Knowledge, attitudes and experience associated with testing for prostate cancer: a comparison between male doctors and men in the community

Background: Debate about testing for prostate cancer using prostate-specific antigen (PSA) and digital rectal examination (DRE) continues. The evidence of benefit from screening for prostate cancer using PSA tests is inconclusive, and it is unclear how PSA can be used most effectively in the detection of prostate cancer. Given the lack of consensus, it is important that consumers understand the issues in a way that will permit them to decide whether or not to have a test and, if symptomatic, how their condition is managed.

Aims: To compare prostate cancer knowledge, attitudes and testing experiences reported by male doctors and men in the community, despite the lack of evidence of a benefit.

Methods : The primary method for ascertaining the attitudes of male doctors (MD) was a telephone survey, with some doctors electing to complete a written survey. Each MD was selected, at random, from a register of male practitioners aged ≥ 49 years of age. A total of 266 MD participated in the survey. The community sample (CS) was accessed using a telephone survey. Five hundred male Victorian residents aged ≥ 49 years of age participated in the study.

Results:
Knowledge − Overall, 55% of the CS indicated ­correctly that prostate disease is sometimes cancer, compared to 83% of MD.

Attitudes − Fifty-five per cent of MD believed men should be tested for prostate disease at least every 2 years, compared to 68% of men in the CS.

Testing experience − Forty-five per cent of MD had been tested for prostate cancer in the past, and 92% of those tests were reported as negative. In the CS, 56% had been tested for prostate cancer in the past, and 78% of the results were reported as negative. The ­significant independent predictors of having had a prostate test among MD were: (i) age (≥ 60 years; odds ratio (OR): 1.59; 95% confidence intervals (CI): 1.30−1.88) and (ii) positive attitudes towards regular testing for prostate cancer (OR: 2.27; 95% CI: 1.98−2.56). The significant independent predictors for the CS were: (i) age (≥ 60 years; OR: 1.65; 95% CI: 1.40−1.89), (ii) being married (OR: 1.30; 95% CI: 1.00−1.60), (iii) knowledge that prostate disease was sometimes cancer (OR: 1.46; 95% CI: 1.26−1.66) and (iv) positive attitudes towards regular testing for prostate cancer (OR: 2.12; 95% CI: 1.90−2.34).

Conclusions: The results highlight that testing for prostate cancer is widespread in the community and in the medical profession. Further research should be undertaken to identify how to help men make fully informed decisions about prostate cancer testing.

Quality of life assessment in the community-dwelling elderly : validation of the Assessment of Quality of Life (AQoL) instrument and comparison with the SF-36

Measurement of Health-Related Quality of Life (HRQoL) of the elderly requires instruments with demonstrated sensitivity, reliability, and validity, particularly with the increasing proportion of older people entering the health care system. This article reports the psychometric properties of the 12-item Assessment of Quality of Life (AQoL) instrument in chronically ill community-dwelling elderly people with an 18-month follow-up. Comparator instruments included the SF-36 and the OARS. Construct validity of the AQoL was strong when examined via factor analysis and convergent and divergent validity against other scales. Receiver Operator Characteristic (ROC) curve analyses and relative efficiency estimates indicated the AQoL is sensitive, responsive, and had the strongest predicative validity for nursing home entry. It was also sensitive to economic prediction over the follow-up. Given these robust psychometric properties and the brevity of the scale, AQoL appears to be a suitable instrument for epidemiologic studies where HRQoL and utility data are required from elderly populations.

Adoption and maintenance of gym-based strength training in the community setting in adults with excess weight or type 2 diabetes: a randomized controlled trial

BACKGROUND: Participant adoption and maintenance is a major challenge in strength training (ST) programs in the community-setting. In adults who were overweight or with type 2 diabetes (T2DM), the aim of this study was to compare the effectiveness of a standard ST program (SST) to an enhanced program (EST) on the adoption and maintenance of ST and cardio-metabolic risk factors and muscle strength. METHODS: A 12-month cluster-randomized controlled trial consisting of a 6-month adoption phase followed by a 6-month maintenance phase. In 2008-2009, men and women aged 40-75 years (n = 318) with T2DM (n = 117) or a BMI >25 (n = 201) who had not participated in ST previously were randomized into either a SST or an EST program (which included additional motivationally-tailored behavioral counselling). Adoption and maintenance were defined as undertaking ≥ 3 weekly gym-based exercise sessions during the first 6-months and from 6-12 months respectively and were assessed using a modified version of the CHAMPS (Community Healthy Activity Models Program for Seniors) instrument. RESULTS: Relative to the SST group, the adjusted odds ratio (OR) of adopting ST for all participants in the EST group was 3.3 (95 % CI 1.2 to 9.4). In stratified analyses including only those with T2DM, relative to the SST group, the adjusted OR of adopting ST in the EST group was 8.2 (95 % CI 1.5-45.5). No significant between-group differences were observed for maintenance of ST in either pooled or stratified analyses. In those with T2DM, there was a significant reduction in HbA1c in the EST compared to SST group during the adoption phase (net difference, -0.13 % [-0.26 to -0.01]), which persisted after 12-months (-0.17 % [-0.3 to -0.05]). CONCLUSIONS: A behaviorally-focused community-based EST intervention was more effective than a SST program for the adoption of ST in adults with excess weight or T2DM and led to greater improvements in glycemic control in those with T2DM. TRIAL REGISTRATION: Registered at ACTRN12611000695909 (Date registered 7/7/2011).

Cost and outcomes associated with participating in the community fireguard program: experiences from the Black Saturday bushfires in Victoria, Australia

There is increasing recognition of the importance of shared responsibility between community and government in supporting community preparedness in disaster risk reduction programs. However, there is limited evidence to support decision making about how best to allocate resources. This paper presents an economic analysis of the Community Fireguard Program coordinated by the Country Fire Authority in Victoria, Australia. The economic analysis evaluates the costs and benefits of the Community Fireguard program (estimated in 2012 Australian dollars) to determine the efficiency of the program in terms of its outcomes of loss of life and property loss in the event of a bushfire. We take a societal perspective, including all costs and benefits regardless of who bears the costs, who receives the benefits or who provides the resources. The analysis uses data from a previous review of the program and estimates of costs and benefits over ten years, assuming each region faces a 10-year risk of major bushfire and the CFG group learnings would last ten years. Totalled over ten years, the cost per Fireguard Group for the program is $10,884, with a range of $2697-$19,071, and in the event of a major bushfire the predicted savings from reduced property loss is $732,747 and from reduced fatality $1.4 million. Even if the risk of major bushfire event in a region were one in 100 years, the estimated cost savings in a 100-year period is $217,116 per group. The value of the psychosocial impacts was not calculated, as quantitative data are currently not available.

Counter-terrorism across the policing continuum

Over the past two decades private and hybrid forms of policing have grown considerably in Australia. As a result, governments have begun to recognize the role played by non-state police agencies and personnel in the provision of public order and safety, further extending and legitimizing non-state policing. In addition, the private ownership of critical infrastructure and 'communal spaces' has led to a central role for non-state police in the area of 'high policing' counter-terrorism. In response to changes to the auspices and providers of policing, state police were beginning to explore new ways of working with private and hybrid forms of policing, with the emergence of a new type of experiment in policing partnerships, the Police-Private Security Committee (POLSEC). This paper examines these trends and implications for ongoing developments in Australian policing.

Policing in the 'communal spaces' of major event venues

The recent re-conceptualization of 'mass private property' as one form of 'communal spaces' raises a series of questions concerning policing and security in these domains. This paper applies the concept of 'communal spaces' to an analysis of policing in 'major event venues.' We assess the character of policing in these communal spaces by drawing upon interviews conducted with policing—private and public—personnel operating in major event venues. The paper identifies different perspectives on the nature of policing in these communal spaces and tension between public and private police personnel concerning their respective roles and responsibilities. We conclude by raising issues concerning the implications for the 'public good' in policing at major event venues.

The role of the print media in informing the community about safety in public hospitals in Victoria, Australia: the case of `golden staph`

Objective. In this article the authors explore how the print media contribute to information and education of the community on issues of safety and quality in the health services, since this is an important avenue of such information and education for many members of the community. Study design. The authors undertook a qualitative study of a random sample of articles in the Australian print press between 1996 and 2004 where ‘golden staph’ was presented as a major issue of risk to the safety of consumers of health services. The content of each article was examined with reference to several criteria including title, the source of the article, and the metaphorical language employed by the journalist.
Results. Results show that while the articles are substantially accurate as sources of information on concrete events, they do not serve as sources of education on issues of safety, typically apportioning blame and serving to maintain the status quo.
Conclusion. The authors conclude that print media are not a good source of community education in areas of safety and quality and do not assist members of the community to participate in addressing issues of safety in health services.

The community takes action : the Carlton residents association.

Since its streets first came to life with a clatter of hooves and rumble of carriage wheels, Carlton has become well known for its diverse ethnic and social character. From the bourgeoisie in the elegant terraces of Drummond Street to the street urchins and prostitutes of a once-seedy Bouverie Street, from student radicals at the University of Melbourne to the tailors and restaurateurs of Lygon, its residents have made the suburb an exciting and distinctive quarter of Melbourne.

Some of the city's greatest political and social controversies were played out here, including the eight-hour-day campaign of the 1850s and the Carlton Association's fight against the Housing Commission in the 1960s. Carlton's passion overflows onto the football field in support of one of Victoria's most successful football clubs.

A celebration of one of the most fascinating suburbs in Melbourne, Carlton: A History richly evokes the vibrant and colourful character of Carlton, today and yesterday.

Developing recreation programs for disadvantaged sectors of the community

Physical activity participation can provide benefits for both the health and well-being of the community. Many people, however, are not active enough to achieve these health and well-being outcomes. The Victorian Health Promotion Foundation’s (VicHealth) 2001 Active Recreation Scheme funded 27 projects designed to provide recreation programs to address the active recreation needs of disadvantaged groups who are often the least physically active members of Victorian communities. This research aimed to identify themes and strategies of these projects that increased participation or reduced barriers to participation in active recreation. Site visit interviews were conducted with representatives of 11 projects to become familiar with successful program strategies and barriers to recreation program development. Following the site visits a focus group discussion with representatives from all 27 funded projects was conducted to explore ways in which barriers to recreation participation could be minimized and what strategies were effective in increasing recreation participation. Nine general dimensions that were identified as strategic approaches to increase the participation of disadvantaged groups in recreation programs were relationships, resources, community values/attitudes, communication (promotion and education), participant awareness/motivation, autonomy supportive, planning, program design, and mentors/role models. It was found that a focus on a community coalitions and complementary policy developments had positive effects on creating active communities. Four themes that guided the community and policy developments were i) community partnerships, ii) community support, iii) focus on the participants and iv) program design elements. The study also showed that the management and manipulation of these themes assisted agencies to develop programs that increased recreation participation.

MOSAIC (MOthers' Advocates In the Community): protocol and sample description of a cluster randomised trial of mentor mother support to reduce intimate partner violence among pregnant or recent mothers

Background : Intimate partner violence (IPV) is prevalent globally, experienced by a significant minority of women in the early childbearing years and is harmful to the mental and physical health of women and children. There are very few studies with rigorous designs which have tested the effectiveness of IPV interventions to improve the health and wellbeing of abused women. Evidence for the separate benefit to victims of social support, advocacy and non-professional mentoring suggested that a combined model may reduce the levels of violence, the associated mental health damage and may increase a woman's health, safety and connection with her children. This paper describes the development, design and implementation of a trial of mentor mother support set in primary care, including baseline characteristics of participating women.

Methods/Design : MOSAIC (MOtherS' Advocates In the Community) was a cluster randomised trial embedded in general practice and maternal and child health (MCH) nursing services in disadvantaged suburbs of Melbourne, Australia. Women who were pregnant or with infants, identified as abused or symptomatic of abuse, were referred by IPV-trained GPs and MCH nurses from 24 general practices and eight nurse teams from January 2006 to December 2007. Women in the intervention arm received up to 12 months support from trained and supported non-professional mentor mothers. Vietnamese health professionals also referred Vietnamese women to bilingual mentors in a sub-study. Baseline and follow-up surveys at 12 months measured IPV (CAS), depression (EPDS), general health (SF-36), social support (MOS-SF) and attachment to children (PSI-SF). Significant development and piloting occurred prior to trial commencement. Implementation interviews with MCH nurses, GPs and mentors assisted further refinement of the intervention. In-depth interviews with participants and mentors, and follow-up surveys of MCH nurses and GPs at trial conclusion will shed further light on MOSAIC's impact.

Discussion : Despite significant challenges, MOSAIC will make an important contribution to the need for evidence of effective partner violence interventions, the role of non-professional mentors in partner violence support services and the need for more evaluation of effective health professional training and support in caring for abused women and children among their populations.

Stakeholder satisfaction with the Australian Rheumatology Association Database (ARAD)

Background: The Australian Rheumatology Association Database (ARAD) is a voluntary national registry for monitoring the long-term benefits and safety of biological disease-modifying anti-rheumatic drugs (bDMARDs) for inflammatory arthritis. Both rheumatologists and patients contribute data to the ARAD.

Objective: To evaluate the satisfaction of patients and rheumatologists with the ARAD.

Methods: Cross-sectional surveys were distributed to a random sample of 100 community-dwelling ARAD patients in 2007 and to rheumatologists attending the 2007 AustralianRheumatologyAssociation (ARA) annual scientific meeting.

Survey questions included items about the usefulness of the ARAD, workload for participants, frequency of questionnaires, and experience of contact with ARAD staff.

Results: A total of 92.5% of patients perceived the ARAD as very important (scoring 9-10 on a numeric rating scale). Patients reported minimal difficulty in completing questionnaires, and 95.0% indicated that a 6-month interval between questionnaires was reasonable. Of responding rheumatologists, 32.3%, 62.1%, and 53.8% indicated that the ARAD was very important (scoring 8-10) with respect to clinical information, research, and the profession, respectively, while 68% of those participating in the ARAD reported that the workload required to enroll patients was manageable and 30% found it difficult or onerous.

Conclusion: Key stakeholders in the ARAD view it as an important resource and are satisfied with its operations. Efforts will be directed towards assisting those rheumatologists who find the associated workload difficult and to improving the perceived clinical value of information available from the ARAD.

Conflict of interest in policing and the public sector

Conflicts of interest are a key factor in the contemporary decline of trust in government and public institutions, eroding public trust in government and democratic systems. Drawing on two unique empirical studies involving policing and the broader public sector, this paper explores the meaning and dimensions of conflict of interest by examining public complaints about conflict of interest and providing distinctive insights into the nature of conflict of interest as a problem for public sector ethics. The paper analyses and explores appropriate regulatory and management approaches for conflict of interest, focusing on three elements: (1) dealing with private interests that are identifiably problematic in the way they clash with the duties of public officials; (2) managing conflicts as they arise in the course of public sector work (manifested in preferential and adverse treatment, and other problematic areas); and (3) developing ethical and accountable organisational cultures. It is concluded that effective and meaningful public sector ethics in the pursuit of the public interest must be based on an ethos of social accountability and a commitment to prioritise the public interest in both fact and appearance.