Ethical dilemmas of a large national multi-centre study in Australia

Aims and objectives: To examine the impact and obstacles that individual Institutional Research Ethics Committee (IRECs) had on a large-scale national multi-centre clinical audit called the National Benchmarks and Evidence-based National Clinical guidelines for Heart failure management programmes Study.

Background: Multi-centre research is commonplace in the health care system. However, IRECs continue to fail to differentiate between research and quality audit projects.

Methods: The National Benchmarks and Evidence-based National Clinical guidelines for Heart failure management programmes study used an investigator-developed questionnaire concerning a clinical audit for heart failure programmes throughout Australia. Ethical guidelines developed by the National governing body of health and medical research in Australia classified the National Benchmarks and Evidence-based National Clinical guidelines for Heart failure management programmes Study as a low risk clinical audit not requiring ethical approval by IREC.

Results: Fifteen of 27 IRECs stipulated that the research proposal undergo full ethical review. None of the IRECs acknowledged: national quality assurance guidelines and recommendations nor ethics approval from other IRECs. Twelve of the 15 IRECs used different ethics application forms. Variability in the type of amendments was prolific. Lack of uniformity in ethical review processes resulted in a six- to eight-month delay in commencing the national study.

Conclusions: Development of a national ethics application form with full ethical review by the first IREC and compulsory expedited review by subsequent IRECs would resolve issues raised in this paper. IRECs must change their ethics approval processes to one that enhances facilitation of multi-centre research which is now normative process for health services.

Relevance to clinical practice: The findings of this study highlight inconsistent ethical requirements between different IRECs. Also highlighted are the obstacles and delays that IRECs create when undertaking multi-centre clinical audits. However, in our clinical practice it is vital that clinical audits are undertaken for evaluation purposes. The findings of this study raise awareness of inconsistent ethical processes and highlight the need for expedient ethical review for clinical audits.

Do MBA degrees matter? A study of boards of directors in Australia's top 200 companies

Pfeffer and Fong (2002) suggest that “business school enrolments have soared and business education has become a big business”. The Master of Business Administration (MBA) degree has often been held out to be useful in the career development of managers. The highest level that managers can aspire to, is to be a director of a large public company. This study investigates how many directors within the boards of Australia’s top 200 companies by market capitalization hold an MBA degree. We find that larger companies have proportionally more MBA holding directors than smaller companies. Interestingly we also find that proportionally more women hold MBAs than men; nearly one in five women directors hold an MBA within the top 200 companies dataset.

Adopting web-based learning and teaching: a case study in higher education

Most universities worldwide are becoming distance education providers through adopting web-based learning and teaching via the introduction of learning management systems that enable them to open their courses to both on- and off-campus students. Whether this is an effective introduction depends on factors that enable and impede the adoption of such systems and their related pedagogical strategies. This study examines such factors related to adopting a learning management system in a large multicampus urban Australian university. The research method used case study approaches and purposively selected the sample consisting of innovative teaching academics from across the university, who used web-based approaches to teach both on- and off-campus learners. The data were analyzed using a combination of Rogers' theory of diffusion of innovations and actor-network theory and revealed a series of enabling and impeding factors faced by pioneering technology-adopter teaching academics, some of which are technology related while others are policy related and common to large multicampus institutions. The study found that safe adoption environments recognizing career priorities of academics are a result of the continuous negotiation between the evolving institution and its innovative and creative staff. The article concludes with a series of conditions that would form a safe, enabling, and encouraging environment for technology-adopter teaching academics in a large multicampus higher education setting.

What do they think when we stack them in? A comparative analysis of student perceptions relating to large and small marketing subjects

University education is in a period of flux with emphasis being focused on quality education, competition for students both local and international as well as changes in governmental financial support and direction. It is with this scenario as a backdrop, that universities in an endeavour to obtain economies of scale offer subjects with large student enrolments. This study investigates marketing students’ perception of and participation in marketing subjects relating to teaching quality, staff availability and support, and individual student involvement in marketing education with large enrolments compared to subjects with small enrolments. This research builds on the investigations of effects of class size by Cuseo (2004) and Binney et al (2004). The study used a multi-method approach. Data from a sample of 621 students was analysed using Factor analysis, MANOVA and ANOVA. Students indicated that there was little difference in the quality of learning obtained in small or large classes. Of interest from a marketing perspective, however, is the perception by students that they are more likely to obtain practical assistance and support from tutors in smaller classes. Student perceptions generally show no major differences between large and small classes in relation to subject selection, ability to learn and lecture  attendance. Students expressed a preference for the opportunity to choose from a number of lecture streams available in subjects with large enrolments. Of interest, however is the student belief that they are less likely to actively participate in large lectures than in small lecture environments.

A phenomenological study of the lived experiences of registered nurses seconded to perform clinical teaching

This phenomenological study explores the clinical teaching experiences of registered nurses seconded from a large metropolitan hospital. The study is based on a conceptual framework encompassing the notion of role, learning and teaching.

Psychiatric disorders, psychotropic medication use and falls among women: an observational study

BACKGROUND: Psychotropic agents known to cause sedation are associated with an increased risk of falls, but the role of psychiatric illness as an independent risk factor for falls is not clear. Thus, this study aimed to investigate the association between psychiatric disorders, psychotropic medication use and falls risk. METHODS: This study examined data collected from 1062 women aged 20-93 yr (median 50 yr) participating in the Geelong Osteoporosis Study, a large, ongoing, population-based study. Depressive and anxiety disorders for the preceding 12-month period were ascertained by clinical interview. Current medication use and falls history were self-reported. Participants were classified as fallers if they had fallen to the ground at least twice during the same 12-month period. Anthropometry, demographic, medical and lifestyle factors were determined. Logistic regression was used to test the associations, after adjusting for potential confounders. RESULTS: Fifty-six women (5.3%) were classified as fallers. Those meeting criteria for depression within the past 12 months had a 2.4-fold increased odds of falling (unadjusted OR = 2.4, 95% CI 1.2-4.5). Adjustment for age and mobility strengthened the relationship (adjusted OR = 2.7, 95% CI 1.4-5.2) between depression and falling, with results remaining unchanged following further adjustment for psychotropic medication use (adjusted OR = 2.7, 95% CI 1.3-5.6). In contrast, past (prior to 12-month) depression were not associated with falls. No association was observed between anxiety and falls risk. Falling was associated with psychotropic medication use (unadjusted OR = 2.8, 95% CI 1.5-5.2), as well as antidepressant (unadjusted OR = 2.4, 95% CI 1.2-4.8) and benzodiazepine use (unadjusted OR = 3.4, 95% CI 1.6-7.3); associations remained unchanged following adjustment for potential confounders. CONCLUSION: The likelihood of falls was increased among those with depression within the past 12 months, independent of psychotropic medication use and other recognised confounders, suggesting an independent effect of depression on falls risk. Psychotropic drug use was also confirmed as an independent risk factor for falls, but anxiety disorders were not. Further research into the underlying mechanisms is warranted.

The impact of maternal smoking during pregnancy on depressive and anxiety behaviors in children: the Norwegian Mother and Child Cohort Study.

BACKGROUND: Maternal smoking during pregnancy (MSDP) is associated with multiple adverse childhood outcomes including externalizing behaviors. However, the association between MSDP and internalizing (anxiety and depressive) behaviors in offspring has received less investigation. We aimed to assess the association between MSDP and childhood internalizing (anxiety and depressive) behaviors in a very large, well-characterized cohort study. METHODS: We assessed the association between MSDP and internalizing behaviors in offspring utilizing information drawn from 90,040 mother-child pairs enrolled in the Norwegian Mother and Child Cohort Study. Mothers reported smoking information, including status and frequency of smoking, twice during pregnancy. Mothers also reported their child's internalizing behaviors at 18 months, 36 months, and 5 years. Associations between MSDP and childhood internalizing behaviors, including dose-response and timing of smoking in pregnancy, were assessed at each time point. RESULTS: MSDP was associated with increased internalizing behaviors when offspring were aged 18 months (B = 0.11, P <0.001) and 36 months (B = 0.06, P <0.01), adjusting for numerous potential confounders. Higher rates of smoking (e.g., >20 cigarettes per day) were associated with higher levels of internalizing behaviors. Maternal smoking during early pregnancy appeared to be the critical period for exposure. CONCLUSIONS: We found evidence supporting a potential role for MSDP in increasing internalizing (anxiety and depressive) behaviors in offspring. We also found evidence supportive of a possible causal relationship, including dose-dependency and support for a predominant role of early pregnancy exposure. Further investigation utilizing genetically informed designs are warranted to assess this association.

Television, computer use and body mass index in Australian primary school children

Objective: To investigate relationships between children's body mass index (BMI) and parent reports of children's television and video game/computer habits, controlling for other potential risk factors for paediatric obesity.

Methods: Child BMI was calculated from measured height and weight collected in 1997 as part of a large, representative, cross-sectional study of children in Victoria, Australia. Parents reported the amount of time children watched television and used video games/computers, children's eating and activity habits, parental BMI and sociodemographic details.

Results: A total of 2862 children aged 5−13 years participated. Child mean BMI z-score was significantly related to television (F = 10.2₃, P < 0.001) but not video game/computer time (F = 2.2₃, P = 0.09), but accounted for only 1 and 0.2% of total BMI variance, respectively. When parental BMI, parental education, number of siblings, food intake, organized exercise and general activity level were included, television ceased to be independently significantly related to child BMI. Using adjusted logistic regression, the odds of being overweight and obese generally increased with increasing television viewing. No relationship was found for video game/computer use.
Conclusions: A small proportion of variance in child BMI was related to television, but not video game/computer time. This was far outweighed by the influence of other variables. Causal pathways are likely to be complex and interrelated.

Attitudes and perceptions of workers to sexual harassment

This thesis highlights the importance of workers’ perceptions of and attitudes to sexual harassment. Past researchers have found that a variety of individual factors (age, gender, gender role, and past experiences of sexual harassment), and organisational factors (gender ratio, sexual harassment policies and the role of employers), correlate with the incidence of sexually harassing behaviours. Two studies presented in this thesis extend this research and were designed to investigate how these factors relate to workers’ attitudes towards and perceptions of sexual harassment. Study one investigated 176 workers from a large, white-collar organisation. Study two sampled 75 workers from a smaller, blue-collar organisation. By comparing two different workplaces the effect of the organisational climate was investigated. Individuals from Study two experienced more sexual harassment, were more tolerant of sexual harassment and perceived less behaviour as sexual harassment compared with individuals from Study one. The organisational context was found to affect the way in which organisational and individual factors related to workers' attitudes to and their experiences of sexual harassment. However, the factors that influenced workers’ perceptions of sexual harassment were stable across both studies. Although workers’ attitudes to and their perceptions of sexual harassment were significantly correlated, they were influenced by different factors. Overall, workers’ perceptions of sexual harassment were influenced by their attitudes, the behavioural context, and the gender of the victim and perpetrator. In contrast, attitudes to sexual harassment appeared to be more strongly influenced by individual factors, such as age, gender, gender role, past experiences of sexual harassment, and perceptions of management’s tolerance of sexual harassment. The broader implications of these findings are discussed and recommendations for future research are suggested.

Differentiating three conceptualisations of the relationship between positive development and psychopathology during the transition to adulthood

The transition to adulthood is characterised by both great potential for positive change and a relatively high incidence of problem outcomes. A multidimensional model of positive development during the transition to adulthood (at 19-20 years) has recently been proposed. However, an unresolved question regarding the nature of positive development during this time is how best to conceptualise its relationship to psychopathology. We drew on data from 1158 participants in the Australian Temperament Project, a large longitudinal community-based study that has followed young people's psychosocial adjustment from infancy to early adulthood. Using structural equation modelling, we compared three models reflecting different conceptualisations of the relationship between positive development and psychopathology. The results suggest that positive development and psychopathology are best modelled as separate but correlated constructs. Hence, development in one domain is likely to influence the other, although separate and specific developmental pathways are also likely to be operating.

Is point of care testing for anaemia (HB) and microalbumin feasible in people with type 2 diabetes attending diabetes outpatient clinics?

Introduction: Diabetes is the major cause of chronic kidney disease (CKD) in Australia. Anaemia of CKD occurs earlier than in non-diabetics and is often insidious and undetected.

Aim: A large, prospective, single-centre study was undertaken to determine the feasibility of point of care testing (POCT) haemoglobin (Hb) and microalbumin in people with type 2 diabetes (T2DM) attending routine outpatient clinic appointments (OPC).

Method: Clinic nurses measured Hb and microalbumin using the HemoCue Haemoglobin Capillary Analyser and the HemoCue Urine Albumin Analyser (Medipac Scientific), respectively when they tested blood glucose, weight and blood pressure. The nurses were trained to use the analysers before the study commenced. Standard demographic data, duration of diabetes, treatment mode, and presence of complications, comorbidities, and HbA1c were ascertained from patients’ medical records.

Results: Five hundred and fifty-four (80%) patients were screened. The nurses were able to perform the tests competently but testing, especially microalbumin, was time-consuming. Patients’ mean age was 62 years (11 SD): 230 females, mean blood glucose (BG) 10 (3.9 SD) mmol/L, mean haemoglobin 127.2 (16.3 SD) g/L; mean microalbumin 47.8 (58.7 SD) mg/L: 324 were males, mean BG 10.2 (3.9 SD) mmol/L, mean Hb 138.6 (18.8 SD) gm/L, and mean microalbumin 67.9 (73.9 SD) mg/L. 27% of males and 22% of females were anaemic. Of those with anaemia, 27% of females and 29% of males had microalbuminuria.

Conclusions: POCT is feasible in routine outpatient clinics but is time-consuming. One in four T2DM attending OPC were anaemic. POCT Hb testing in OPC is feasible and could identify T2DM who need full haematological assessment.

Precursors and correlates of anxiety trajectories from late childhood to late adolescence

The present research employed a prospective, multi-informant design to examine precursors and correlates of differing anxiety profiles from late childhood to late adolescence. The sample consisted of 626 boys and 667 girls who are participants in the Australian Temperament Project, a large, longitudinal, community-based study that has followed young people's psychosocial adjustment from infancy to adulthood. The present research analyzes data collected from the first 12 waves of data, from 4–8 months to 17 years. Parents, primary school teachers, maternal and child health nurses, and from the age of 11 onward, the young people themselves have provided survey data. Trajectory analyses revealed three distinct patterns of self-reported anxiety from late childhood to late adolescence, comprising low, moderate, and high (increasing) trajectories, which differed somewhat between boys and girls. A range of parent- and teacher-reported factors was found to be associated with these trajectories, including temperament style, behavior problems, social skills, parenting, negative family events, and peer relationships. Compared with male trajectories, female trajectories were associated with a greater variety of psychosocial variables (including parenting and externalizing problems), which may partially account for the higher prevalence of anxiety in adolescent girls compared with boys. Findings shed light on gender-specific pathways to anxiety and the need for comprehensive, integrative approaches to intervention and prevention programs.

Physical activity, leisure-time screen use and depression among children and young adolescents

Objectives:
Adolescent mental disorders remain a relatively neglected area of research, despite evidence that these conditions affect youth disproportionately. We examined associations between physical activity, leisure-time screen use and depressive symptoms among Australian children and adolescents.

Design:
Large cross-sectional observational study.

Methods:
Self-reported physical activity and leisure-time screen behaviours, and depressive symptoms using the Short Mood and Feeling Questionnaire were assessed in 8256 students aged 10–16 years (mean age = 11.5 years, SD = 0.8).

Results:
Thirty three percent of the sample reported moderate to high depressive symptoms, with rates higher among females (OR = 1.18; 95% CI: 1.02, 1.36; p = 0.001). Increased opportunities to be active at school outside class (OR = 0.70; 0.58, 0.85; p < 0.001), being active in physical education classes (OR = 0.77; 0.69, 0.86; p < 0.001), greater involvement in sports teams at school (OR = 0.77; 0.67, 0.88; p < 0.001) and outside of school (OR = 0.84; 0.73, 0.96; p = 0.01) were all independently associated with lower odds for depressive symptoms. Meeting recommended guidelines for physical activity (OR = 0.62; 0.44, 0.88; p = 0.007) and, for 12–14 year olds, leisure-time screen use (OR = 0.77; 0.59, 0.99; p = 0.04) were also independently associated with lower odds for depressive symptoms.

Conclusions:
Higher levels of physical activity among children and young adolescents, and lower levels of leisure-time screen use among young adolescents, are associated with lower depressive symptoms. Longitudinal studies are needed to understand the causal relationships between these variables.

Physical activity, television viewing time and 12 year changes in waist circumference

PURPOSE: Both moderate-to-vigorous physical activity (MVPA) and sedentary behavior can be associated with adult adiposity. Much of the relevant evidence is from cross-sectional studies or from prospective studies with relevant exposure measures at a single time point prior to weight gain or incident obesity. This study examined whether changes in MVPA and television (TV) viewing time are associated with subsequent changes in waist circumference, using data from three separate observation points in a large population-based prospective study of Australian adults. METHODS: Data were obtained from the Australian Diabetes, Obesity and Lifestyle study collected in 1999-2000 (baseline), 2004-05 (Wave 2), and 2011-12 (Wave 3). The study sample consisted of adults aged 25 to 74 years at baseline who also attended site measurement at three time points (n=3261). Multilevel linear regression analysis examined associations of initial five-year changes in MVPA and TV viewing time (from baseline to Wave 2) with 12-year change in waist circumference (from baseline to Wave 3), adjusting for well-known confounders. RESULTS: As categorical predictors, increases in MVPA significantly attenuated increases in waist circumference (p for trend< 0.001). TV viewing time change was not significantly associated with changes in waist circumference (p for trend =0.06). Combined categories of MVPA and TV viewing time changes were predictive of waist circumference increases; compared to those who increased MVPA and reduced TV viewing time, those who reduced MVPA and increased TV viewing time had a 2cm greater increase in waist circumference (p=0.001). CONCLUSION: Decreasing MVPA emerged as a significant predictor of increases in waist circumference. Increasing TV viewing time was also influential, but its impact was much weaker than MVPA.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.