People and environment : the outdoor education community : curriculum ideas

This session is based on the concept of people as part of a broad ecological community. It focuses on relationships between people and between people and their environment. We look at outdoor education curriculum and teaching ideas aimed at developing the concepts of community, interdependence and responsibility for people and other living and non-living things. The concepts will be discussed in relation to developing outdoor education programs for students in years Prep-10.
Examples of teaching and assessment ideas will be provided from the Outdoor Education Course Advice Materials which have been developed for the Victorian Curriculum and Standards Framework (CSF). Resources will also be discussed and displayed. The session will be part presentation and part interactive group work. It is relevant to teachers, curriculum developers and other outdoor educators working with children in the years Prep-10 age range.

Individual calibration for estimating free-living walking speed using the MTI monitor

Purpose : This study was conducted to devise a new individual calibration method to enhance MTI accelerometer estimation of free-living level walking speed.

Method : Five female and five male middle-aged adults walked 400 m at 3.5, 4.5, and 5.5 km·h-1, and 800 m at 6.5 km·h-1 on an outdoor track, following a continuous protocol. Lap speed was controlled by a global positioning system (GPS) monitor. MTI counts-to-speed calibration equations were derived for each trial, for each subject for four such trials with each of four MTI, for each subject for the average MTI, and for the pooled data. Standard errors of the estimate (SEE) with and without individual calibration were compared. To assess accuracy of prediction of free-living walking speed, subjects also completed a self-paced, "brisk" 3-km walk wearing one of the four MTI, and differences between actual and predicted walking speed with and without individual calibration were examined.

Results : Correlations between MTI counts and walking speed were 0.90 without individual calibration, 0.98 with individual calibration for the average MTI, and 0.99 with individual calibration for a specific MTI. The SEE (mean ± SD) was 0.58 ± 0.30 km·h-1 without individual calibration, 0.19 ± 0.09 km·h-1 with individual calibration for the average MTI monitor, and 0.16 ± 0.08 km·h-1 with individual calibration for a specific MTI monitor. The difference between actual and predicted walking speed on the "brisk" 3-km walk was 0.06 ± 0.25 km·h-1 using individual calibration and 0.28 ± 0.63 km·h-1 without individual calibration (for specific accelerometers).

Conclusion : MTI accuracy in predicting walking speed without individual calibration might be sufficient for population-based studies but not for intervention trials. This individual calibration method will substantially increase precision of walking speed predicted from MTI counts.

Validity of treadmill- and track-based individual calibration methods for estimating free-living walking speed and VO2 using the Actigraph accelerometer

BACKGROUND: For many patients clinical prescription of walking will be beneficial to health and accelerometers can be used to monitor their walking intensity, frequency and duration over many days. Walking intensity should include establishment of individual specific accelerometer count, walking speed and energy expenditure (VO2) relationships and this can be achieved using a walking protocol on a treadmill or overground. However, differences in gait mechanics during treadmill compared to overground walking may result in inaccurate estimations of free-living walking speed and VO2. The aims of this study were to compare the validity of track- and treadmill-based calibration methods for estimating free-living level walking speed and VO2 and to explain between-method differences in accuracy of estimation.

METHODS: Fifty healthy adults [32 women and 18 men; mean (SD): 40 (13) years] walked at four pre-determined speeds on an outdoor track and a treadmill, and completed three 1-km self-paced level walks while wearing an Actigraph monitor and a mobile oxygen analyser. Speed- and VO2-to-Actigraph count individual calibration equations were computed for each calibration method. Between-method differences in calibration equation parameters, prediction errors, and relationships of walking speed with VO2 and Actigraph counts were assessed. RESULTS: The treadmill-calibration equation overestimated free-living walking speed (on average, by 0.7 km · h(-1)) and VO2 (by 4.99 ml · kg(-1) · min(-1)), while the track-calibration equation did not. This was because treadmill walking, from which the calibration equation was derived, produced lower Actigraph counts and higher VO2 for a given walking speed compared to walking on a track. The prediction error associated with the use of the treadmill-calibration method increased with free-living walking speed. This issue was not observed when using the track-calibration method. CONCLUSIONS: The proposed track-based individual accelerometer calibration method can provide accurate and unbiased estimates of free-living walking speed and VO2 from walking. The treadmill-based calibration produces calibration equations that tend to substantially overestimate both VO2 and speed.

Adaptive behaviour in Australia : what items are essential for assessing independent living?

Adaptive behaviour is important in the assessment of eligibility for intellectual disability services. However, there is some question about which behaviours should be assessed. The purpose of the present study was to clarify which everyday behaviours are considered essential for independent functioning by young adults in the Australian community. Parents, disability workers, and young adults judged the importance of 130 everyday behaviours. Items that assessed safety, health, self-care, functional literacy and numeracy, respecting others' rights, and day-to-day decisionmaking were most frequently rated as essential for independent functioning. Our findings raise important questions about the assessment of adaptive behaviour in Australia, and point to the need for a more valid approach to the measurement of adaptive behaviour for the purpose of eligibility assessment. The research provides a first step towards providing such a scale for use in the Australian context.

Learning to take charge : women's experiences of living with endometriosis

This paper describes aspects of a study that was conducted to determine women's needs for information related to laparoscopy for endometriosis. Sixty-one women attended focus groups, during which they described endometriosis as a disease of multiple losses: of relationships, of career and of a sense of self-worth. The women indicated that the pathway to diagnosis and treatment had been long and unnecessarily difficult. Many women said that they had reached a point where they decided enough was enough: the medical merry-go-round had to finish. They had to become assertive, take control and decide for themselves how they were going to manage their disease and their quality of life. For all but one woman in the study, complementary therapies were vital. For some women, alternative therapies had replaced allopathic medicine completely. Complementary/alternative therapies were a mechanism for regaining control.

The Effects of Progressive Resistance Training on Obstructed-Gait Tasks in Community-Living Older Adults

This study examined the effects of improved strength on an obstacle course (OC) simulating gait tasks commonly encountered by community-living older adults. Forty-five adults (mean age 68.2 +/- 1.5 years) were randomly assigned to a control (10 women, 5 men) or an experimental group (EXP; 19 women, 10 men) and trained 3 days/week for 12 weeks.

The effects of improved strength on obstacle negotiation in community-living older adults

Poor mobility has been associated with age-related deterioration in muscle strength. While previous work has examined the effects of improved strength on level walking, we have quantified the effects of a resistance-training program on obstructed gait tasks using biomechanical-dependent measures. Forty-five community-dwelling participants aged 62 years or older were randomised to either a control (n=16) or experimental group (n=29). The experimental subjects exercised for 24 weeks on a progressive resistance-training program designed to improve lower body strength. Dynamic strength was assessed at weeks 0 and 24 as well as specific laboratory gait kinetics and kinematics during stepping over an obstacle and negotiation of a raised surface set at 10, 20 and 30% of each subject's leg length.

Australian women`s experiences of living with hepatitis C virus: results from a cross-sectional survey

Background: Of the estimated 160 000 Australians currently infected with the hepatitis C virus (HCV), over one-third are women and very few have received clinical treatment, with most managing their illness in non-specialist settings. Little is known about the experiences of women living with HCV in the general community. The present study provides the results from the first comprehensive social survey of Australian women's experiences of living with HCV.

Methods: In 2000, a questionnaire was administered to a largely non-clinical sample of women with HCV (n = 462) living in the state of Victoria and the Australian Capital Territory, Australia. The questionnaire was self-administered with a return rate of 75%. The mean age was 35 years and 83% were 'current' or 'past' injecting drug users. The mean time since diagnosis was 4.6 years (SD = 4.0) and the mean time since infection was 10.5 years (SD = 8.2).

Results: Fifty-eight percent of women reported experiencing symptoms related to their HCV, the most common being tiredness (78%) and nausea (44%). Of the sample, 56% currently saw a doctor for their HCV, and while 52% had ever been referred to a specialist, only 17% of the total sample had ever begun interferon-based combination or monotherapy. Forty-eight percent of women reported experiencing less favorable treatment by a health professional because of their HCV. Age-related self-assessed health status was significantly lower than Australian norms, as were SF-12 physical and mental health scores. The SF-12 physical and mental health scores were highly correlated, indicating a significant physical and mental health burden associated with HCV.

Conclusion: The social, physical and mental health needs of women living with HCV are considerable. Most women had not accessed specialist treatment and the response of the primary health care system to HCV-related women's health issues requires improvement.

Blood pressure response to dietary modifications in free-living individuals 1,2

A diet rich in fruits, vegetables, and low-fat dairy foods has been shown to lower blood pressure (BP) when all foods are provided. We compared the effect on BP (measured at home) of 2 different self-selected diets: a low-sodium, high-potassium diet, rich in fruit and vegetables (LNAHK) and a high-calcium diet rich in low-fat dairy foods (HC) with a moderate-sodium, high-potassium, high-calcium DASH-type diet, high in fruits, vegetables and low-fat dairy foods (OD). Subjects were randomly allocated to 2 test diets for 4 wk, the OD and either LNAHK or HC diet, each preceded by a 2 wk control diet (CD). The changes in BP between the preceding CD period and the test diet period (LNAHK or HC) were compared with the change between the CD and the OD periods. Of the 56 men and 38 women that completed the OD period, 43 completed the LNAHK diet period and 48 the HC diet period. The mean age was 55.6 ± 9.9 (±SD) years. There was a fall in systolic pressure between and the CD and OD [-1.8 ± 0.5 mm Hg (P < 0.001)]. Compared with OD, systolic and diastolic BPs fell during the LNAHK diet period [-3.5 ± 1.0 (P < 0.001) and -1.9 ± 0.7 (P < 0.05) mmHg, respectively] and increased during the HC diet period [+3.1 ± 0.9 (P < 0.01) and +0.8 ± 0.6 (P = 0.15) mm Hg, respectively]. A self-selected low-sodium, high-potassium diet resulted in a greater fall in BP than a multifaceted OD, confirming the beneficial effect of dietary intervention on BP in a community setting.

Effect of migration on food habits of Somali women living as refugees in Australia

This study aimed to assess the dietary changes that occur for migrants moving from a low-income to a high-income country. The sample included 45 females who had migrated to Australia from Somalia within the past 5years (1996-2001). The data for the study was derived from structured interviews conducted by a bilingual interviewer and anthropometry. Usual dietary intake and frequency of consumption of 54 foods were determined both for Australia (current home) and for Somalia (previous home). In Australia, subjects maintained the structure of the diet from their country of birth. They did increase their consumption of some processed food, such as instant noodles, crisps, and pizza. However, there was little evidence that the subjects adopted ready or partially prepared meals or takeaway meals. A significant addition to the diet in Australia was the use of breakfast cereals. Significant substitutions were of ready-baked bread for traditional bread and lamb for camel meat. The mean BMI of the sample was 27.4kg/m². Sixty percent of the sample were overweight or obese (BMI>25). Some of the dietary changes observed may be consistent with increased energy intake and altered nutrient density. Given the association between transition to a high-income diet and obesity, it is important that migrants are encouraged to retain the best of their traditional diet while adopting healthy foods from host country.

Service provision factors that affect the health and wellbeing of people living in a lower SES environment: the perspective of service providers

Inequalities in health and wellbeing within low socioeconomic (SES)  environments are well documented. Factors inherent to the health care system itself, such as inaccessible, inflexible or inappropriate seroiceprovision, contribute to the poorer health status ofresidents oflow SES areas. This paper explores the issues ofseroice provision in low SES areas, documenting the perceptions of seroice providers about the seroice needs of residents, in order to understand the systemic factors that negatively impact on health and wellbeing. A total of54 health and welfare seroice providers from two adjacent low SES suburbs within regional Victoria were interoiewed using qualitative research methods. Keyfindings indicate that successful navigation of health care seroices by residents within these low SES environments is being impeded by issues ofaccess, a lack ofappropriate early interoention options or measures, and general resident disempowerment. Central to the improvement of seroice provision is the need for seroices to become economically, geographically and culturally accessible. In particular, the importance of community involvement in health planning and health promoting seroices must be reflected in the ethos ofseroice provision.