Is restricting tobacco sales the answer to adolescent smoking?

Background: Enforcement of legislation restricting retail access to tobacco is increasingly relied on to reduce adolescent smoking rates. In 1996, health authorities in the Northern Sydney Health Area began monitoring tobacco retailer compliance (PROOF program) with staged purchase attempts by adolescents below the legal age (18 years).

Methods: Repeat cross-sectional surveys before (1995) and after (2000) the introduction of PROOF monitored changes in adolescent smoking behaviour. Students aged 12 to 17 years from 11 Northern Sydney metropolitan public secondary schools were surveyed for self-reported smoking and tobacco purchasing behavior in 1995 (n = 5,206) and 2000 (n = 4,120).

Results: Between 1996 and 2000, 545 retailer compliance checks found 34% unlawfully sold cigarettes to minors and 28% of these repeated the offence. Nine prosecutions resulted. Modelling revealed a significant association between the intervention and never having smoked (adjusted OR = 1.16, 95% CI = 1.01–1.33) although there was no significant association with being a current smoker. The odds of being a smoker were greater for students from coeducational schools, with this effect being modified by gender.

Conclusions: There was no reduction in adolescent smoking with active enforcement of tobacco access laws despite an apparent increase in students who reported never to have smoked.

Sand pads : a promising technique to quantify human visitation into nature conservation areas

In many places the expansion of urban areas has brought recreationists into close proximity to nature conservation areas, sometimes leading to conflict where recreation and sensitive environmental or natural values are incompatible. An important first step in managing these conflicts is to assess the degree and nature of the problem. We describe the application, and methodological considerations, associated with the use of an innovative, low-cost, practical technique to monitor human intrusions into a wetland reserve which has been designated as ‘off-limits’ to the general public. The use of seven frequently monitored sand pads over 13 weeks enabled us to determine that intrusions occurred in every week (3–14 per sand pad), deep inside the reserve during most weeks, and also identified the key access points. Most intrusions occurred during holiday periods and were by walkers or cyclists. We also conducted a series of simple experiments to examine the utility of sand pads. Our sand pads maintained their shape well and held footprints for over 1 month, they were rarely avoided by people and provided reliable indices of the level of human activity. Sand hardness varied with rainfall, and hardened sand was frequent (53.8% of 26 days) and potentially prevented detection of people. We conclude that the sand pad technique is an effective and efficient tool to measure recreational use of off-limits areas and other conservation and recreation areas, provided human traffic is not too intense, and that checks are made reasonably frequently.

Communication at the bedside to enhance patient care : a survey of nurses’ experience and perspective of handover

Strategies to support continuity of care and improve patient safety during clinical handover have been developed. The aims of this study were to identify the strengths and limitations in current practice of nursing clinical handover and implement a new bedside handover process. A total of 259 nurses completed a cross-sectional survey at change of shift on 1 day, which was followed by an audit of the pilot implementation of bedside handover. The survey results showed great variation in the duration, location and method of handover with significant differences in the experience of nurses employed part-time compared with full-time. Following implementation of standardized bedside handover on two wards, the audit revealed significant improvement in the involvement of patients, use of Situation-Background-Assessment-Recommendation, active patient checks and checking of documentation. These findings suggest the use of standardized protocols and communication tools for bedside handover improve continuity of patient care

Outcomes of population based language promotion for slow to talk toddlers at ages 2 and 3 years: let’s learn language cluster randomised controlled trial

Objective To determine the benefits of a low intensity parent-toddler language promotion programme delivered to toddlers identified as slow to talk on screening in universal services.
Design Cluster randomised trial nested in a population based survey.
Setting Three local government areas in Melbourne, Australia.
Participants Parents attending 12 month well child checks over a six month period completed a baseline questionnaire. At 18 months, children at or below the 20th centile on an expressive vocabulary checklist entered the trial.
Intervention Maternal and child health centres (clusters) were randomly allocated to intervention (modified “You Make the Difference” programme over six weekly sessions) or control (“usual care”) arms.
Main outcome measures The primary outcome was expressive language (Preschool Language Scale-4) at 2 and 3 years; secondary outcomes were receptive language at 2 and 3 years, vocabulary checklist raw score at 2 and 3 years, Expressive Vocabulary Test at 3 years, and Child Behavior Checklist/1.5-5 raw score at 2 and 3 years.
Results 1217 parents completed the baseline survey; 1138 (93.5%) completed the 18 month checklist, when 301 (26.4%) children had vocabulary scores at or below the 20th centile and were randomised (158 intervention, 143 control). 115 (73%) intervention parents attended at least one session (mean 4.5 sessions), and most reported high satisfaction with the programme. Interim outcomes at age 2 years were similar in the two groups. Similarly, at age 3 years, adjusted mean differences (intervention−control) were −2.4 (95% confidence interval −6.2 to 1.4; P=0.21) for expressive language; −0.3 (−4.2 to 3.7; P=0.90) for receptive language; 4.1 (−2.3 to 10.6; P=0.21) for vocabulary checklist; −0.5 (−4.4 to 3.4; P=0.80) for Expressive Vocabulary Test; −0.1 (−1.6 to 1.4; P=0.86) for externalising behaviour problems; and −0.1 (−1.3 to 1.2; P=0. 92) for internalising behaviour problems.
Conclusion This community based programme targeting slow to talk toddlers was feasible and acceptable, but little evidence was found that it improved language or behaviour either immediately or at age 3 years.

Watching me, watching you

The planned introduction of quality checks by the Go8 on final-year students is a welcome move. Hopefully it will be taken up more broadly in the sector under the influence of the new Tertiary Education Quality and Standards Agency.

The spiral of learning : 4 R’s of education

The purpose of this paper is to explore the integration of learning, continuous improvement theories and reflective evaluation for enhancing management education. Conceptual development is combined with the outcomes of a pilot focus group as an example of reflective evaluation. The Spiral of Learning concept is uniquely augmented through hermeneutics, action research and the Deming cycle. Four R’s are identified in the Spiral of Learning: Review, Revise, Reconstruct and Reveal. Recommendations for each of the 4 R’s are made to assist continuous improvement of management education. For instance, emerging suites of social software appropriately chosen, timed and applied can assist student learning. Direct human connection in some form is recommended for learners when information is delivered online. The concepts and resultant recommendations inform practice through prioritization of online applications and development of appropriate checks and balances by academics and administrators.

The Assyrians

This chapter seeks to extend earlier works on Mesopotamian democracy to a civilisation that is not only typically excluded from such discussions of democracy in the ancient Near East, but generally considered to be among the region’s most bloodthirsty and bellicose: the Assyrians. On the one hand it cannot be denied that the Assyrians went through periods of aggressive expansion, that they were cruel to at least some of their enemies and that the more militant Assyrian kings struck fear into the hearts of men and women across the region (I:106-110, 113; II:1, 54-6 in: Grayson 1991: 201). On the other hand, however, it is peculiar that the intermittent war-mongering of the Assyrians is seen not only as ‘a modern myth exaggerated beyond all proportion’ (Parpola 2003: 1060), but also seen to exclude them from practicing any form of democracy. This is starkly inconsistent with the contemporary assessment of other societies of the ancient world, such as the Greeks or Romans who were both belligerent and at least nominally democratic. To give one example of this double standard, Jana Pecirkova argues that while the Greek polis enabled the birth of science, philosophy and the rule of law, the Assyrians were not able to distinguish ‘between the rational and the irrational, between reality and illusion’ (Pecirkova 1985: 155). The reason for this, according to Pecrikova, is simple: their ‘only alternative to monarchy … was anarchy … Political decisions were arbitrary in character and not governed by any laws or generally acknowledged and accepted rules’ and the ‘people were the passive subjects of political decision-making’ (Pecirkova 1985: 166-8). This chapter, while cautious not to over-state the democratic tendencies of the Assyrians, takes Pecirkova’s argument to task by examining the complex functioning of power and politics, the checks and balances on monarchical authority, the rule of law and the sophisticated intellectual scene of the three key epochs of ancient Assyrian civilisation.

Get fact: were there really 50,000 boat arrivals a year under Labor?

Tony Abbott has claimed that before he “stopped the boats”, they were coming in at a rate of 50,000 a year. Is that true? David Tittensor, a research fellow to the UNESCO Chair, with Deakin’s Centre for Citizenship and Globalisation, checks the claim.

The relationship between labour market conditions and welfare receipt in Australia: A stock-flow analysis

Understanding the determinants of changes in welfare caseloads is an important, but little studied, topic in Australia. This paper evaluates the role of labour market conditions in explaining the changes in the Australian welfare caseload since the late 1990s. The paper employs a stock-flow approach to better control for persistence in welfare receipt and includes different specifications to deal with measurement error in labour market data. The results suggest that the labour market is an important determinant of movements on and off welfare, accounting for the majority of the caseload decline during 1997-2005. The results also highlight the importance of robustness checks when data are measured with error.

Hierarchical Bayesian models of subtask learning

 The current study used Bayesian hierarchical methods to challenge and extend previous work on subtask learning consistency. A general model of individual-level subtask learning was proposed focusing on power and exponential functions with constraints to test for inconsistency. To study subtask learning, we developed a novel computer-based booking task, which logged participant actions, enabling measurement of strategy use and subtask performance. Model comparison was performed using deviance information criterion (DIC), posterior predictive checks, plots of model fits, and model recovery simulations. Results showed that although learning tended to be monotonically decreasing and decelerating, and approaching an asymptote for all subtasks, there was substantial inconsistency in learning curves both at the group- and individual-levels. This inconsistency was most apparent when constraining both the rate and the ratio of learning to asymptote to be equal across subtasks, thereby giving learning curves only 1 parameter for scaling. The inclusion of 6 strategy covariates provided improved prediction of subtask performance capturing different subtask learning processes and subtask trade-offs. In addition, strategy use partially explained the inconsistency in subtask learning. Overall, the model provided a more nuanced representation of how complex tasks can be decomposed in terms of simpler learning mechanisms.

The Assyrians

This chapter seeks to extend earlier works on Mesopotamian democracy to a civilisation that is not only typically excluded from such discussions of democracy in the ancient Near East, but generally considered to be among the region’s most bloodthirsty and bellicose: the Assyrians. On the one hand it cannot be denied that the Assyrians went through periods of aggressive expansion, that they were cruel to at least some of their enemies and that the more militant Assyrian kings struck fear into the hearts of men and women across the region (I:106-110, 113; II:1, 54-6 in: Grayson 1991: 201). On the other hand, however, it is peculiar that the intermittent war-mongering of the Assyrians is seen not only as ‘a modern myth exaggerated beyond all proportion’ (Parpola 2003: 1060), but also seen to exclude them from practicing any form of democracy. This is starkly inconsistent with the contemporary assessment of other societies of the ancient world, such as the Greeks or Romans who were both belligerent and at least nominally democratic. To give one example of this double standard, Jana Pecirkova argues that while the Greek polis enabled the birth of science, philosophy and the rule of law, the Assyrians were not able to distinguish ‘between the rational and the irrational, between reality and illusion’ (Pecirkova 1985: 155). The reason for this, according to Pecrikova, is simple: their ‘only alternative to monarchy … was anarchy … Political decisions were arbitrary in character and not governed by any laws or generally acknowledged and accepted rules’ and the ‘people were the passive subjects of political decision-making’ (Pecirkova 1985: 166-8). This chapter, while cautious not to over-state the democratic tendencies of the Assyrians, takes Pecirkova’s argument to task by examining the complex functioning of power and politics, the checks and balances on monarchical authority, the rule of law and the sophisticated intellectual scene of the three key epochs of ancient Assyrian civilisation.

Negative appraisals of insulin therapy are common among adults with Type 2 diabetes using insulin: results from diabetes MILES - Australia cross-sectional survey

AIM: To identify insulin therapy appraisals among adults with Type 2 diabetes using insulin and how negative appraisals relate to clinical, self-care and psychosocial outcomes. METHODS: Diabetes MILES - Australia 2011 was a national survey of adults with diabetes, focused on behavioural and psychosocial issues. Subgroup analyses were conducted on the responses of 273 adults with Type 2 diabetes using insulin (46% women; mean ± sd age: 59 ± 9 years; diabetes duration: 12 ± 7 years; years using insulin: 4 ± 4). They completed validated measures of insulin therapy appraisals (ITAS), depression (PHQ-9), anxiety (GAD-7), diabetes distress (PAID) and diabetes-specific self-efficacy (DES-SF). RESULTS: Insulin was perceived to be very important, and its benefits (e.g. improves health) were endorsed by most (82%). Fifty-one per cent believed that taking insulin means their diabetes has become worse; 51% that insulin causes weight gain; 39% that they have 'failed to manage' their diabetes. Those with the greatest and least 'ITAS negative' scores did not differ by diabetes duration or years using insulin, or by average number of insulin injections or blood glucose checks per day. Those with more negative insulin appraisals were significantly younger (Mean Diff. = 5 years, P < 0.001), less satisfied with recent blood glucose levels (P < 0.001, d = 0.63), had reduced diabetes-specific self-efficacy (P < 0.001, d = 0.7), and were more likely to report depressive symptoms, anxiety or diabetes distress (all P < 0.001, d = 0.65-1.1). CONCLUSIONS: Negative insulin therapy appraisals are common among adults with Type 2 diabetes using insulin, and are associated with lower general and diabetes-specific emotional well-being, reduced diabetes-specific self-efficacy and satisfaction with blood glucose.

Using care plans to better manage multimorbidity

BACKGROUND: The health care for patients having two or more long-term medical conditions is fragmented between specialists, allied health professionals, and general practitioners (GPs), each keeping separate medical records. There are separate guidelines for each disease, making it difficult for the GP to coordinate care. The TrueBlue model of collaborative care to address key problems in managing patients with multimorbidity in general practice previously reported outcomes on the management of multimorbidities. We report on the care plan for patients with depression, diabetes, and/or coronary heart disease that was embedded in the TrueBlue study. METHODS: A care plan was designed around diabetes, coronary heart disease, and depression management guidelines to prompt implementation of best practices and to provide a single document for information from multiple sources. It was used in the TrueBlue trial undertaken by 400 patients (206 intervention and 194 control) from 11 Australian general practices in regional and metropolitan areas. RESULTS: Practice nurses and GPs successfully used the care plan to achieve the guideline-recommended checks for almost all patients, and successfully monitored depression scores and risk factors, kept pathology results up to date, and identified patient priorities and goals. Clinical outcomes improved compared with usual care. CONCLUSION: The care plan was used successfully to manage and prioritise multimorbidity. Downstream implications include improving efficiency in patient management, and better health outcomes for patients with complex multimorbidities.

The new Keynesian Phillips curve in a small open economy: empirical evidence from Australia

This study estimates the new Keynesian Phillips curve (NKPC) ofGali and Monacelli for a small open economy using Australian data.Our detailed investigation hinges on estimating the structuralparameters in five different variants of the Gali–Monacelli NKPC,which relates the inflation process to terms of trade and the realexchange rate; the marginal cost and output gap as proxies for realeconomic activity and the hybrid version incorporating bothforward- and backward-looking inflation expectations. The analysisand extensive robustness checks overwhelmingly establish that theGali–Monacelli NKPC cannot explain the dynamics of inflation andis rejected by the Australian data.

Child obesity prevention in primary health care: the role of practice nurses

Aim

Overweight and obesity affects approximately 20% of Australian pre-schoolers. The general practice nurse (PN) workforce has increased in recent years; however, little is known of PN capacity and potential to provide routine advice for the prevention of child obesity. This mixed methods pilot study aims to explore the current practices, attitudes, confidence and training needs of Australian PNs surrounding child obesity prevention in the general practice setting.

Methods

PNs from three Divisions of General Practice in New South Wales were invited to complete a questionnaire investigating PN roles, attitudes and practices in preventive care with a focus on child obesity. A total of 59 questionnaires were returned (response rate 22%). Semi-structured qualitative interviews were also conducted with a subsample of PNs (n = 10).

Results

Questionnaire respondent demographics were similar to that of national PN data. PNs described preventive work as enjoyable despite some perceived barriers including lack of confidence. Number of years working in general practice did not appear to strongly influence nurses' perceived barriers. Seventy per cent of PNs were interested in being more involved in conducting child health checks in practice, and 85% expressed an interest in taking part in child obesity prevention training.

Conclusions

Findings from this pilot study suggest that PNs are interested in prevention of child obesity despite barriers to practice and low confidence levels. More research is needed to determine the effect of training on PN confidence and behaviours in providing routine healthy life-style messages for the prevention of child obesity.