The view from the trenches : satisfaction with eHealth systems by a group of health professionals

The integration and adoption of eHealth systems within the health sector faces challenges. As health care practitioners are the end users of eHealth systems, their perceptions of these systems are critical in order to address the issues surrounding their implementation and application. This paper presents the views that a group of health care professionals hold regarding the eHealth systems that they use as part of their day to day work. These views were analysed according to the perceptions of satisfaction and dissatisfaction with eHealth systems that these professionals expressed. They expressed satisfaction with the information consistency, work efficiency, access to information, quality of information, and availability of technical support associated with their systems use. They expressed dissatisfaction with a lack of communication and compatibility between systems, deficiency in terms of system functionality, a lack of system reliability, a lack of initial and ongoing training, and a need to develop workarounds in order to achieve work goals. Overall this research indicates that satisfaction with eHealth systems is a complex issue, and that the negative aspects of system satisfaction need to be addressed and the positive aspects carefully built upon.

Approximation of riemanns zeta function by finite dirichlet series: A multiprecision numerical approach

The finite Dirichlet series of the title are defined by the condition that they vanish at as many initial zeros of the zeta function as possible. It turns out that such series can produce extremely good approximations to the values of Riemanns zeta function inside the critical strip. In addition, the coefficients of these series have remarkable number-theoretical properties discovered in large-scale high-precision numerical experiments. So far, we have found no theoretical explanation for the observed phenomena.

Assessing the strain experienced by managers and professional Australian footballers using an augmented job strain model

Generic models of job stress, such as the Job Strain Model (JSM), have recently been criticised for focusing on a small number of general work characteristics while ignoring those that are occupation-specific (Sparks & Cooper, 1999). However this criticism is based on limited research that has not examined the relative influence of all three dimensions of the JSM - job demand, job control and social support - and job-specific stressors. The JSM is the most commonly used model underpinning large-scale occupational stress research (Fox, Dwyer, & Ganster, 1993) and is regarded as the most influential model in the research on the psycho-social work environment, stress and disease in recent times (Kristensen, 1995). This thesis addresses the lack of information on the relative influence of the JSM and job-specific stressors by assessing the capacity of an augmented JSM to predict the strain experienced by managers and professional Australian footballers. The augmented JSM consisted of job-specific stressors in addition to the generic components of the model. Managers and professional Australian footballers represent two very different occupational groups. While the day-today roles of a manager include planning, organising, monitoring and controlling (Carroll & Gillen, 1987), the working life of a professional Australian footballer revolves around preparing for and playing football (Shanahan, 1998). It was expected that the large differences in the work undertaken by managers and professional Australian footballers would maximise the opportunities for identifying job-specific stressors and measuring the extent that these vary from one group to the next. The large disparity between managers and professional footballers was also used to assess the cross-occupational versatility of the JSM when it had been augmented by job-specific stressors. This thesis consisted of three major studies. Study One involved a survey of Australian managers, while studies Two and Three focused on professional Australian footballers. The latter group was under-represented in the literature, and as a result of the lack of information on the stressors commonly experienced by this group, an in-depth qualitative study was undertaken in Study Two. The results from Study Two then informed the survey of professional footballers that was conducted in Study Three. Contrary to previous research examining the relative influence of generic and job-specific stressors, the results only provided moderate support for augmenting the JSM with job-specific stressors. Instead of supporting the versatility of the augmented JSM, the overall findings reinforced the broad relevance of the original JSM. Of the four health outcomes measured in Studies One and Three, there was only one - the psychological health of professional Australian footballers - where the proportion of total variance explained by job-specific stressors exceeded 13%. Despite the generally strong performance of the JSM across the two occupational groups, the importance of demand, control and support diminished when examining the less conventional occupation of professional football. The generic model was too narrow to capture the highly specific work characteristics that are important for this occupational group and, as a result, the job-specific stressors explained significantly more of the strain over and above that already provided by the generic model. These findings indicate that when investigating the stressors experienced by conventional occupational groups such as managers, the large amount resources required to identify job-specific stressors are unlikely to be cost-effective. In contrast, the influence of the more situation specific stressors is significantly greater in unconventional occupations and thus the benefits of identifying these non-generic stressors are more likely to outweigh the costs. Studies One and Three identified strong connections between job-specific stressors and important characteristics of the occupation being studied. These connections were consistent with previous research and suggest that before attempting to identify job-specific stressors, researchers need to first become familiar with the nature and context of the occupation. The final issue addressed in this thesis was the role of work and non-work support. The findings indicate that the support provided by supervisors and colleagues was a significant predictor of wellbeing for both managers and professional footballers. In contrast, the level of explained strain accounted for by non-work support was not significant. These results indicate that when developing strategies to protect and enhance employee well-being, particular attention should be given to monitoring and, where necessary, boosting the effectiveness of work-based support. The findings from this thesis have been fed back to the management and sporting communities via conference presentations and peer-reviewed journals (refer pp 220-221). All three studies have been presented at national and international conferences and, overall, were well received by participants. Similarly, the methods, results and major findings arising from Studies One and Two have been critiqued by anonymous reviewers from two international journals. These papers have been accepted for publication in 2001 and 2002 and feedback from the reviewers indicates that the findings represent a significant and unique contribution to the literature. The results of Study Three are currently under review by a sports psychology journal.

Diabetes and ethnic minorities

The global prevalence of diabetes for all age groups is estimated to be 2.8%. Type 2 diabetes accounts for at least 90% of diabetes worldwide. Diabetes incidence, prevalence, and disease progression varies by ethnic group. This review highlights unique aspects of the risk of developing diabetes, its overwhelming vascular complications, and their management mainly using data among South Asians and African-Caribbeans in the UK but also using non-UK data. It is concluded that although the origin of the ethnic differences in incidence need further clarification, many factors should be amenable to prevention and treatment in all ethnic groups worldwide.

Mark-aided distributed filtering by using neural network for DDoS defense

Currently Distributed Denial of Service (DDoS) attacks have been identified as one of the most serious problems on the Internet. The aim of DDoS attacks is to prevent legitimate users from accessing desired resources, such as network bandwidth. Hence the immediate task of DDoS defense is to provide as much resources as possible to legitimate users when there is an attack. Unfortunately most current defense approaches can not efficiently detect and filter out attack traffic. Our approach is to find the network anomalies by using neural network, deploy the system at distributed routers, identify the attack packets, and then filter them. The marks in the IP header that are generated by a group of IP traceback schemes, Deterministic Packet Marking (DPM)/Flexible Deterministic Packet Marking (FDPM), assist this process of identifying attack packets. The experimental results show that this approach can be used to defend against both intensive and subtle DDoS attacks, and can catch DDoS attacks’ characteristic of starting from multiple sources to a single victim. According to results, we find the marks in IP headers can enhance the sensitivity and accuracy of detection, thus improve the legitimate traffic throughput and reduce attack traffic throughput. Therefore, it can perform well in filtering DDoS attack traffic precisely and effectively.

Socio-demographic constraints to travel behavior

Purpose – This study aims to ascertain the effect of socio-demographic constraints on dimension of travel choice. This study also seeks to derive personal ecological explanations for variation in travel preference, travel intention and travel choice behavior of a wide range of destinations.

Design/methodology/approach – A large representative sample of 49,105 Australian respondents is utilized. Binary logistic regression is used to determine the impact of constraint variables.

Findings – Age, income and life stage have significant differential and interactive effects on travel behavior. Socio-demographic variables act in different ways to constrain/free different types of travel behavior. However there are significant levels of travel by even the most constrained groups as well as significant amounts of non-travel by the least constrained sectors of our society. These impacts are country specific.

Research limitations/implications – The travel motivations of constraint groups need to be considered to order better understand travel behavior. Investigation of psychological and ecological facilitators and constraints to travel is needed.

Practical implications – This information is most useful for market segmentation and the development of constraint group destination marketing plans. Managers can use utilize such results to minimize the barriers to travel by particular groups.

Originality/value – This paper utilizes a large database to provide insights into the personal ecological constraints to travel.

A practitioner's report on the interactive effects of socio-demographic barriers to travel

Researchers have viewed constraints as a subset of reasons for not engaging in a particular behavior. This study investigates the impact of two-way interactions between age, income, and life stage (forming groups of more and less constrained respondents) on dependent variables comprising intentions held by Australian residents to travel intrastate, interstate or overseas for a vacation. A representative sample of 49,105 Australian respondents is utilized. Binary logistic regression is used to profile respondents who intend to take a domestic or an overseas holiday of more than three days duration. This paper finds that the interactions between the constraint variables of age, income and life stage are important in explaining travel preferences. Constraint groups are then formed by combining the important constraint variables. There are significant levels of vacation travel by even the most constrained groups as well as significant amounts of non-travel by the least constrained sectors of our society. Marketing insights and recommendations are provided for the most constrained travel group and the least constrained travel group.

Short term reoffending by child victim sex offenders in New Zealand : a comparison of those with and without extended supervision

Sexual offenders with child victims in New Zealand who are considered at high risk for reoffending are subject to an Extended Supervision Order. This allows for a period of supervision of up to ten years following release to the community. The present study examined 89 offenders given Extended Supervision Orders over the 33 month period since the legislation was enacted. All types of reoffending resulting in criminal convictions by this group were included. A matched sample of sexual offenders with child victims released prior to this legislation and a sample of offenders judged to be lower risk were compared to those under extended supervision. Offenders under extended supervision reoffended faster and at a higher rate for both sexual and general offences than those deemed lower risk, but at a lower rate than pre-extended supervision high risk offenders. The relationship between specialist treatment programme attendance and completion, actuarial risk level, and recidivism in the extended supervision sample were also investigated. These variables were found not to be significant predictors of sexual recidivism.

Modelling income group differences in the health and economic impacts of targeted food taxes and subsidies

Objective : To examine the effects, by income group, of targeted food taxes and subsidies on nutrition, health and expenditure in the UK.

Methods : A model based on consumption data and demand elasticity was constructed to predict the effects of four food taxation-subsidy regimens. Resulting changes in demand, expenditure, nutrition, cardiovascular disease (CVD) and cancer mortality were estimated.

Data : Expenditure data were taken from the Expenditure and Food Survey; estimates of price elasticities of demand for food were taken from a report based on the National Food Survey 1988–2000. Estimates of effect on CVD and cancer mortality of changing fat, salt, fruit and vegetable intake were taken from previous meta-analyses.

Results : (i) Taxing principal sources of dietary saturated fat is unlikely to reduce cardiovascular disease (CVD) or cancer mortality. (ii) Taxing ‘less healthy’ foods (defined by the WXYfm nutrient profiling model) could increase CVD and cancer deaths by 35–1300 yearly. (iii) Taxing ‘less healthy’ foods and subsidising fruits and vegetables by 17.5% could avert up to 2900 CVD and cancer deaths yearly. (iv) Taxing ‘less healthy’ foods and using all tax revenue to subsidize fruits and vegetables could avert up to 6400 CVD and cancer deaths yearly. Few obesity-related CVD deaths are averted by any of the regimens. All four regimens would be economically regressive and positive health effects will not necessarily be greater in lower-income groups where the need for dietary improvement is higher.

Conclusions : A targeted food tax combined with the appropriate subsidy on fruits and vegetables could reduce deaths from CVD and cancer.

Lay healing practices in the household

This thesis explores the power-knowledge relationship underlying lay healing practices in the household; a non-traditional area of study in public health. Lay knowledge continues to be discounted as illegitimate and !non-expert' by policymakers, health professionals and academics. Given the absence of theory on lay knowledge and decision-making, an eclectic theoretical approach was undertaken in this study. Theory is drawn from medical anthropology, sociology of the body, health economics, gender studies, social theory, psychology, nursing, ethics, philosophy and history of medicine in order to contribute to and advance debate. Operating within the genre of a 'multi-sited ethnography' (working across different sites), methods for data collection included 'anthropology at home' by undertaking fieldwork in Geelong, Victoria, Australia. I conducted interviews and focus group discussions with, and administered a questionnaire to, 98 participants who are parents of young children. They were recruited via primary schools and snowball sampling. The quantitative data presents a socio-demographic 'picture' of 78 women and 20 men (representing 98 households) from urban, rural and coastal areas of the region. The qualitative data contains case studies as well as narratives, analysed for their content and discourses. Additional methods included maintenance of a 'reflexive journal', inter-sectoral consultations and public health policy analysis. Research findings indicate laypeople's conceptualisations of the body, self, health and illness rest upon a notion of the embodied self and health that is physical, mental and spiritual. Lay people have a substantial knowledge base on health and ill-health that derives from many sources, is both generalised and specialised, and is set within the context of everyday life. Laypeople make diagnoses and treat illness and injury within the household. They also exercise substantial agency in determining their choice of healer(s) for therapeutic intervention and management of ill-health outside the household. This study has substantial implications for public health in terms of healers' clinical practices, research and policy.

Evaluation of the childhood obesity prevention program kids - go for your life

Background
Kids - 'Go for your life' (K-GFYL) is an award-based health promotion program being implemented across Victoria, Australia. The program aims to reduce the risk of childhood obesity by improving the socio-cultural, policy and physical environments in children's care and educational settings. Membership of the K-GFYL program is open to all primary and pre-schools and early childhood services across the State. Once in the program, member schools and services are centrally supported to undertake the health promotion (intervention) activities. Once the K-GFYL program 'criteria' are reached the school/service is assessed and 'awarded'. This paper describes the design of the evaluation of the statewide K-GFYL intervention program.

Methods/Design
The evaluation is mixed method and cross sectional and aims to:
1) Determine if K-GFYL award status is associated with more health promoting environments in schools/services compared to those who are members only;
2) Determine if children attending K-GFYL award schools/services have higher levels of healthy eating and physical activity-related behaviors compared to those who are members only;
3) Examine the barriers to implementing and achieving the K-GFYL award; and
4) Determine the economic cost of implementing K-GFYL in primary schools
Parent surveys will capture information about the home environment and child dietary and physical activity-related behaviors. Environmental questionnaires in early childhood settings and schools will capture information on the physical activity and nutrition environment and current health promotion activities. Lunchbox surveys and a set of open-ended questions for kindergarten parents will provide additional data. Resource use associated with the intervention activities will be collected from primary schools for cost analysis.

Discussion
The K-GFYL award program is a community-wide intervention that requires a comprehensive, multi-level evaluation. The evaluation design is constrained by the lack of a non-K-GFYL control group, short time frames and delayed funding of this large scale evaluation across all intervention settings. However, despite this, the evaluation will generate valuable evidence about the utility of a community-wide environmental approach to preventing childhood obesity which will inform future public health policies and health promotion programs internationally.

Trial Registration
ACTRN12609001075279

Interventions for preventing obesity in children (review)

Background

Prevention of childhood obesity is an international public health priority given the significant impact of obesity on acute and chronic diseases, general health, development and well-being. The international evidence base for strategies that governments, communities and families can implement to prevent obesity, and promote health, has been accumulating but remains unclear.
Objectives

This review primarily aims to update the previous Cochrane review of childhood obesity prevention research and determine the effectiveness of evaluated interventions intended to prevent obesity in children, assessed by change in Body Mass Index (BMI). Secondary aims were to examine the characteristics of the programs and strategies to answer the questions "What works for whom, why and for what cost?"
Search methods

The searches were re-run in CENTRAL, MEDLINE, EMBASE, PsychINFO and CINAHL in March 2010 and searched relevant websites. Non-English language papers were included and experts were contacted.
Selection criteria

The review includes data from childhood obesity prevention studies that used a controlled study design (with or without randomisation). Studies were included if they evaluated interventions, policies or programs in place for twelve weeks or more. If studies were randomised at a cluster level, 6 clusters were required.
Data collection and analysis

Two review authors independently extracted data and assessed the risk of bias of included studies. Data was extracted on intervention implementation, cost, equity and outcomes. Outcome measures were grouped according to whether they measured adiposity, physical activity (PA)-related behaviours or diet-related behaviours. Adverse outcomes were recorded. A meta-analysis was conducted using available BMI or standardised BMI (zBMI) score data with subgroup analysis by age group (0-5, 6-12, 13-18 years, corresponding to stages of developmental and childhood settings).
Main results

This review includes 55 studies (an additional 36 studies found for this update). The majority of studies targeted children aged 6-12 years. The meta-analysis included 37 studies of 27,946 children and demonstrated that programmes were effective at reducing adiposity, although not all individual interventions were effective, and there was a high level of observed heterogeneity (I2=82%). Overall, children in the intervention group had a standardised mean difference in adiposity (measured as BMI or zBMI) of -0.15kg/m2 (95% confidence interval (CI): -0.21 to -0.09). Intervention effects by age subgroups were -0.26kg/m2 (95% CI:-0.53 to 0.00) (0-5 years), -0.15kg/m2 (95% CI -0.23 to -0.08) (6-12 years), and -0.09kg/m2 (95% CI -0.20 to 0.03) (13-18 years). Heterogeneity was apparent in all three age groups and could not explained by randomisation status or the type, duration or setting of the intervention. Only eight studies reported on adverse effects and no evidence of adverse outcomes such as unhealthy dieting practices, increased prevalence of underweight or body image sensitivities was found. Interventions did not appear to increase health inequalities although this was examined in fewer studies.
Authors' conclusions

We found strong evidence to support beneficial effects of child obesity prevention programmes on BMI, particularly for programmes targeted to children aged six to 12 years. However, given the unexplained heterogeneity and the likelihood of small study bias, these findings must be interpreted cautiously. A broad range of programme components were used in these studies and whilst it is not possible to distinguish which of these components contributed most to the beneficial effects observed, our synthesis indicates the following to be promising policies and strategies:

· school curriculum that includes healthy eating, physical activity and body image

· increased sessions for physical activity and the development of fundamental movement skills throughout the school week

· improvements in nutritional quality of the food supply in schools

· environments and cultural practices that support children eating healthier foods and being active throughout each day

· support for teachers and other staff to implement health promotion strategies and activities (e.g. professional development, capacity building activities)

· parent support and home activities that encourage children to be more active, eat more nutritious foods and spend less time in screen based activities

However, study and evaluation designs need to be strengthened, and reporting extended to capture process and implementation factors, outcomes in relation to measures of equity, longer term outcomes, potential harms and costs.

Childhood obesity prevention research must now move towards identifying how effective intervention components can be embedded within health, education and care systems and achieve long term sustainable impacts.