The relationship between residence and the pharmacological management of challenging behavior in individuals with intellectual disability

Many individuals with intellectual disability are administered psychotropic drugs to manage their challenging behavior. The increased relocation of individuals from institutions into community-based accommodation during the past decade provides an opportunity to examine the relationship between setting and drug administration. This study provides acomparison of drug use according to the type of residential facility of 873 individuals reported to have been administered drugs for behavioral restraint in March 2000, with 762 individuals reported in March 1993. In 2000, individuals in institutions were reported toreceive a moderately greater number of drugs concurrently than those in the community. However, there were no differences in the proportion of individuals prescribed drugs relative to the total population living in the respective settings. This is in contrast to the findings from 1993, where drug use was greater in individuals who were living in institutions. It was also more common for individuals who continued to be medicated across time to have previously lived in an institution. Although relocation into the community may be associated with improved living conditions, it is important to recognize that this change in living conditions is not necessarily associated with less use of drugs to manage behavior.

Managing the transition from school to university: a challenging or stressful experience?

Times of transition are stressful for most people. In this study, the aim was to investigate the stress reported by students as they commenced university, and to investigate whether stress levels, use of coping strategies, the availability of social support, and mood and anxiety differed among students who had moved house to commence university and those who had not. Results from 551 students indicate that 88% of them rated the level of commencing stress above the mid-point on a 5-pt Likert scale but there was no difference between students living at home and those not so, neither did these groups differ on their perceptions of available social support nor their use of coping strategies to deal with commencing university. There were however, gender differences on the use of appraisal of the stressor with females utilizing appraisal more so than males. Students who changed residence to study reported higher levels of depressive symptoms but not of anxiety symptoms. The strain of moving house and a deterioration in living conditions predicted scores on the stress of commencing university. These results are discussed in tenns of student welfare.

Gender and health promotion: A multisectoral policy approach

Women and men are different as regards their biology, the roles and responsibilities that society assigns to them and their position in the family and community. These factors have a great influence on causes, consequences and management of diseases and ill-health and on the efficacy of health promotion policies and programmes. This is confirmed by evidence on male–female differences in cause-specific mortality and morbidity and exposure to risk factors. Health promoting interventions aimed at ensuring safe and supportive environments, healthy living conditions and lifestyles, community involvement and participation, access to essential facilities and to social and health services need to address these differences between women and men, boys and girls in an equitable manner in order to be effective. The aim of this paper is to (i) demonstrate that health promotion policies that take women's and men's differential biological and social vulnerability to health risks and the unequal power relationships between the sexes into account are more likely to be successful and effective compared to policies that are not concerned with such differences, and (ii) discuss what is required to build a multisectoral policy response to gender inequities in health through health promotion and disease prevention. The requirements discussed in the paper include i) the establishment of joint commitment for policy within society through setting objectives related to gender equality and equity in health as well as health promotion, ii) an assessment and analysis of gender inequalities affecting health and determinants of health, iii) the actions needed to tackle the main determinants of those inequalities and iv) documentation and dissemination of effective and gender sensitive policy interventions to promote health. In the discussion of these key policy elements, we use illustrative examples of good practices from different countries around the world.

Solar thermal drying of canarium indicum nuts

Many situations exist in rural areas of developing countries where the help of simple technology can make substantial positive impacts on living conditions, finance, and in this case; sustainability. In the Melanesia region, there are numerous areas identified as needing improvement, including indigenous food preservation which will be addressed with a proposed solar thermal solution utilizing locally available materials as much as possible for low cost local construction. The current knowledge of the drying requirements for the product chosen in this study is quite limited. However, it is believed that solar thermal drying might be feasible for the remote sunny regions as in Melanesia. This paper describes the processes involved in determining the drying parameters of the Canarium indicum nut, and the proposed solar dryer designs that have been considered for the particular environmental conditions and product specifications. Through the selection process, a mixed mode, low-tunnel solar dryer was chosen as the best match to satisfy the different parameters.

Methodological challenges to research among Chinese : using mixed methods to investigate older persons with depression in Macau

The article offers an example of using a mixed methods design that was implemented when investigating depression among Chinese older persons in Macau. A challenge in designing the study was that in light of literature on Chinese culture and somatization theory, the acceptability of the methodology was uncertain. Participants (n = 31) were purposively selected and quantitative data were collected using multiple standardized measures. Questions raised by the quantitative approach were then reflected through in-depth interviews. Four dominant categories emerged: (a) negative thinking, (b) physical limitations and complaints, (c) present living conditions and social support, and (d) the lives participants have lived. There was a high level of congruence between quantitative scores and narratives. The research approach was acceptable to the participants, and the findings contributed to an understanding of depression and therapeutic interventions for that population within Chinese culture.

Conservation of urban historic districts in China : present models of integration and utilization of historic resources and challenges for authenticity

Chinese urban historic districts retain abundant urban traditional features, local characteristics and historic architecture. They not only gather and display urban cultural heritage but extend and develop urban historic culture and social traditions. In 1964 the “Venice Charter” expanded the concept and scope of historical and cultural heritage conservation from individual building heritage, historical sites comprising heritage buildings and historical environments to whole historic districts. At the same time, authenticity was adopted as a principle of heritage conservation. In 1994 the Nara Document on Authenticity confirmed that authenticity is of great importance to the conservation of cultural heritage. In 2003, “The Hoi An Declaration on Conservation of Historic Districts of Asia” reinforced the significance, integrity and authenticity of historic district conservation. In China, with the accelerated urbanization process and improved living conditions of urban residents, the unique values and historic and cultural heritage of historic districts is being destroyed. Considerable historic and cultural heritage has been reconstructed, leading to the loss of authenticity of these historic districts. This paper provides an overview of the Chinese situation. It highlights the problems and demonstrates a clear need to protect the authenticity of these historic districts. Authenticty is evaluated against various Chinese conservation of historic districts having regard to international experience and methods. As a result, it will be demonstrated that conservation modes of authenticity of urban historic districts in China and historic resources should be employed to ensure: 1) the restoration and conservation of historic architecture; 2) the preservation and renovation of old spaces and structures; 3) the integration and coordination of historic and new buildings; and the 4) the continuation and succession of historic culture and local tradition.

A framework to understand depression among older persons

Aims and objectives.  To develop an explanatory framework to understand depression among community-dwelling Chinese older persons in Macau.

Background.  Depression has been described as the most common psychological problem among Chinese older persons. Dominant psychosocial theories are derived from research conducted mainly in western societies and similar research in Chinese populations is scant.

Design.  Mixed methods.

Methods.  Qualitative and quantitative methods (mixed methods) were employed to collect data from 31 participants between 2007–2009 in Macau.

Results.  Four categories of factors related to depression emerged: (1) negative thinking, (2) physical limitations and complaints, (3) present living conditions and social support and (4) past experiences. Each category interacts with the others and, consequently, one category both affects and is affected by others. The categories captured participants’ life-long hardship and bio-psycho-social-cultural disability that lay at the root of their negative thinking. The consequences and impacts of their negative thinking appear to feed and sustain depression.

Conclusion.  The framework offers a deeper understanding of the nature and meaning of the experiences of depressed older persons in a Chinese context.

Relevance to clinical practice.  The findings have several implications for clinical practice. First, the cultural context of Chinese older persons should be emphasised in nursing practice. Second, the root of depression among Chinese older persons is seen to lie in their social, family, cultural and day to day living issues. Finally, this study illustrates the potential for incorporating psychosocial nursing interventions as a therapeutic approach on its own or as an adjunct to other therapy.

Australia’s initiatives in post-conflict nation building in Iraq

After decades of growth and development, Iraq has become amongst the worst performing states worldwide as a legacy of successive wars and sanctions despite the rich endowment with ample natural resources and capable human resources. Many observers expected that the “new” Iraq after the US “liberation” in 2003 will be a tolerant and unified nation-state that “with a degree of civil society” will grant and secure the human rights for all the Iraqi people (Gresham 2006: 27). However, due to the external military intervention lead by the US, the Iraq state collapsed after the 2003 war (Diamond 2005) as well as its economic, educational, health systems and infrastructure; and, Iraq’s development indicators are amongst the lowest globally (Hassin 2010). Australia’s controversial joining of Bush’s Coalition of Willing has been discussed by various intellectual studies from different angles. It is discussed in the socio-political discourse from an international relations perspective (Verrier 2003), social resistance to war (Hil 2008), and the implications on the Australian internal politics (McAllister and Bean 2006) and federal elections (Kelton 2008). However, there is scarce evidence about any research engaging with Australia’s roles in post-conflict nation building in Iraq. This article explores developmental roles and initiatives played and funded by Australia in Iraq since the invasion in 2003. Based on Hippler’s (Hippler 2004- 2005) multi-faceted approach to nation building this paper will study Australia’s roles in the three interlinked dimensions or “starting points” for nation building: improvement of living conditions, structural reforms and integration of the national political system.

Examining the Suojia Ecomuseum and the Nandan Ecomuseum in China

China hosts some 55 ethnic minority groups, which together account for 8.41% of the Chinese population. These populations reside in predominantly Ethnic Minority Villages presenting great value and culture of their heritage, with living landscape, festivals, architecture and costumes, but the actual living conditions are very poor. Since the 1990s, China has adopted French concept 'ecomuseum', for the conservation of some ethnic villages to relieve the conflict between poverty and heritage conservation. ln short, this concept involves the creation of open-air museums keeping buildings and people in their original sites, with local communities serving as curators managing their own sites, which necessitates democracy in the conservation and interpretation processes. The concept seems ideal for the Chinese government, with its bilateral objectives of heritage conservation and poverty alleviation, without necessitating the relocation of any or buildings. However, does this concept really work? It remains unanswered and the subject of little academic research. In order to examine how successfully these ecomuseums are being managed, two projects has been selected for case studies - the Suojia Ecomuseum and the Nandan Ecomuseum. In-depth field studies have been conducted at the two ecomuseums, involving the methodologies of site observation, documentation and semi-structured interviews. This paper reviews the ecomuseum development in China, and then provides detailed critiques and overviews of the Suojia Ecomuseum and the Nandan Ecomuseum in terms of their backgrounds, management structures, programs and activities as well as pertinent issues. Based upon these descriptions, it is·identified that the two cases have different management structures and focuses: 1) the Suojia Ecomuseum has been under the management of government authorities whilst the Nandan Ecomuseum has been operated by local villagers, and 2) the focus of the Suojia Ecomuseum has been improving living conditions for the residents, while in Nandan Ecomuseum cultural inheritance has been operated as a core program. However, there is a lack of financial support in both cases. All these issues lead to a discussion that the Nandan Ecomuseum has made greater achievement in terms of being community-based. The conclusions are hence drawn as to the suggestions to Chinese ecomuseums--the sustainability and success requires local villagers as curators as well as external financial assistance. In addition, another and more urgent need is to pass the ethnic cultures and their values to the next generation.

Addressing the social determinants of inequities in physical activity and sedentary behaviours

 Participation in both physical activity and sedentary behaviours follow a social gradient, such that those who are more advantaged are more likely to be regularly physically active, less likely to be sedentary, and less likely to experience the adverse health outcomes associated with inactive lifestyles than their less advantaged peers. The aim of this paper is to provide, in a format that will support policymakers and practitioners, an overview of the current evidence base and highlight promising approaches for promoting physical activity and reducing sedentary behaviours equitably at each level of ‘Fair Foundations: The VicHealth framework for health equity’. A rapid review was undertaken in February–April 2014. Electronic databases (Medline, PsychINFO, SportsDISCUS, CINAHL, Scopus, Web of Science, Cochrane Library, Global Health and Embase) were searched using a pre-defined search strategy and grey literature searches of websites of key relevant organizations were undertaken. The majority of included studies focussed on approaches targeting behaviour change at the individual level, with fewer focussing on daily living conditions or broader socioeconomic, political and cultural contexts. While many gaps in the evidence base remain, particularly in relation to reducing sedentary behaviour, promising approaches for promoting physical activity equitably across the three levels of the Fair Foundations framework include: community-wide approaches; support for local and state governments to develop policies and practices; neighbourhood designs (including parks) that are conducive to physical activity; investment in early childhood interventions; school programmes; peer- or group-based programmes; and targeted motivational, cognitive-behavioural, and/or mediated individual-level approaches.

Wearable cameras can reduce dietary under-reporting: doubly labelled water validation of a camera-assisted 24 h recall

Preliminary research has suggested that wearable cameras may reduce under-reporting of energy intake (EI) in self-reported dietary assessment. The aim of the present study was to test the validity of a wearable camera-assisted 24 h dietary recall against the doubly labelled water (DLW) technique. Total energy expenditure (TEE) was assessed over 15 d using the DLW protocol among forty adults (n 20 males, age 35 (sd 17) years, BMI 27 (sd 4) kg/m2 and n 20 females, age 28 (sd 7) years, BMI 22 (sd 2) kg/m2). EI was assessed using three multiple-pass 24 h dietary recalls (MP24) on days 2-4, 8-10 and 13-15. On the days before each nutrition assessment, participants wore an automated wearable camera (SenseCam (SC)) in free-living conditions. The wearable camera images were viewed by the participants following the completion of the dietary recall, and their changes in self-reported intakes were recorded (MP24+SC). TEE and EI assessed by the MP24 and MP24+SC methods were compared. Among men, the MP24 and MP24+SC measures underestimated TEE by 17 and 9%, respectively (P< 0.001 and P= 0.02). Among women, these measures underestimated TEE by 13 and 7%, respectively (P< 0.001 and P= 0.004). The assistance of the wearable camera (MP24+SC) reduced the magnitude of under-reporting by 8% for men and 6% for women compared with the MP24 alone (P< 0.001 and P< 0.001). The increase in EI was predominantly from the addition of 265 unreported foods (often snacks) as revealed by the participants during the image review. Wearable cameras enhance the accuracy of self-report by providing passive and objective information regarding dietary intake. High-definition image sensors and increased imaging frequency may improve the accuracy further.

Living alone, social support, and feeling lonely among the elderly

This study aimed to describe the characteristics of the elderly population living alone, and to examine how living alone relates to feeling lonely. Interviews were conducted with a stratified random sample of 4,859 elderly individuals living in Kaohsiung, Taiwan. Variables collected included demographic information, living alone or not, activities of daily living
(ADL), instrumental activities of daily living (IADL), Short Portable Mental Status Questionnaire (SPMSQ), chronic conditions, perceived social support, and a subjective measure of feeling lonely. Using logistic regression, it was found that factors associated with living alone included gender, marital status, occupation, source of income, religion, and IADL. Living alone was, in tum, related to decreased levels of both perceived social support
and feeling lonely after adjustment for potential confounders. Managing retired life is important for adult elders, particularly for men. Lack ofsocial support is common among the elderly community who live alone, which could wel1 be a main reason for this group to feel lonely. As loneliness is linked to physical and mental health problems, increasing social support and facilitating friendship should be factored into life-style management for
communities of elderly.

Living in an obesogenic environment

The article discusses obesity which is the product of an energy imbalance in the body. The factors influencing obesity includes biological, behavioral, and environmental influences. The term obesogenic is defined as the sum of influences that the surroundings, opportunities or conditions of life have on promoting obesity in individuals or populations. It explains the ANGELO Framework (Analysis Grid for Environments linked to Obesity).

Getting the complete picture : combining parental and child data to identify the barriers to social inclusion for children living in low socio-economic areas

Background: Childhood mental health problems are prevalent in Australian children (14–20%). Social exclusion is a risk factor for mental health problems, whereas being socially included can have protective effects. This study aims to identify the barriers to social inclusion for children aged 9–12 years living in low socio-economic status (SES) areas, using both child-report and parent-report interviews.

Methods: Australian-born English-speaking parents and children aged 9–12 years were sampled from a low SES area to participate in semi-structured interviews. Parents and children were asked questions around three prominent themes of social exclusion; exclusion from school, social activities and social networks.

Results: Many children experienced social exclusion at school, from social activities or within social networks. Overall, nine key barriers to social inclusion were identified through parent and child interviews, such as inability to attend school camps and participate in school activities, bullying and being left out, time and transport constraints, financial constraints and safety and traffic concerns. Parents and children often identified different barriers.

Discussion: There are several barriers to social inclusion for children living in low SES communities, many of which can be used to facilitate mental health promotion programmes. Given that parents and children may report different barriers, it is important to seek both perspectives.

Conclusion: This study strengthens the evidence base for the investments and action required to bring about the conditions for social inclusion for children living in low SES communities.