Scaling up community-based obesity prevention in Australia : background and evaluation design of the health promoting communities : being active eating well initiative

Background : There is only limited evidence available on how best to prevent childhood obesity and community-based interventions hold promise, as several successful interventions have now been published. The Victorian Government has recently funded six disadvantaged communities across Victoria, Australia for three years to promote healthy eating and physical activity for children, families, and adults in a community-based participatory manner. Five of these intervention communities are situated in Primary Care Partnerships and are the subject of this paper. The interventions will comprise a mixture of capacity-building, environmental, and whole-of-community approaches with targeted and population-level interventions. The specific intervention activities will be determined locally within each community through stakeholder and community consultation. Implementation of the interventions will occur through funded positions in primary care and local government. This paper describes the design of the evaluation of the five primary care partnership-based initiatives in the 'Go for your life' Health Promoting Communities: Being Active Eating Well (HPC:BAEW) initiative.

Methods/Design : A mixed method and multi-level evaluation of the HPC:BAEW initiative will capture process, impact and outcome data and involve both local and state-wide evaluators. There will be a combined analysis across the five community intervention projects with outcomes compared to a comparison group using a cross-sectional, quasi-experimental design. The evaluation will capture process, weight status, socio-demographic, obesity-related behavioral and environmental data in intervention and comparison areas. This will be achieved using document analysis, paper-based questionnaires, interviews and direct measures of weight, height and waist circumference from participants (children, adolescents and adults).

Discussion : This study will add significant evidence on how to prevent obesity at a population level in disadvantaged and ethnically diverse communities. The outcomes will have direct influence on policy and practice and guide the development and implementation of future obesity prevention efforts in Australia and internationally.

Transition to motherhood in type 1 diabetes : design of the pregnancy and postnatal well-being in transition questionnaires

Background : Life transitions are associated with high levels of stress affecting health behaviours among people with Type 1 diabetes. Transition to motherhood is a major transition with potential complications accelerated by pregnancy with risks of adverse childbirth outcomes and added anxiety and worries about pregnancy outcomes. Further, preparing and going through pregnancy requires vigilant attention to a diabetes management regimen and detailed planning of everyday activities with added stress on women. Psychological and social well-being during and after pregnancy are integral for good pregnancy outcomes for both mother and baby. The aim of this study is to establish the face and content validity of two novel measures assessing the well-being of women with type 1 diabetes in their transition to motherhood, 1) during pregnancy and 2) during the postnatal period.

Methods : The approach to the development of the Pregnancy and Postnatal Well-being in T1DM Transition questionnaires was based on a four-stage pre-testing process; systematic overview of literature, items development, piloting testing of questionnaire and refinement of questionnaire. The questionnaire was reviewed at every stage by expert clinicians, researchers and representatives from consumer groups. The cognitive debriefing approach confirmed relevance of issues and identified additional items.

Results : The literature review and interviews identified three main areas impacting on the women’s postnatal self-management; (1) psychological well-being; (2) social environment, (3) physical (maternal and fetal) well-being. The cognitive debriefing in pilot testing of the questionnaire identified that immediate postnatal period was difficult, particularly when the women were breastfeeding and felt depressed.

Conclusions : The questionnaires fill an important gap by systematically assessing the psychosocial needs of women with type 1 diabetes during pregnancy and in the immediate postnatal period. The questionnaires can be used in larger data collection to establish psychometric properties. The questionnaires potentially play a key role in prospective research to determine the self-management and psychological needs of women with type 1 diabetes transitioning to motherhood and to evaluate health education interventions.

How well do Australian women comply with dietary guidelines?

Objective: To investigate the proportion of middle-aged Australian women meeting national dietary recommendations and its variation according to selected sociodemographic and behavioural characteristics.

Design: This cross-sectional population-based study used a food-frequency questionnaire to investigate dietary patterns and compliance with 13 commonly promoted dietary guidelines among a cohort of middle-aged women participating in the Australian Longitudinal Study on Women's Health.

Setting: Nation-wide community-based survey.

Subjects: A total of 10 561 women aged 50–55 years at the time of the survey in 2001.

Results: Only about one-third of women complied with more than half of the guidelines, and only two women in the entire sample met all 13 guidelines examined. While guidelines for meat/fish/poultry/eggs/nuts/legumes and ‘extra’ foods (e.g. ice cream, chocolate, cakes, potatoes, pizza, hamburgers and wine) were met well, large percentages of women (68–88%) did not meet guidelines relating to the consumption of breads, cereal-based foods and dairy products, and intakes of total and saturated fat and iron. Women working in lower socio-economic status occupations, and women living alone or with people other than a partner and/or children, were at significantly increased risk of not meeting guidelines.

Conclusions: The present results indicate that a large proportion of middle-aged Australian women are not meeting dietary guidelines. Without substantial changes in their diets, and help in making these changes, current national guidelines appear unachievable for many women.

Design of reduced-order scalar functional observers

In the existing literature, the existence conditions and design procedures for scalar functional observers are available for the cases where the observers’ order p is either p=1 or p=(v-1), where v is the observability index of the matrix pair (C,A). Therefore, if an observer with an order p=1 does not exist, the other available option is to use a higher order observer with p=(v-1). This paper shows that there exists another option that can be used to design scalar linear functional observers of the order lower than the well-known upper bound (v-1). The paper provides the existence conditions and a design procedure for scalar functional observers of order 0≤ p ≤2, and demonstrates the presented results with a numerical example.

Design of scalar functional observers of order less than (v-1)

This paper presents a new method of designing scalar functional observers of order less than the well-known upper bound (ν - 1). A condition for the existence of observers of order p where 1 ≤ p ≤ (ν - 1) is given. A simple and effective algorithm for solving the constrained generalized Sylvester equation is proposed. Several numerical examples are given to illustrate the attractiveness of the design algorithm.

Evaluating health promotion in schools: a case study of design, implementation and results from the Hong Kong Healthy Schools Award Scheme

Health promoting schools (HPS) and Healthy Schools Award Schemes from a number of countries have demonstrated positive changes in children’s health behaviours and the culture and organisation of the school. The Hong Kong Healthy Schools Award Scheme (HKHSA) aims to promote staff development, parental education, involvement of the whole school community, and linkage with different stakeholders to improve the health and well-being of the pupils, parents and staff, and the broader community, supported by a system to monitor the achievement. This concept is very much in line with the research literature on school effectiveness and improvement. The indicators examined to evaluate the success of the HKHSA reflect outcomes related to both health and education and are not limited to changes in population health status. The early results demonstrated significant improvements in various aspects of student health and also improvement in school culture and organisation. The evaluation framework described in this paper and data collected to assess how schools perform in the HKHSA scheme, provides insight into how HPSs could lead to better outcomes for both education and health.

The health and well-being of adolescents: a school-based population study of the self-report child health questionnaire

Purpose: To evaluate a new generic measure of adolescent health status, the self-report version of the Child Health Questionnaire (CHQ), and provide population-based data. Furthermore, we aimed to examine the impact of common adolescent illness and health concerns on their health and well-being.

Methods: A stratified, two-stage, random cluster sampling design was used to obtain a cross-sectional sample of subjects through schools. A written questionnaire included the 80-item 12-scale self-report CHQ and items measuring health concerns, illnesses/health conditions, and sociodemographics.

Results: A total of 2361 adolescents participated (response rate of 70%). Reliability was high: Tests of internal consistency and discriminant validity reported 90% of item-scale correlations >.4; all scales had Cronbach alpha coefficients >.7. Adolescents with illnesses/conditions or health concerns reported lower scores and larger differences for content-related scales, supporting content and construct validity. Statistically significant age and gender trends were observed for Mental Health, Self-Esteem, General Health, and Family Cohesion scales. Health status worsened as health concerns increased (X2 linear trend, p = .00) with deterioration in health of 5–20% on all scales for emotional health concerns (40% of sample).

Conclusions: The self-report CHQ is a reliable and seemingly valid measure of health and well-being for adolescent health research, although additional measures may be required where scales have high ceiling values. The significantly lower scores reported by adolescents with illness and/or health concerns lend support to the use of standardized health measures and longitudinal research to further examine the impact of adolescent comorbidities and their causal determinants.

Agreement between adolescent self-report and parent reports of health and well-being: results of an epidemiological study.

Objective To examine parent and adolescent agreement on physical, emotional, mental and social health and well-being in a representative population.
Methodology An epidemiological design was used to obtain parent–child/adolescent dyad data on comparable items and scales of a generic measure of health and well-being, the Child Health Questionnaire (parent/proxy report 50 item, self-report 80 item). Scale analysis included intraclass correlations (ICCs) to examine strength of parent–child associations and independent t-tests for differences between adolescents (with or without an illness). Where there were significant differences in scale scores, analysis of variance and two sample t-tests were used to examine the influence of social, demographic, health concern and school variables. Single items were examined for trends in response categories.
Results 2096 parent–adolescent dyads (adolescent mean age of 15.1 years, males 50%, maternal parent 83.2%, biological parent 93.5%). ICCs were strong. Overall, adolescents reported poorer emotional and social health, and clinically significant differences were observed for perceptions of general health (mean difference 8.1/100), frequency and amount of body pain (5.94/100), experience of mental health (5.14/100), and impact of health on family activities (12.43/100), which widen significantly for adolescents with illness. Social, health and school enjoyment and performance significantly widened parent–child differences.
Conclusions All adolescents were much less optimistic about their health and well-being than their parents, and were only in close agreement on aspects of health and well-being they rated highly. Adolescent reports are more likely to be sensitive to pain, mental health problems, health in general and the impact of their health on family activities.

Existence and design of reduced-order scalar functional observers

In the existing literature, the existence conditions and design procedures for scalar functional observers are available for the cases where the observers’ order p is either p=1 or p=(v-1), where v is the observability index of the matrix pair (C,A). Therefore, if an observer with an order p=1 does not exist, the other option is to use a high-order observer with p=(v-1). This paper provides the existence conditions and a design procedure for scalar functional observers of order 0≤p≤2, and demonstrates the presented results with a numerical example. where K, M, E, H and G are constant matrices to be designed. The problem of observing a scalar functional or multi functionals (z(t)∈Rk , k>1) of the state vector has been the subject of numerous papers, and different algorithms have been proposed (see, [1]-[13] and references therein). There are also papers that deal with the order reduction of multi-dimensional functional observers [9,10,12,13]. For scalar functional observers, a well-known Luenberger’s classic result [1] provides an upper bound on the order with p=(v-1). It is interesting to note here that, except for a recent result of Darouach [12,13], little results have been reported on the order reduction for scalar functional observers.

Truth is God harm minimization through the practice of ecologically sustainable design and buddhism

The emergence of the global ecological crisis is presenting unique opportunities for the coordination of ethical thinking across cultural boundaries. Harm minimization as an ethical imperative operates as the ‘modus operandi’ behind both Ecologically Sustainable Design (ESD) and Buddhist practice. The architectural response to ESD is founded upon the ‘Declaration of Interdependence for a Sustainable Future’ adopted in 1993 by the International Union of Architects, of which the RAIA is a member.

Buddhism is a response to existential concerns universal to humanity. It developed as a set of principles for personal transformation known as the Four Noble Truths elucidated two and a half thousand years ago. Buddhist meditation practise ‘interrupts automatic patterns of conditioned behaviour’ recognised as the major obstacle to be overcome in any programme for change. Unsustainable egocentric behaviour is considered fundamental to our global ecological crisis and calls for radical behavioural change are increasingly being heard at the professional as well as the personal level. Emerging synergies between the Western cognitive sciences and Buddhist study of the mind increasingly validate the Tibetan Buddhist mind development phenomenon. Buddhists argue that their programme for enhancing ethical behaviour through mind development is a step-by step process of observation and analysis built upon empirical observation – a fundamental pre-requisite of any ‘scientific’ enquiry. Collaborative research programmes currently underway are an attempt to re-interpret Buddhist meditation techniques within a framework acceptable to Western scientific understanding. A truly holistic approach to harm minimization requires its consideration.

Cross-discipline collaboration and innovation in the design studio : drawing on the Bath model

As information expands and comprehension becomes more complex, so the need increases to develop focused areas of knowledge and skill acquisition. However, as the number of specialty areas increases so the languages that define each separate knowledge base become increasingly remote. Hence, concepts and viewpoints that were once considered part of a whole become detached. This phenomenon is typical of the development of tertiary education, especially within professional oriented courses, where disciplines and sub-disciplines have grown further apart and the ability to communicate has become increasingly fragmented.
One individual and visionary who was well acquainted with the shortcomings of the piecemeal development between the disciplines was Professor Sir Edmond Happold, the leader of the prestigious group known as Structures 3 at Ove Arup and Partners, who were responsible for making happen some of the landmark buildings of their time, including Sydney Opera House and the Pompidou Centre, and the founding professor of the Bath school of Architecture and Civil Engineering in 1975. While still having a profound respect for the knowledge bases of the different professions within the building and construction industry, Professor Happold was also well aware of the extraordinary synergies in design and innovation which could come about when the disciplines of Architecture and Civil Engineering were brought together at the outset of the design process.
This paper discusses the rational behind Professor Happold’s cross-discipline model of education and reflects on the method, execution and pedagogical worth of the joint studio-based projects which formed a core aspect of the third year program at the School of Architecture and Civil Engineering at the Bath University.

Fluorescent photoinduced electron transfer (PET) sensors for anions; from design to potential application

This mini review highlights the synthesis and photophysical evaluation of anion sensors, for nonaqueous solutions, that have been developed in our laboratories over the last few years. We have focused our research mainly on developing fluorescent photoinduced electron transfer (PET) sensors based on the fluorophore-spacer-anion receptor principle using several anthracene (emitting in the blue) and 1,8-naphthalimide (emitting in the green) fluorophores, with the aim of targeting biologically and industrially relevant anions such as acetates, phosphate and amino acids, as well as halides such as fluoride. The receptors and the fluorophore are separated by a short methyl or ethyl spacer, where the charge neutral anion receptors are either aliphatic or aromatic urea (or thiourea) moieties. For these, the anion recognition is through hydrogen bonding, yielding anion:receptor complexes. Such bonding gives rise to enhanced reduction potential in the receptor moieties which causes enhancement in the rate of PET quenching of the fluorophore excited state from the anion:receptor moiety. This design can be further elaborated on by incorporating either two fluorophores, or urea/thiourea receptors into the sensor structures, using anthracene as a fluorophore. For the latter design, the sensors were designed to achieve sensing of bis-anions, such as di-carboxylates or pyrophosphate, where the anion bridged the anthracene moiety. In the case of the naphthalimide based mono-receptor based PET sensors, it was discovered that in DMSO the sensors were also susceptible to deprotonation by anions such as F− at high concentrations. This led to substantial changes in the absorption spectra of these sensors, where the solution changed colour from yellow/green to deep blue, which was clearly visible to the naked eye. Hence, some of the examples presented can act as dual fluorescent-colorimetric sensors for anions. Further investigations into this phenomenon led to the development of simple colorimetric sensors for fluorides, which upon exposure to air, were shown to fix carbon dioxide as bicarbonate.

Library learning space design : a good student fit

We are seeing a renewed interest nationally and internationally in the design and development of new learning environments. There is, at Deakin and more generally in the higher education sector, recognition that the students' experience of a flexible and supportive educational environment is central to excellent teaching and fosters student success. Recent Carrick Institute (now the Australian Learning and Teaching Council) grants have supported the need for a greater understanding of good practice, with workshops being held around the country.

The student experience is integral to planning the re-purposing of Library spaces at Deakin's two larger campuses, Waurn Ponds and Burwood. The physical spaces within the Library will be flexible and provide support for individual learning and study, group learning and discussion, with ubiquitous ICT access and assistance services readily accessible. The improvement to the amenities, including contemporary, wired casual spaces, will encourage students to come on to campus and stay, strengthening opportunities to build a learning community. This learning community can extend through opportunities for social networking to students studying online and off-campus.

Library services and spaces will align with the new pedagogical needs of the university, providing holistic support for students' flexible learning experiences.
"We know that space can have a significant impact on teaching and learning . . . What we know about how people learn has changed our ideas about learning space. There is value from bumping into someone and having a casual conversation. There is value from hands on, active learning as well as from discussion and reflection. There is value in being able to receive immediate support when needed and from being able to integrate multiple activities [and multiple information sources] to complete a project." (Diane Oblinger, Learning Spaces, EDUCAUSE, 2006).

Reducing unhealthy weight gain in children through community capacity−building: results of a quasi−experimental intervention program, Be Active Eat Well

Background:
Be Active Eat Well (BAEW) was a multifaceted community capacity-building program promoting healthy eating and physical activity for children (aged 4–12 years) in the Australian town of Colac.
Objective:
To evaluate the effects of BAEW on reducing children's unhealthy weight gain.
Methods:
BAEW had a quasi-experimental, longitudinal design with anthropometric and demographic data collected on Colac children in four preschools and six primary schools at baseline (2003, n=1001, response rate: 58%) and follow-up (2006, n=839, follow-up rate: 84%). The comparison sample was a stratified random selection of preschools (n=4) and primary schools (n=12) from the rest of the Barwon South Western region of Victoria, with baseline assessment in 2003–2004 (n=1183, response rate: 44%) and follow-up in 2006 (n=979, follow-up rate: 83%).
Results:
Colac children had significantly lower increases in body weight (mean: -0.92 kg, 95% CI: -1.74 to -0.11), waist (-3.14 cm, -5.07 to -1.22), waist/height (-0.02, -0.03 to -0.004), and body mass index z-score (-0.11, -0.21 to -0.01) than comparison children, adjusted for baseline variable, age, height, gender, duration between measurements and clustering by school. In Colac, the anthropometric changes were not related to four indicators of socioeconomic status (SES), whereas in the comparison group 19/20 such analyses showed significantly greater gains in anthropometry in children from lower SES families. Changes in underweight and attempted weight loss were no different between the groups.
Conclusions:
Building community capacity to promote healthy eating and physical activity appears to be a safe and effective way to reduce unhealthy weight gain in children without increasing health inequalities.

The meaning of leisure for well-elderly Italians in an Australian community : implications for occupational therapy

Aim: This paper documents a study that aimed to discover the meaning of leisure experiences for an ageing Italian community in a large regional centre in Victoria, Australia.
Methods: This qualitative investigation used a phenomenological study design, and data were collected through semistructured interviews with 10 well-elderly Australian Italians.
Results: Participants engaged in numerous leisure occupations that were meaningful to them and directly impacted on positive subjective experiences and health outcomes.
Conclusion: This paper adds to an understanding of how leisure impacts on the health of well-elderly Australians and how occupational therapists can use leisure effectively in interventions for successful ageing.