patch isolation, and species–environment relations – using data on assemblages of pond-breeding amphibians in the Greater Melbourne area of Australia. I also assessed the relative impact of habitat fragmentation, habitat isolation, and changes to habitat quality on these assemblages.
3. Poisson regression modelling provided support for an important increase in species richness with patch area (pond size) and a decrease in species richness with increasing patch isolation, as measured by surrounding road cover. Holding all other variables constant, species richness was predicted to be 2·8–5·5 times higher at the largest pond than at the smallest, while the most isolated pond was predicted to have 12–19% of the species richness of the least isolated pond. Thus, the data were consistent with the first two assumptions of metacommunity theory evaluated.
4. The quality of habitat at a pond was also important, with a predicted 44–56% decrease in the number of species detected at ponds with a surrounding vertical wall compared with those with a gently sloping bank. This demonstrates that environmental differences between habitat patches were also influencing amphibian assemblages, providing support for the species-sorting and/or mass-effect perspectives of metacommunity theory.
5. Without management intervention, urbanization may lead to a reduction in the number of amphibian species persisting in urban ponds, particularly where increasing isolation of ponds by roads and associated infrastructure reduces the probability of re-colonization following local extinction.

The influence of reduced flow during a drought on patterns of variation in macroinvertebrate assemblages across a spatial hierarchy in two lowland rivers

1. With the aim of determining whether patterns of variation in macroinvertebrate assemblage composition across the hierarchy of spatial units in two lowland rivers changed during a supra-seasonal drought (1997–2000), patterns during a reduced flow season (1999–2000) were compared with those during two preceding higher flow seasons (1997–98 and 1998–99) using samples from the Glenelg and Wimmera Rivers, two lowland regulated rivers in western Victoria, Australia.

2. We hypothesised that (i) differences between reaches would increase during the reduced flow season owing to decreased hydrological connectivity, (ii) differences between the habitats would decrease because the cessation of flow in run habitats should cause them to become more similar to pool habitats and (iii) differences between microhabitats would also decrease because of reduced scour of inorganic substrata and large woody debris.

3. During each season, macroinvertebrates were sampled from three microhabitats (sand/silt substratum, large woody debris and macrophytes) that were hierarchically nested within a run or pool habitat and within one of three reaches within each river. A range of physico-chemical variables was also sampled.

4. Analysis of similarity showed that assemblage composition in both rivers during the higher flow seasons differed more among microhabitats than other spatial units. However, during the reduced flow season, assemblage composition in the Wimmera River differed most among reaches. This change in pattern was associated with the combined effects of decreased flow and longitudinal increases in salinity. In contrast, the fauna of the Glenelg River appeared to be resistant to the effects of the reduced flow season, owing to limited decline in water quality despite lower river discharge.

5. As salinisation and poor water quality in the Wimmera River result from human activities in the catchment, these results support the idea that human impacts on rivers can change macroinvertebrate scaling patterns and exacerbate the effects of drought beyond the tolerance of many riverine macroinvertebrates.

Assessing cost-effectiveness in mental health : family interventions for schizophrenia and related conditions

Objective: Existing evidence suggests that family interventions can be effective in reducing relapse rates in schizophrenia and related conditions. Despite this, such interventions are not routinely delivered in Australian mental health services. The objective of the current study is to investigate the incremental cost-effectiveness ratios (ICERs) of introducing three types of family interventions, namely: behavioural family management (BFM); behavioural intervention for families (BIF); and multiple family groups (MFG) into current mental health services in Australia.

Method: The ICER of each of the family interventions is assessed from a health sector perspective, including the government, persons with schizophrenia and their families/carers using a standardized methodology. A two-stage approach is taken to the assessment of benefit. The first stage involves a quantitative analysis based on disability-adjusted life years (DALYs) averted. The second stage involves application of 'second filter' criteria (including equity, strength of evidence, feasibility and acceptability to stakeholders) to results. The robustness of results is tested using multivariate probabilistic sensitivity analysis.

Results: The most cost-effective intervention, in order of magnitude, is BIF (A$8000 per DALY averted), followed by MFG (A$21 000 per DALY averted) and lastly BFM (A$28 000 per DALY averted). The inclusion of time costs makes BFM more cost-effective than MFG. Variation of discount rate has no effect on conclusions.

Conclusions: All three interventions are considered 'value-for-money' within an Australian context. This conclusion needs to be tempered against the methodological challenge of converting clinical outcomes into a generic economic outcome measure (DALY). Issues surrounding the feasibility of routinely implementing such interventions need to be addressed.

Patient or consumer? The colonization of the psychiatric clinic

Information is given a privileged place in the psychiatric clinic, as illustrated by the prevalence and volume of data to be collected and forms to be completed by psychiatric nurses. Information though is different to knowledge. The present paper argues that information is part of a managerial discourse that implies commodification whereas knowledge is part of a clinical discourse that allows room for the suffering of the patient. Information belongs to the discourse of managerialism, one that positions the patient as customer/consumer and in doing so renders them unsuffering. The patient's suffering is silenced by their construction as a consumer. The discourse of managerialism seeks a complete data set of information. By way of contrast, another discourse, that of psychoanalysis offers the institution the idea that there are always holes, gaps, and uncertainty. The idea of uncertainty, gaps, things remaining unknown and a limit sits uncomfortably with the dominant discourse of managerialism; one that demands no limits, complete data sets, and many satisfied customers. This market model of managerialism denies the potential of the therapeutic relationship; that something curative might be produced via the transference. In addition, the managerialist discourse potentially positions the patient as both illegitimate and unsuffering.

Quality of care for women presenting with benign breast conditions

The aim of the study was to investigate the management of women with benign breast problems. A consecutive sample of women (n = 194) was assessed who presented to public or private sector providers. The main reasons for referral were breast lumps (62%); 56% of women who attended the public sector did not receive any recommendation compared to 40% who attended the private sector and clinical/general practitioner reviews were recommended to more women in the private sector (54%). Reasons for the discrepancy between public and private patients require further investigation. (Intern Med J 2005; 35: 357–358)

Cost-effectiveness of cognitive-behavioural therapy and drug interventions for major depression

Objective: Antidepressant drugs and cognitive–behavioural therapy (CBT) are effective treatment options for depression and are recommended by clinical practice guidelines. As part of the Assessing Cost-effectiveness – Mental Health project we evaluate the available evidence on costs and benefits of CBT and drugs in the episodic and maintenance treatment of major depression.

Method: The cost-effectiveness is modelled from a health-care perspective as the cost per disability-adjusted life year. Interventions are targeted at people with major depression who currently seek care but receive non-evidence based treatment. Uncertainty in model inputs is tested using Monte Carlo simulation methods.

Results: All interventions for major depression examined have a favourable incremental cost-effectiveness ratio under Australian health service conditions. Bibliotherapy, group CBT, individual CBT by a psychologist on a public salary and tricyclic antidepressants (TCAs) are very cost-effective treatment options falling below $A10 000 per disability-adjusted life year (DALY) even when taking the upper limit of the uncertainty interval into account. Maintenance treatment with selective serotonin re-uptake inhibitors (SSRIs) is the most expensive option (ranging from $A17 000 to $A20 000 per DALY) but still well below $A50 000, which is considered the affordable threshold.

Conclusions: A range of cost-effective interventions for episodes of major depression exists and is currently underutilized. Maintenance treatment strategies are required to significantly reduce the burden of depression, but the cost of long-term drug treatment for the large number of depressed people is high if SSRIs are the drug of choice. Key policy issues with regard to expanded provision of CBT concern the availability of suitably trained providers and the funding mechanisms for therapy in primary care.

Identifying depression in patients following admission for acute coronary syndrome

Sun exposure and sun protection behaviours among young adult sport competitors

Objective: To explore the relationship between sun protection and physical activity in young adults (18-30 years) involved in four organised sports.

Methods: Participants (n=237) in field hockey, soccer, tennis and surf sports completed a self-administered survey on demographic and sun-protective behaviours while playing sport. Differences in sun-protective behaviour were explored by sport and by gender.

Results: Sunburn during the previous sporting season was high (69%). There were differences between sports for sunburn, sunscreen use and reapplication of sunscreen. Lifesaving had the highest rates compared with the other three sports. Hats and sunglasses worn by participants varied significantly by sports. A greater proportion of soccer and hockey players indicated they were not allowed to wear a hat or sunglasses during competition. For all sports, competition was played mainly in the open with no shade provision for competitors while they were playing. There were some gender differences within each of the sports. Female soccer and tennis players were more likely to wear sunscreen compared with males. Female hockey players were more likely to wear a hat compared with males.

Conclusions: Our findings highlight that there is still room for improvement in sun-protective behaviours among young adult sport competitors. There is a need for a systematic approach to sun protection in the sporting environments of young adults.

Implications: Health promotion efforts to increase physical activity need to be paired with sun protection messages.

What have sampling and data collection got to do with good qualitative research?

Objective: To highlight the importance of sampling and data collection  processes in qualitative interview studies, and to discuss the contribution of  these processes to determining the strength of the evidence generated and  thereby to decisions for public health practice and policy.

Approach: This discussion is informed by a hierarchy-of-evidence-for-practice  model. The paper provides succinct guidelines for key sampling and data  collection considerations in qualitative research involving interview studies. The  importance of allowing time for immersion in a given community to become  familiar with the context and population is discussed, as well as the practical  constraints that sometimes operate against this stage. The role of theory in  guiding sample selection is discussed both in terms of identifying likely sources  of rich data and in understanding the issues emerging from the data. It is noted  that sampling further assists in confirming the developing evidence and also  illuminates data that does not seem to fit. The importance of reporting sampling  and data collection processes is highlighted clearly to enable others to assess  both the strength of the evidence and the broader applications of the findings.

Conclusion: Sampling and data collection processes are critical to determining  the quality of a study and the generalisability of the findings. We argue that  these processes should operate within the parameters of the research goal, be  guided by emerging theoretical considerations, cover a range of relevant   participant perspectives, and be clearly outlined in research reports with an  explanation of any research limitations.

Heterologous microarray experiments used to identify the early gene response to heat stress in a coral reef fish

Coral reef fishes are expected to experience rising sea surface temperatures due to climate change. How well tropical reef fishes will respond to these increased temperatures and which genes are important in the response to elevated temperatures is not known. Microarray technology provides a powerful tool for gene discovery studies, but the development of microarrays for individual species can be expensive and time-consuming. In this study, we tested the suitability of a Danio rerio oligonucleotide microarray for application in a species with few genomic resources, the coral reef fish Pomacentrus moluccensis. Results from a comparative genomic hybridization experiment and direct sequence comparisons indicate that for most genes there is considerable sequence similarity between the two species, suggesting that the D. rerio array is useful for genomic studies of P. moluccensis. We employed this heterologous microarray approach to characterize the early transcriptional response to heat stress in P. moluccensis. A total of 111 gene loci, many of which are involved in protein processing, transcription, and cell growth, showed significant changes in transcript abundance following exposure to elevated temperatures. Changes in transcript abundance were validated for a selection of candidate genes using quantitative real-time polymerase chain reaction. This study demonstrates that heterologous microarrays can be successfully employed to study species for which specific microarrays have not yet been developed, and so have the potential to greatly enhance the utility of microarray technology to the field of environmental and functional genomics.

Blood cells of Murray cod maccullochella peelii peelii (Mitchell)

Analysis of the peripheral blood cells of Murray cod Maccullochella peelii peelii identified seven distinct subpopulations including a novel basophilic cell. Haematological reference ranges were established to facilitate future diagnostic blood sampling of this fish.

Baseline assessment of metals and hydrocarbons in the sediments of Lake Mulwala, Australia

An assessment of hydrocarbon and metal/metalloids (arsenic, cadmium, copper, lead, mercury, selenium, zinc) contamination in sediments from Lake Mulwala, Australia, was undertaken. The objectives of the study were: (i) to determine the extent of contamination in the lake sediments, compared to Australian and international sediment quality guidelines, and (ii) to attempt to identify the contaminant sources to the lake. With the exception of a few samples containing elevated levels of arsenic and/or mercury, the levels of all contaminants in the sediment samples taken from the lake were below the 'lower trigger' of the Australian Sediment Quality Guidelines that would warrant further investigation. High molecular weight hydrocarbons (up to 700 mg kg−1) were found in most sediment samples. Non-metric statistical analysis indicated that the contaminant distribution was different in different parts of the lake, with the lowest concentrations generally found at the influent to the lake. No definitive source(s) of contamination could be identified for either metalloids or hydrocarbons.

The Permian-Triassic Boundary Stratigraphic Set: characteristics and correlation

Eased on field observations and compilation of data, a new stratigraphic concept, herein named the Permian-Triassic boundary stratigraphic set (PTBST), is proposed. The PTBST consists of, in ascending order, beds of claystone, limestone (or marl) and claystone. This boundary stratigraphic
set has been recognized at many sections in the Yangtze region of South China, with laterally stable lithological characters, the same or comparable biotas, comparable radiometric ages, and identical or similar magnetostratigraphic and chemostratigraphic signals. Therefore, the PTBST marks an isochronous unit and can serve as an important and effective marker set for regional and global correlations.
The important index fossils for the lowermost Triassic, Hindeodus parvus or Claraia, may be diachronous in their first occurrences with respect to the base of the PTBST and, therefore, should not be used as an exclusive indicator for the beginning of the Triassic. Rather more attention should
be paid to events, succession of events and/or event surfaces, which would potentially provide a more precise tool for high-resolution stratigraphic division and correlation.

The DALY, context and the determinants of the severity of disease: an exploratory comparison of paraplegia in Australia and Cameroon

This paper summarises the findings of an empirical investigation of some of the technical and social assumptions on which the disability adjusted life year (DALY) is based. The objectives of the study were to examine the notion that the burden of disease is broadly similar without regard to country, environment, gender or socio-economic status and to develop detailed descriptions of the experiences of the burden of disease as they related to these contextual factors. The study was a multi-factorial exploratory study employing qualitative and quantitative techniques to obtain data on the effects of country (development), environment (urban versus rural), gender and socio-economic status on people with paraplegia. The data provided an extensive and detailed compilation of context rich descriptions of living with paraplegia. Striking features of the data were the differences between countries with respect to the impact of the health conditions on functioning and highlight a context in which paraplegia of like clinical severity can be fatal in one environment and not in another. While there has been some focus on the control of social determinants of disease, there has been little work on the social determinants of the severity of disease. The underlying assumptions of the DALY, which ignore context in the assessment of the burden of disease, risk exacerbating inequalities by undervaluing the burden of disease in less-developed countries. There is a need to continue to subject the development of indicators to rigorous debate to determine a balance between the assumption of a global “average social milieu” and the treatment of each individual as belonging to their own context in the assessment of population health in order for indicators to be meaningful cross-culturally.