Community center-based resistance training for the maintenance of glycemic control in adults with type 2 diabetes

OBJECTIVE--The purpose of this study Was to determine whether beneficial effects on glycemic control of an initial laboratory-supervised resistance training program could be sustained through a community center-based maintenance program.

RESEARCH DESIGN AND METHODS--We studied 57 overweight (BMI [greater than or equal to] 27 kg/[m.sup.2]) sedentary men and women aged 40-80 years with established (>6 months) type 2 diabetes. Initially, all participants attended a twice-weekly 2-month supervised resistance training program conducted in the exercise laboratory. Thereafter, participants undertook a resistance training maintenance program (2 times/week) for 12 months and were randomly assigned to carry this out either in a community fitness and recreation center (center) or in their domestic environment (home). Glycemic control ([HbA.sub.1c] [A1C]) was assessed at 0, 2, and 14 months.

RESULTS--Pooling data from the two groups for the 2-month supervised resistance training program showed that compared with baseline, mean A1C fell by -0.4% [95% CI -0.6 to -0.2]. Within-group comparisons showed that A1C remained lower than baseline values at 14 months in the center group (-0.4% [-0.7 to -0.03]) but not in the home group (-0.1% [-0.4 to 0.3]). However, no between-group differences were observed at each time point. Changes in A1C during the maintenance period were positively associated with exercise adherence in the center group only.

CONCLUSIONS--Center-based but not home-based resistance training was associated with the maintenance of modestly improved glycemic control from baseline, which was proportional to program adherence. Our findings emphasize the need to develop and test behavioral methods to promote healthy lifestyles including increased physical activity in adults with type 2 diabetes.

Investigating health, economic and socio-political factors that need consideration when establishing Victorian Aboriginal land management projects

This article focuses on three Victorian Aboriginal¹ groups (Bangerang, Boonwurrung and Yorta Yorta) to explore elements that provide or discourage development of land management projects. Results from this small qualitative study show that a number of distinct health, socio-political and economic factors need to be considered when developing Aboriginal land management projects. This study indicates that a greater involvement in Aboriginal land management projects -- critical to Aboriginal peoples' health, economic and social structures - will only occur through increased community consultation, respect, training, consistency between all stakeholders involved, resources and the provision of employment opportunities. Further research is required to strengthen this evidence, allowing policy-makers to be progressive when developing land management projects for Aboriginal Victorian people as a health promoting tool.

Developing a rural and regional science challenge to utilise community and industry-based partnerships

Interest and participation in science in schools has been declining for many years and there is a genuine need to rejuvenate interest in science at the high school level. One possible solution is the completion of challenging science projects which fulfill an authentic purpose in the community. This paper discusses the results of ongoing research into the establishment of a rural and regional Science Challenge which makes use of partnerships with local industries and community groups to encourage the development of authentic science projects. In the development of the Science Challenge, many issues are emerging in relation to teachers' work, resources, administration and school cultures. This paper reports on the preliminary findings and indicates directions for the future.

Rebuilding regimes or rebuilding community? Teachers' agency for social reconstruction

Non-government organisations (NGOs) are playing an increasingly significant role in post-conflict situations as donor funding pours into rebuilding programs. Donor funding supports the development of a range of humanitarian and civic programs such as peace restoration, civic reconstruction and peace-keeping. This article is a case study of the rebuilding of the education system in post-conflict Iraq that contextualises the activities sanctioned by new regime and aid agencies in post-conflict Iraq. While the war and crisis in Iraq continues to fuel great debate, a full political discussion falls outside the scope of this paper. Instead, the intention is to unpack the way that the dominant regime rehabilitates the education system in a seemingly apolitical way. Attempts to rebuild the Iraqi education system appear to be a case of the separation of political rehabilitation and social reconstruction. As the need for the new regime to assert political legitimacy grows, an institution such as education experiences vast changes as local educational practices are restructured to complement the new regime. In this process, the local teachers and their cultural and educational expertise are overshadowed by the ‘neutral’ politics of reconstruction. However, the rebuilding of education systems is a political process, the politics of which are evident in the way that critical agents, such as teachers, are being reshaped in the image of the new regime. Teachers have the capacity to contribute to the long-term social and cultural rebuilding of post-conflict nations through their broad social and educational agency. However, the educational policy and plans of regime-sponsored funding effectively marginalise the important role of local educators in the civic rebuilding. Teachers’ agency in Iraq is being overlooked as a means of using educators as peace-keepers who can build long-term educational capacity and stability in the post-conflict situation.

The need for treaty-based e-consumer protections in global B2C e-commerce

The thesis puts forward historical, logical and efficiency arguments for the implementation of treaty-based legal protections for e-consumers transacting in global Business to Customer (B2C) e-commerce. It concludes, however, that the international political climate is such that the implementation by the international community of such protections is very unlikely in the near future.

Re-engagement in education through community partnerships in south west Victoria

This case study provided policy direction for post-compulsory education. It highlighted the need for a mandated responsibility for the provision of on-going transition advice and re-engagement programs for young people who have left school. It confirmed the complexity of the work of networks formed in order to improve educational pathways.

Improving the coordination of care for low back pain patients by creating better links between acute and community services

This paper reports on the development of a care-pathway to improve service linkages between the acute setting and community health services in the treatment of low back pain. The pathway was informed by two processes: (1) a literature review based on best-practice guidelines in the assessment, treatment and continuity of care for low back pain patients; and (2) consultation with staff and key stakeholders. Stakeholders from both the acute and community sectors comprised the Working Group, who identified central areas of concern to be addressed in the care-pathway, with the goal of preventing chronicity of low back pain and reducing emergency department presentations. The main outcomes achieved include: the development of a new care-coordinator role, which would support a greater focus on integration between acute and community sectors for low back pain patients; identifying the need to screen at-risk patients; implementation of the SCTT (Service Coordination Tool Templates) tool as a system of referral across the acute and community settings; and agreement on the need to develop an evidence-based self-management program to be offered to low back pain patients. The benefits and challenges of implementing this care pathway are discussed.

Engaging community pharmacists in the primary prevention of cardiovascular disease : protocol for the pharmacist assessment of adherence, risk and treatment in cardiovascular disease (PAART CVD) pilot study

Background: Cardiovascular disease (CVD) is the leading cause of death globally. Community pharmacist intervention studies have demonstrated clinical effectiveness for improving several leading individual CVD risk factors. Primary prevention strategies increasingly emphasise the need for consideration of overall cardiovascular risk and concurrent management of multiple risk factors. It is therefore important to demonstrate the feasibility of multiple risk factor management by community pharmacists to ensure continued currency of their role.
Methods/Design: This study will be a longitudinal pre- and post-test pilot study with a single cohort of up to 100 patients in ten pharmacies. Patients aged 50-74 years with no history of heart disease or diabetes, and taking antihypertensive or lipid-lowering medicines, will be approached for participation. Assessment of cardiovascular risk, medicines use and health behaviours will be undertaken by a research assistant at baseline and following the intervention (6 months). Validated interview scales will be used where available. Baseline data will be used by accredited medicines management pharmacists to generate a report for the treating community pharmacist. This report will highlight individual patients’ overall CVD risk and individual risk factors, as well as identifying modifiable
health behaviours for risk improvement and suggesting treatment and behavioural goals. The treating community pharmacist will use this information to finalise and implement a treatment plan in conjunction with the patient and their doctor. Community pharmacists will facilitate patient improvements in lifestyle, medicines adherence, and medicines management over the course of five counselling sessions with monthly intervals. The primary outcome will be the change to average overall cardiovascular risk, assessed using the Framingham risk equation.
Discussion: This study will assess the feasibility of implementing holistic primary CVD prevention programs into community pharmacy, one of the most accessible health services in most developed countries.

Scope of practice of occupational therapists working in Victorian community health settings

Background/aim: Current health policy places emphasis on community-based health care and it is expected that there will be an increase in the number of people receiving care in community settings. This study aimed to examine the profile and scope of practice of occupational therapists working in Victorian community health settings and the amount and type of health promotion activity incorporated into their role.
Method:  An anonymous postal questionnaire was sent to 205 community-based Victorian occupational therapists. One hundred and one (49.3% response rate) questionnaires were returned, with 72 respondents (35.1%) meeting study inclusion criteria. A descriptive research design was used to address study aims.
Results:  Results indicate that the majority of community health occupational therapists are experienced practitioners, have a varied scope of practice and report a high level of job satisfaction. Compared with previous studies, there is an increase in new graduate occupational therapists starting their career in community health settings, a greater number of part-time workers and a diversification of clinical and non-clinical roles. Barriers to practice that exist include high demand for service, limited funding and time spent on administrative tasks. Although health promotion was regarded as an important role of community health workers, a large number of therapists were not involved in this activity because of limited knowledge and clinical work taking priority.
Conclusion: Study findings have implications for occupational therapy training, and there is a clear need for input at policy level to address the significant resource allocation issues raised.

Supporting information needs of senior citizens in community aged care

To address the challenge of an ageing population in an information society, it is important to introduce information systems to assist the aged people in maintaining and improving their quality of life. An understanding of what information aged people need, how they seek and use information, and how they adopt Information and Communication Technology (ICT) is required. This paper reports the findings of an empirical study undertaken in Australia to understand the information needs of senior citizens who reside in the community. The study aims to understand how ICT can support the independent living of senior people in the community from both the social and health perspectives. We offer a new understanding of the information needs of aged people in the community and extend the information systems research in aged care. This research also contributes to the development of innovative ICT enabled aged care service solutions in community aged care.

An evaluation of a mental health screening and referral pathway for community nursing care : nurses' and general practitioners' perspectives

Aims and objectives. To evaluate a feasible, best practice mental health screening and referral clinical pathway for generalist community nursing care of war veterans and war widow(er)s in Australia.
Background. War veterans commonly experience mental health difficulties and do not always receive required treatment, as can also occur for war widow(er)s. Whenever opportunity arises, such as during community nursing care, it is vital to identify mental health problems in a health promotion framework.
Design. A clinical pathway was developed by literature review and consultation and then trialled and evaluated using mixed methods – quantitative and qualitative.
Methods. Community nurses who trialled the pathway completed an evaluation survey and attended focus groups. General practitioners responded to an evaluation survey.
Results. Most nurses found the pathway clear and easy to understand but not always easy to use. They emphasised the need to establish trust and rapport with clients prior to implementing the pathway. It was sometimes difficult to ensure effective referral to general practitioners for clients who screened positive for a mental health problem. When referral was accomplished, general practitioners reported adequate and useful information was provided. Some general practitioners also commented on the difficulty of achieving effective communication between general practitioners and nurses.
Conclusions. Nurses and some general practitioners found the pathway useful for their practice. They offered several suggestions for improvement by simplifying the trialled pathway and accompanying guidelines and strategies to improve communication between nurses and general practitioners. This study adds understanding of how community nurses might productively screen for mental health difficulties.
Relevance to clinical practice. The trialled pathway, which was modified and refined following the study, is an evidence-based
resource for community nurses in Australia and similar contexts to guide practise and maximise holistic care for war veterans and war widow(er)s and possibly other client groups.

Information needs in community aged care

This paper focuses on the information needs and behaviours of senior citizens and their carers in the community. Two case studies concerning elderly stroke patients and their carers are described and discussed. Analysis of the case study data reveals a number of themes including the actual information needs and information behaviours of the senior citizens, the importance of proxy information seekers and advocates and the need for usable, accessible and useful tool to support the needs of care recipients. A preliminary framework is developed that highlights important aspects of supporting the information needs of care recipients and carers in community aged care. Finally we suggest opportunities for technology interventions that address various information needs of senior citizens in the community.

Strengthening work integrated learning (WIL) experiences for rural education students : exploring community based partnerships

This paper investigates three areas of priority for rural teacher education: work integrated learning (WIL); attraction and retention of teachers to rural areas; and the potential challenges and benefits of community based partnerships to address these areas of need. The data on which this paper is based focuses on a Victorian project around six case studies that explored the research and scholarship of teaching graduates to be work ready for the needs of rural and regional communities. The project also aimed to explore how preservice teacher education can develop and better support pre-service teachers (PSTs) through rural and regional community-based WIL experiences.
The project investigated what sort of support PSTs undertaking WIL experiences in rural and regional communities need in order to develop positive attitudes and understandings in relation to working in a rural/regional community. Consideration was also given to how support from the university, school,
supervising teacher and broader local community enhances or detracts from the PST’s experience of WIL in rural and regional areas. In order to explore these issues in this paper the authors will outline some recommendations with regards to ways in which teacher education programs may enhance the experiences of stakeholders involved in rural and regional WIL experiences, including PSTs, supervising teachers, university teacher educators and community members.
The project’s underlying conceptual framework of place, productivity and partnerships will be explained in terms of its overlapping dimensions of community, creativity and capital in order to reconceptualise preservice teacher education in local, rural and regional and global contexts as adaptive community-based work integrated learning within a knowledge economy.
The final discussion will make recommendations on how universities and other identified stakeholders can better facilitate WIL and enhance stakeholder engagement in rural and regional areas in order to equip PSTs
and classroom teachers to work creatively together in productive partnerships to meet the future demands of local rural and global contexts of change in a knowledge economy.

Perceptions of climate change and adaptation responses in a local community : the Barwon Estuary Complex, Victoria

The climate change focus in Australia has shifted from mitigation to adaptation with an emphasis on place-specific case studies. The Barwon Estuary Complex (BEC) on the Bellarine Peninsula, central Victoria, was the focus of this place-specific study in which 37 local stakeholders were consulted through a series of semi-structured interviews on the impacts of climate change on their coastal community. Overall there was uniformity in stakeholder perceptions of the climate change impacts and vulnerabilities pertaining to the BEC. In contrast, discussion on adaptation drew a diversity of responses. While 53 per cent of stakeholders indicated a need to limit the use of hard structures, and rather plan around a changing estuarine environment, opinion amongst the community group was divided. Some believed ‘retreat is the only option’ whilst others felt ‘there won’t be much leaving’. The present level of confusion around adaptation highlights the imperative of commencing discussions now to allow sufficient time to develop strategies which are both environmentally and socially responsible. This is important as ultimately it will be the community that will determine whether adaptation strategies are adopted or met with resistance.

Provocation in New South Wales : the need for abolition

Over the past two decades significant debate has emerged surrounding the operation of the partial defence of provocation. Such debates have led to its abolition in several Australian and international jurisdictions where Government and Law Commission bodies have argued that provocation has operated in a gender biased way that is no longer reflective of community values and expectations of justice. In contrast to the Australian states of Tasmania, Victoria and Western Australia, who have transferred consideration of provocation to sentencing, New South Wales (NSW) has retained provocation as a partial defence to murder. Drawing upon in-depth interviews conducted with legal stakeholders and an analysis of recent case law, this article considers whether the operation of provocation in NSW is still in the best interests of justice, and, specifically, whether in practice it privileges one gender above the other. This research concludes that the continued operation of provocation in NSW raises key issues surrounding the legitimisation of male violence against women, the denial and minimisation of the harm caused by lethal domestic violence, and the continued inability of the law to appropriately respond to women who kill in the context of prolonged family violence.