What is important for you? A qualitative interview study of living with diabetes and experiences of diabetes care to establish a basis for a tailored Patient-Reported Outcome Measure for the Swedish National Diabetes Register

OBJECTIVES: There is a growing emphasis on the perspective of individuals living with diabetes and the need for a more person-centred diabetes care. At present, the Swedish National Diabetes Register (NDR) lacks patient-reported outcome measures (PROMs) based on the perspective of the patient. As a basis for a new PROM, the aim of this study was to describe important aspects in life for adult individuals with diabetes. DESIGN: Semistructured qualitative interviews analysed using content analysis. SETTING: Hospital-based outpatient clinics and primary healthcare clinics in Sweden. PARTICIPANTS: 29 adults with type 1 diabetes mellitus (DM) (n=15) and type 2 DM (n=14). INCLUSION CRITERIA: Swedish adults (≥18 years) living with type 1 DM or type 2 DM (duration ≥5 years) able to describe their situation in Swedish. Purposive sampling generated heterogeneous characteristics. RESULTS: To live a good life with diabetes is demanding for the individual, but experienced barriers can be eased by support from others in the personal sphere, and by professional support from diabetes care. Diabetes care was a crucial resource to nurture the individual's ability and knowledge to manage diabetes, and to facilitate life with diabetes by supplying support, guidance, medical treatment and technical devices tailored to individual needs. The analysis resulted in the overarching theme 'To live a good life with diabetes' constituting the two main categories 'How I feel and how things are going with my diabetes' and 'Support from diabetes care in managing diabetes' including five different categories. CONCLUSIONS: Common aspects were identified including the experience of living with diabetes and support from diabetes care. These will be used to establish a basis for a tailored PROM for the NDR.

Levels and family correlates of positive adolescent development: A cross national comparison

The article examines the levels of positive school engagement, and family characteristics associated with engagement, in adolescents in Australia and the United States. There are several modifiable family characteristics related to positive behavior. These include parents boosting both rewards for and opportunities to participate in prosocial activities, and the importance of expressing clear disapproval of antisocial behavior and drug use. Family management practices and family conflict influence adolescents' views about school and home and need to be addressed. There is evidence of the validity of ecological approaches to development, which underscores the inter-relationships between young people's developmental contexts.

Be the Change You Wish to See: National Attiudes and Climate Change Policy

A multitude of views characterize what should or should not be done about climate change, and in the past decades, nations have acted very differently in the face of climate change. This study explores factors that affect individuals' attitudes and concerns towards the environment and how those attitudes ultimately affect climate change policy. One model investigates the link between individual attitudes and countries' actions on climate change, and the results show that attitudes indeed matter in the implementation of policy. Different measures of democracy such as freedom of the press also prove to be important as channels for these attitudes. A second model identifies a number of political, socioeconomic and demographic characteristics that matter for people's attitudes towards climate change.

Greek shipping and the crisis of the 1980's

In 1982, Greek shipping plunged into a severe crisis: the size of the fleet declined dramatically and over 30% of the fleet was laid-up. catapulting many shipping companies into bankruptcy. The causes of the crisis were: The world recession, leading to regulation, protectionism, subsidization. and the growth of new competition in the tramp shipping market. The erosion of the cost differential between Greek shipping and other maritime nations of the world. The specialization and containerization of the world fleet. The old age and other characteristics of the Greek fleet, which exacerbated the crisis. Greek shipping, with its long history and the expertise, diligence, and supreme opportunism of its dynamic shipowners, will survive the crisis.

The prevalence and selected characteristics of non-fatal opioid overdoses attended by ambulance in Australia

Key Points
1. Ambulance attendance at non-fatal opioid overdose is a common event in mainland Australia (among heroin users in particular).
2. The monthly rate of non-fatal opioid overdose attended by ambulance was generally highest in Victoria (Melbourne) followed by NSW with the rates substantially lower in the remaining mainland states over the period Jan  1999 - Feb 2001.
3. Non-fatal opioid overdose victims were most likely to be male in all states with the proportion of males highest in Victoria (77%).
4. Non-fatal opioid overdose victims were aged around 28 years with ages lowest in WA (26) and highest in NSW (30).
5. The rates of transportation varied according to ambulance service practice across the states with around 94% of cases transported in WA and around 19% and 30% of cases transported in Melbourne and NSW respectively.

Heterogeneity in service delivery and inequity in access are common characteristics of chronic heart failure management programs

Background: The prevalence of heart failure in Australia is similar to that of Europe. In Australia, chronic heart failure management programs (CHF-MPs) have become part of standard care for patients with Chronic Heart Failure (CHF). However, heterogeneity among programs is common which can result in variable patient outcomes.

Method: A national survey was undertaken of 59 post-discharge CHF-MPs identified from within the Australian health care system. Two had ceased operating and one centre declined to participate in the study. A 33-item investigator-developed questionnaire, examining the characteristics and interventions used within each CHF-MP, was sent to the remaining 56 CHF-MPs. A response rate of 100% was achieved.

Results: Our survey revealed a disproportional distribution of CHF-MPs across the Australian continent: the State of Victoria had 3.6 CHF-MPs/million population, New South Wales had 3.7 CHF-MPs/million population, Queensland had 1 program/million population, South Australia had 0.3 CHF-MPs/million population and Western Australia had 1 program/million population.Overall, 8000 postdischarge CHF pts (median: 126; IQR: 26-260) were managed via CHF-MPs. Approximately 40,000 CHF pts are discharged from metropolitan institutions nationally, this represents only 22% of the potential caseload for these cost-effective CHF-MPs. Only 8% of these programs were located within rural regions. The majority of CHF-MPs were located within an acute metropolitan hospital (52%) and 36% were community based (all associated with a hospital). Heterogeneity of CHF-MPs in applied models of care was evident with 75% of CHF-MPs offering CHF outpatient clinics and 77% conducting home visits. Of the programs offering home visits 78% were funded by regional government (p<0.048). There were no nurse-led CHF outpatient clinics. A hybrid approach to CHF-MPs was common with many CHF-MPs comprising an outpatient clinic, home visits and inpatient visits. Various medications were titrated by nurses in 43% of CHF-MPs. In the programs that allowed nurses to titrate medications 79% were located in an acute hospital (p<0.011).

Conclusion: Variability of service availability is of concern within the context of universal coverage. In addition, heterogeneity between programs and the diversity in models of care delivery highlights the inconsistency and questions the quality of health related outcomes. We are currently analysing health outcome data from the 1015 patients managed in these CHF-MPs to describe the relationship between quality of care and health outcomes.

Range extension of the Millewa Skink Hemiergis millewae in the Murray-Sunset National Park, Victoria

This article reports a range extension for the critically endangered Millewa Skink Hemiergis millewae in Victoria. An individual H. millewae was found approximately 85 km east of its former known range in mature mallee vegetation, near the eastern edge of the Murray-Sunset National Park on 27 March 2007. Site characteristics are described, and a list of other reptile species found at the same site is provided. Further research into the habitat associations and distribution of H. millewae is recommended in order to guide the management of this species.

The demography of investor heaven : a synthesis of international research on the characteristics, attitudes, and investment behaviour of business angels

The purpose of this paper was to compile and compare the findings of all robust international research providing national profiles of business angels (informal venture capitalists). At the outset, it was not clear how comparable studies would be and, as the project advanced, it became clear that few direct comparisons would be possible. Nevertheless, there were broad categories common to many studies and consequently a template was developed and used to summarise each study in a consistent format. The resulting report thus provides a summary of the data across 16 studies covering 9 different countries, with key points from the findings of each study.

This is by no means an elegant report, but the authors believe it is a useful one. It provides a compendium of international angel research neatly bundled in one package. It should benefit anyone considering conducting the first study of business angels for their country or building on research already completed.

Twice born : Dionysos films and the establishment of Greek film circuit in Australia

From the late 1940s until the late 1970s Melbourne was home to a dynamic Greek cinema circuit made up of some 30 different inner-city and suburban venues operated by a handful of vertically integrated exhibition/distribution businesses. Dionysos Films was amongst the first Greek film exhibition/distribution companies to form in Australia and from 1949 until 1956 it operated with little significant competition, establishing the parameters for a diasporic Greek film circuit that stretched across regional and metropolitan Australia and into New Zealand. This article measures the shadow cast by Dionysos Films (and its charismatic proprietor Stathis Raftopoulos) over the history of Antipodean Greek film experiences and the implications that this neglected aspect of Australian and Greek film history has for our understanding of the national cinemas in both countries.

Patterns of alcohol use and associated physical and lifestyle characteristics according to new Australian guidelines

Objective: To describe the pattern of alcohol consumption and associated physical and lifestyle characteristics in a population-based sample of Australian men.
Method: A community-based age-stratifi ed random sample of 1420 men (median age 56 years, range 20 – 93) participating in the Geelong Osteoporosis Study, an epidemiological study set in south-eastern Australia. Daily alcohol intake was ascertained from a detailed food frequency questionnaire and categorized according to the Australian National Health and Medical Research Council 2009 guidelines (non-drinkers, greater than zero but ≤ 2 drinks per day, > 2 drinks per day), with a standard drink equivalent to 10 g of ethanol. Anthropometry was measured and lifestyle factors self-reported. Body composition was determined using dual energy absorptiometry. Socio-economic status was categorized according to the Australian Bureau of Statistics data. Results were age standardized to the Australian male population figures.
Results: The median daily ethanol consumption was 12 g (IQR 2 – 29) per day with a range of 0 – 117 g/day. The age-standardized proportion of non-drinkers was 8.7%, 51.5% consumed up to two drinks per day ( ≤ 20 g ethanol/day), and 39.9% exceeded 2 standard drinks per day ( > 20 g ethanol/day). Alcohol consumption was positively associated with cigarette smoking, weight, higher SES and inversely with age and physical activity.
Conclusions: Approximately, 40% of Australian men consume alcohol at levels in excess of current recommendations, which in combination with other risk factors may adversely impact upon health.

Accounting for the multidimensional nature of the relationship between adult obesity and socio-economic status : the French second National Individual Survey on Food Consumption (INCA 2) dietary survey (2006–07)

The objective was to study the multidimensional nature of the relationship between adult obesity (OB) and socio-economic status (SES),
using comprehensive indices of SES taken separately or synthesised in an overall index. A nationally representative sample of adults aged
18–79 years was taken from the French second National Individual Survey on Food Consumption (INCA 2) dietary survey (2006–07).
Weight and height were measured and OB defined as BMI $ 30 kg/m². SES variables were reported in questionnaires and included
occupation, education and characteristics of household wealth. Composite indices of SES (household wealth and overall SES indices)
were computed by correspondence analysis, and relationships with OB were investigated with logistic regression analysis. In total, 11·8
(95% CI 10·1, 13·4) % of French adults were obese, without significant difference by sex. While no significant relationship was observed
in men, all SES indicators were inversely correlated to OB in women. Both education and the household wealth index were retained in the
stepwise multivariate model, confirming that different socio-economic variables are not necessarily proxies of each other regarding the OB
issue. On the other hand, ‘controlling for SES’ while including several measures of SES in multivariate models may lead to collinearity, and
thus over-adjustment. A more integrative approach may be to derive a synthetic index by including the SES factors available in a given
study. Beyond this methodological perspective, understanding how OB is related to the different dimensions of SES should help to
target the more vulnerable groups and increase the effectiveness of prevention.

The needs, concerns and characteristics of younger Australian adults with Type 2 diabetes

Aims : The mean age of onset of Type 2 diabetes mellitus is decreasing in Australia and internationally. We conducted an internet-based survey to improve our understanding of the emotional well-being and unmet needs of younger adults with Type 2 diabetes, and to inform service provision for this group.

Methods : A random sample of National Diabetes Services Scheme registrants (n = 1,417) with Type 2 diabetes, aged 18–39 years, living in the Australian state of Victoria received an invitation to complete the online survey. The study was also advertised state-wide. The survey included validated scales (PAID-5: diabetes-related distress; WHO-5: general emotional well-being) and study-specific items. A total of 149 eligible respondents participated.

Results : Almost two-thirds (63%) of respondents reported severe-diabetes related distress; more than a quarter (27%) had impaired general emotional well-being. Most (82%) were overweight or obese (BMI ≥ 25); most (77%) had at least one other co-morbidity. Lack of motivation, feeling burned out, and being time-poor were identified as top barriers to self-management. More than half (59%) of respondents had not participated in structured diabetes education. Respondents perceived that younger adults with Type 2 diabetes had different health-care needs than their older counterparts (68%), and that most Type 2 diabetes information/services were aimed at older adults (62%). Of a range of potential new services, respondents indicated greatest interest in an online forum specifically for younger adults with Type 2 diabetes.

Conclusions : Younger adults with Type 2 diabetes have impaired emotional well-being and physical health. Population-based research is needed to confirm the current findings, to further inform service delivery and optimise outcomes for this group.

Spoken mathematics as a distinguishing characteristics of mathematics classrooms in different countries

This paper reports research into the occurrence of spoken mathematics in some well-taught classrooms in Australia, China (both Shanghai and Hong Kong), Japan, Korea and the USA. The analysis distinguished one classroom from another on the basis of public “oral interactivity” (the number of utterances in whole class and teacher-student interactions in each lesson) and “mathematical orality” (the frequency of occurrence of key mathematical terms in each lesson). Our concern in this analysis was to document the opportunity provided to students for the oral articulation of the relatively sophisticated mathematical terms that formed the conceptual content of the lesson. Classrooms characterized by high public oral interactivity were not necessarily sites of high mathematical orality. The contribution of student-student conversations also varied significantly. Of particular interest are the different learning theories implicit in the role accorded to spoken mathematics in each classroom.