Telephone support to rural and remote patients with heart failure : the Chronic Heart failure Assessment by Telephone (CHAT) study

Background Heart failure (HF) remains a condition with high morbidity and mortality. We tested a telephone support strategy to reduce major events in rural and remote Australians with HF, who have limited healthcare access. Telephone support comprised an interactive telecommunication software tool (TeleWatch) with follow-up by trained cardiac nurses. Methods Patients with a general practice (GP) diagnosis of HF were randomised to usual care (UC) or UC and telephone support intervention (UC+I) using a cluster design involving 143 GPs throughout Australia. Patients were followed for 12 months. The primary end-point was the Packer clinical composite score. Secondary end-points included hospitalisation for any cause, death or hospitalisation, as well as HF hospitalisation. Results Four hundred and five patients were randomised into CHAT. Patients were well matched at baseline for key demographic variables. The primary end-point of the Packer Score was not different between the two groups (P=0.98), although more patients improved with UC+I. There were fewer patients hospitalised for any cause (74 versus 114, adjusted HR 0.67 [95% CI 0.50-0.89], p=0.006) and who died or were hospitalised (89 versus 124, adjusted HR 0.70 [95% CI 0.53 – 0.92], p=0.011), in the UC+I vs UC group. HF hospitalisations were reduced with UC+I (23 versus 35, adjusted HR 0.81 [95% CI 0.44 – 1.38]), although this was not significant (p=0.43). There were 16 deaths in the UC group and 17 in the UC+I group (p=0.43). Conclusions Although no difference was observed in the primary end-point of CHAT (Packer composite score), UC+I significantly reduced the number of HF patients hospitalised amongst a rural and remote cohort. These data suggest that telephone support may be an efficacious approach to improve clinical outcomes in rural and remote HF patients.

Front interactions in a three-component system

The three-component reaction-diffusion system introduced in [C. P. Schenk et al., Phys. Rev. Lett., 78 (1997), pp. 3781–3784] has become a paradigm model in pattern formation. It exhibits a rich variety of dynamics of fronts, pulses, and spots. The front and pulse interactions range in type from weak, in which the localized structures interact only through their exponentially small tails, to strong interactions, in which they annihilate or collide and in which all components are far from equilibrium in the domains between the localized structures. Intermediate to these two extremes sits the semistrong interaction regime, in which the activator component of the front is near equilibrium in the intervals between adjacent fronts but both inhibitor components are far from equilibrium there, and hence their concentration profiles drive the front evolution. In this paper, we focus on dynamically evolving N-front solutions in the semistrong regime. The primary result is use of a renormalization group method to rigorously derive the system of N coupled ODEs that governs the positions of the fronts. The operators associated with the linearization about the N-front solutions have N small eigenvalues, and the N-front solutions may be decomposed into a component in the space spanned by the associated eigenfunctions and a component projected onto the complement of this space. This decomposition is carried out iteratively at a sequence of times. The former projections yield the ODEs for the front positions, while the latter projections are associated with remainders that we show stay small in a suitable norm during each iteration of the renormalization group method. Our results also help extend the application of the renormalization group method from the weak interaction regime for which it was initially developed to the semistrong interaction regime. The second set of results that we present is a detailed analysis of this system of ODEs, providing a classification of the possible front interactions in the cases of $N=1,2,3,4$, as well as how front solutions interact with the stationary pulse solutions studied earlier in [A. Doelman, P. van Heijster, and T. J. Kaper, J. Dynam. Differential Equations, 21 (2009), pp. 73–115; P. van Heijster, A. Doelman, and T. J. Kaper, Phys. D, 237 (2008), pp. 3335–3368]. Moreover, we present some results on the general case of N-front interactions.

Pulse dynamics in a three-component system : stability and bifurcations

In this article, we analyze the stability and the associated bifurcations of several types of pulse solutions in a singularly perturbed three-component reaction-diffusion equation that has its origin as a model for gas discharge dynamics. Due to the richness and complexity of the dynamics generated by this model, it has in recent years become a paradigm model for the study of pulse interactions. A mathematical analysis of pulse interactions is based on detailed information on the existence and stability of isolated pulse solutions. The existence of these isolated pulse solutions is established in previous work. Here, the pulse solutions are studied by an Evans function associated to the linearized stability problem. Evans functions for stability problems in singularly perturbed reaction-diffusion models can be decomposed into a fast and a slow component, and their zeroes can be determined explicitly by the NLEP method. In the context of the present model, we have extended the NLEP method so that it can be applied to multi-pulse and multi-front solutions of singularly perturbed reaction-diffusion equations with more than one slow component. The brunt of this article is devoted to the analysis of the stability characteristics and the bifurcations of the pulse solutions. Our methods enable us to obtain explicit, analytical information on the various types of bifurcations, such as saddle-node bifurcations, Hopf bifurcations in which breathing pulse solutions are created, and bifurcations into travelling pulse solutions, which can be both subcritical and supercritical.

Qualitative study of adversity activated development and resilience in adolescents and young adults with congenital heart disease and their parents

What is it like to have a medical condition that few people have ever heard about? How does it feel to have to question whether daily physical activities are dangerous for you, whilst you watch your friends enjoy those activities without a care? Can you imagine that you need to have a complicated heart surgery, with risks such as paralysis or death? Or even imagine facing the painful recovery period and scars after such a surgery? Then imagine that you are a child or teenager dealing with this medical condition when all your friends are simply occupied with school and normal life. Now consider that surgery has been undertaken to extend your lifespan, but the operation is so new that the long-term outcomes are just not known? All you really know is that you might have ‘surgical repairs’ to your heart and symptoms may be relieved or managed by medications or cardiac devices, but you are never going to be cured. What if you had already experienced painful, frightening, lonely and tedious hospitalisations and you were forced to put your life on hold to re-enter that situation, time and time again. This may be your life, as a Congenital Heart Disease or CHD patient. How do such patients cope and in many cases even thrive? This chapter will review current international literature regarding the medical and personal impact of CHD. Our qualitative study of the perspectives of young CHD patients and their parents contributes to the Australian story of CHD, as well as highlighting the potential for CHD related adversity to promote personal development.

Predictors of sexually transmitted infection in Australian women : evidence from the Australian longitudinal study on women’s health

This longitudinal study examined characteristics of women diagnosed with sexually transmitted infections (STI) for the first time in their later 20s and early 30s. Participants were 6,840 women (born 1973–1978) from the Australian Longitudinal Study on Women’s Health. Women aged 18–23 years were surveyed in 1996 (S1), 2000 (S2), 2003 (S3), and 2006 (S4). There were 269 women reporting an STI for the first time at S3 or S4. Using two multivariable logistic regression analyses (examining 18 predictor variables), these 269 women were compared (1) with 306 women who reported an STI at S2 and (2) with 5,214 women who never reported an STI across the four surveys. Women who reported an STI for the first time at S3 or S4 were less likely to have been pregnant or had a recent Pap smear compared to women reporting an STI at S2.Women reporting a first STI at S3 or S4 were less likely to have been pregnant or had a recent Pap smear compared to women reporting an STI at S2. Women were more likely to report an STI for the first time at S3 or S4 compared to women not reporting an STI at any survey if they were younger, unpartnered, had a higher number of sexual partners, had never been pregnant, were recently divorced or separated, and reported poorer access to Women’s Health or Family Planning Centres at S2. These findings demonstrate the value of longitudinal studies of sexual health over the life course beyond adolescence.

Social innovation and social enterprise : evidence from Australia

‘Social innovation’ is a construct increasingly used to explain the practices, processes and actors through which sustained positive transformation occurs in the network society (Mulgan, G., Tucker, S., Ali, R., Sander, B. (2007). Social innovation: What it is, why it matters and how can it be accelerated. Oxford:Skoll Centre for Social Entrepreneurship; Phills, J. A., Deiglmeier, K., & Miller, D. T. Stanford Social Innovation Review, 6(4):34–43, 2008.). Social innovation has been defined as a “novel solution to a social problem that is more effective, efficient, sustainable, or just than existing solutions, and for which the value created accrues primarily to society as a whole rather than private individuals.” (Phills,J. A., Deiglmeier, K., & Miller, D. T. Stanford Social Innovation Review, 6 (4):34–43, 2008: 34.) Emergent ideas of social innovation challenge some traditional understandings of the nature and role of the Third Sector, as well as shining a light on those enterprises within the social economy that configure resources in novel ways. In this context, social enterprises – which provide a social or community benefit and trade to fulfil their mission – have attracted considerable policy attention as one source of social innovation within a wider field of action (see Leadbeater, C. (2007). ‘Social enterprise and social innovation: Strategies for the next 10 years’, Cabinet office,Office of the third sector http://www.charlesleadbeater.net/cms xstandard/social_enterprise_innovation.pdf. Last accessed 19/5/2011.). And yet, while social enterprise seems to have gained some symbolic traction in society, there is to date relatively limited evidence of its real world impacts.(Dart, R. Not for Profit Management and Leadership, 14(4):411–424, 2004.) In other words, we do not know much about the social innovation capabilities and effects of social enterprise. In this chapter, we consider the social innovation practices of social enterprise, drawing on Mulgan, G., Tucker, S., Ali, R., Sander, B. (2007). Social innovation: What it is, why it matters and how can it be accelerated. Oxford: Skoll Centre for Social Entrepreneurship: 5) three dimensions of social innovation: new combinations or hybrids of existing elements; cutting across organisational, sectoral and disciplinary boundaries; and leaving behind compelling new relationships. Based on a detailed survey of 365 Australian social enterprises, we examine their self-reported business and mission-related innovations, the ways in which they configure and access resources and the practices through which they diffuse innovation in support of their mission. We then consider how these findings inform our understanding of the social innovation capabilities and effects of social enterprise,and their implications for public policy development.

Licensing age issues : deliberations from a workshop devoted to this topic

Objective: To highlight the issues and discuss the research evidence regarding safety, mobility, and other consequences of different licensing ages. Methods: Information included is based on presentations and discussions at a one-day workshop on licensing age issues, and a review and synthesis of the international literature. Results: The literature indicates that higher licensing ages are associated with safety benefits. There is an associated mobility loss, more likely to be an issue in rural states. Legislative attempts to raise the minimum age for independent driving in the United States, e.g., from 16 to 17, have been resisted, although in some states the age has been raised indirectly through graduated driver licensing (GDL) policies. Conclusions: Jurisdictions can achieve reductions in teenage crashes by raising the licensing age. This can be done directly, or indirectly by strengthening GDL systems, in particular extending the minimum length of the learner period.

The search for individualism : Self-expression through product personalisation

This research paper explores the impact product personalisation has upon product attachment and aims to develop a deeper understanding of why, how and if consumers choose to do so. The current research in this field is mainly based on attachment theories and is predominantly product specific. This paper researches the link between product attachment and personalisation through in-depth, semi-structured interviews, where the data has been thematically analysed and broken down into three themes, and nine sub-themes. It was found that participants did become more attached to products once they were personalised and the reasons why this occurred varied. The most common reasons that led to personalisation were functionality and usability, the expression of personality through a product and the complexity of personalisation. The reasons why participants felt connected to their products included strong emotions/memories, the amount of time and effort invested into the personalisation, a sense of achievement. Reasons behind the desire for personalisation included co-designing, expression of uniqueness/individualism and having choice for personalisation. Through theme and inter-theme relationships, many correlations were formed, which created the basis for design recommendations. These recommendations demonstrate how a designer could implement the emotions and reasoning for personalisation into the design process.

From vision to reality : views of primary school principals on inclusive education in New South Wales, Australia

This paper discusses the findings of a research study that used semi-structured interviews to explore the views of primary school principals on inclusive education in New South Wales, Australia. Content analysis of the transcript data indicates that principals’ attitudes towards inclusive education and their success in engineering inclusive practices within their school are significantly affected by their own conception of what “inclusion” means, as well as the characteristics of the school community, and the attitudes and capacity of staff. In what follows, we present two parallel conversations that arose from the interview data to illustrate the main conceptual divisions existing between our participants’ conceptions of inclusion. First, we discuss the act of “being inclusive” which was perceived mainly as an issue of culture and pedagogy. Second, we consider the mechanics of “including,” which reflected a more instrumentalist position based on perceptions of individual student deficit, the level of support they may require and the amount of funding they can attract.

The association between motivation in school physical education and self-reported physical activity during Finnish junior high school : a self-determination theory approach

The main purpose of this longitudinal study was to investigate the role of motivational climates, perceived competence and motivational regulations as antecedents of self-reported physical activity during junior high school years. The participants included 237 Finnish students (101 girls, 136 boys) that were 13 years old at the first stage of the study. Students completed the motivational climate and perceived competence questionnaires at Grade 7, motivation towards physical education questionnaire at Grade 8, and self-reported physical activity questionnaire at Grade 9. A path analysis revealed a path from task-involving motivational climate via perceived competence and intrinsic motivation to self-reported physical activity. Perceived competence and intrinsic motivation were statistically significant mediators between task-involving motivational climate and self-reported physical activity. This finding supports the four-stage causal sequence model of motivation.

Hepatitis C : a socio-cultural perspective on the effects of a new virus on a community’s health

Since the emergence of diagnostic medical tests in Australia in 1990, hepatitis C (HCV) has been shown to account for over 90 percent of all non-A non-B hepatitis, revealing it to be a widespread and major public health problem. The diagnosis of HCV involves a diverse range of issues for affected persons, introducing identity and lifestyle changes, which are commonly articulated through psychological concepts. In this article we argue that it is important to examine the broader social and cultural contexts that contribute to the experiences of persons affected by HCV. The thematic analysis of qualitative data from six individuals diagnosed with HCV is included to exemplify some of the processes that are involved in the changing identity of a person following a positive diagnosis. The theoretical framework for the interpretation of these processes is interpretive interactionism. In this research, we are attempting to extend the understanding of the effects of HCV diagnoses beyond internal, psychological processes by examining how these diagnoses transform some of the processes of self-formation and expression. The participants’ experiences indicate that there are at least four dimensions of self that were significant to their changing sense of self: relationship of self to others; the emotional self; self-stories and identity; and self-scrutiny and relationships. We conclude that a socio-cultural perspective contributes to the explanation of the transition period following a HCV-positive diagnosis and the redefinition of self towards a HCV status.

Sleepless nights : the effect of socioeconomic status, physical activity, and lifestyle factors on sleep quality in a large cohort of Australian women

The aims of this study were to examine: (1) the association between sociodemographic and lifestyle factors and sleep quality in a population-based cohort of Australian women and (2) possible influence of reproductive status and mental and physical health factors on these associations. Data on 3,655 women (mean age046.6 years, range 34.3–67.4) were obtained from the Mater Hospital University of Queensland Study of Pregnancy for this cross-sectional study. Self-rated sleep quality was assessed using the Pittsburgh Sleep Quality Index. For the purpose of this study, two cutoff points (scores 5 and 10) were used to divide women into three categories: normal (65.2 %), moderately poor (26.4 %), and very poor sleep quality (8.5 %). Other covariates were measured at 21-year follow-up as well. After adjusting for reproductive status, mental and physical health, there were significant associations between moderately poor sleep quality and education and between very poor sleep quality and unemployment, both measures of socioeconomic status. In addition, work-related exertion was associated with increased rates of moderately poor sleep quality, whereas those women undertaking moderate exercise were less likely to experience very poor sleep quality. Independent associations between sociodemographic factors and exercise with moderately poor and very poor sleep quality were identified. These findings demonstrate the dynamic nature of the association between exercise/exertion, socioeconomic status, and sleep quality and highlight the importance of taking these into consideration when dealing with issues of poor sleep quality in women.

Detection of mRNA levels for the estrogen alpha, estrogen beta and androgen nuclear receptor genes in archival breast cancer tissue

Previous studies in our laboratory have shown association of nuclear receptor expression and histological breast cancer grade. To further investigate these findings, it was the objective of this study to determine if expression levels of the estrogen alpha, estrogen beta and androgen nuclear receptor genes varied in different breast cancer grades. RNA extracted from paraffin embedded archival breast tumour tissue was converted into cDNA and cDNA underwent PCR to enable quantitation of mRNA expression. Expression data was normalised against the 18S ribosomal gene multiplex and analysed using ANOVA. Analysis indicated a significant alteration of expression for the androgen receptor in different cancer grades (P=0.014), as well as in tissues that no longer possess estrogen receptor alpha proteins (P=0.025). However, expression of estrogen receptors alpha and beta did not vary significantly with cancer grade (P=0.057 and 0.622, respectively). Also, the expression of estrogen receptor alpha or beta did not change, regardless of the presence of estrogen receptor alpha protein in the tissue (P=0.794 and 0.716, respectively). Post-hoc tests indicate that the expression of the androgen receptor is increased in estrogen receptor negative tissue as well as in grade 2 and grade 3 tumours, compared to control tissue. This increased expression in late stage breast tumours may have implications to the treatment of breast tumours, particularly those lacking expression of other nuclear receptor genes.

Young women's recent experience of labour and birth care in Queensland

Background Young parenthood continues to be an issue of concern in terms of clinical and psychosocial outcomes for mothers and their babies, with higher rates of medical complications such as preterm labour and hypertensive disease and a higher risk of depression. The aim of this study was to investigate how young age impacts on women's experience of intrapartum care. Methods Secondary analysis of data collected in a population based survey of women who had recently given birth in Queensland, comparing clinical and interpersonal aspects of the intrapartum maternity care experience for 237 eligible women aged 15–20 years and 6534 aged more than 20 years. Descriptive and multivariate analyses were undertaken. Results In the univariate analysis a number of variables were significantly associated with clinical aspects of labour and birth and perceptions of care: young women were more likely to birth in a public facility, to travel for birth and to live in less economically advantaged areas, to have a normal vaginal birth and to have one carer through labour. They were also less likely to report being treated with respect and kindness and talked to in a way they could understand. In logistic regression models, after adjustment for parity, other socio-demographic factors and mode of birth, younger mothers were still more likely to birth in a public facility, to travel for birth, to be more critical about interpersonal and aspects of care and the hospital or birth centre environment. Conclusion This study shows how experience of care during labour and birth is different for young women. Young women reported poorer quality interpersonal care which may well reflect an inferior care experience and stereotyping by health professionals, indicating a need for more effective staff engagement with young women at this time.

Contracts

Contracting essentially involves an agreement between two parties in relation to a particular matter. When defined in this way, contracting has been occurring as a social practice since humans first bartered and conducted trade, and should be understood as both an economic as well as a social transaction. This entry explains key aspects of the sociology While contracting is commonly understood to be a market based transaction, Polyani famously argued that for most of recorded history commercial transactions were in fact secondary to social relationships. In other words, whenever economic transactions occurred, they were always in the context of reciprocal social relationships. Historically the primary mode of exchange may well have been based on social exchange and reciprocity, however with the rise of extensive industrialization in the 18th Century, the primary mode of exchange has led to more of a market based mode of exchange in developed countries, with the focus more about the economic transaction. As an agreement between two entities, contracting is an essential element to economic systems as it is the basis of most transactions, whether the agreement is verbal or written, explicit or implied. Contracting is thus a pervasive activity in our society, particularly between organizations, although individuals also engage in contracting. Typically, when discussing contracting, authors have either focused on the nature of the agreement itself, or on the governance arrangements in place to carry out the agreement.