A randomised controlled trial to prevent hospital readmissions and loss of functional ability in high risk older adults: a study protocol

Background Older people have higher rates of hospital admission than the general population and higher rates of readmission due to complications and falls. During hospitalisation, older people experience significant functional decline which impairs their future independence and quality of life. Acute hospital services comprise the largest section of health expenditure in Australia and prevention or delay of disease is known to produce more effective use of services. Current models of discharge planning and follow-up care, however, do not address the need to prevent deconditioning or functional decline. This paper describes the protocol of a randomised controlled trial which aims to evaluate innovative transitional care strategies to reduce unplanned readmissions and improve functional status, independence, and psycho-social well-being of community-based older people at risk of readmission. Methods/Design The study is a randomised controlled trial. Within 72 hours of hospital admission, a sample of older adults fitting the inclusion/exclusion criteria (aged 65 years and over, admitted with a medical diagnosis, able to walk independently for 3 meters, and at least one risk factor for readmission) are randomised into one of four groups: 1) the usual care control group, 2) the exercise and in-home/telephone follow-up intervention group, 3) the exercise only intervention group, or 4) the in-home/telephone follow-up only intervention group. The usual care control group receive usual discharge planning provided by the health service. In addition to usual care, the exercise and in-home/telephone follow-up intervention group receive an intervention consisting of a tailored exercise program, in-home visit and 24 week telephone follow-up by a gerontic nurse. The exercise only and in-home/telephone follow-up only intervention groups, in addition to usual care receive only the exercise or gerontic nurse components of the intervention respectively. Data collection is undertaken at baseline within 72 hours of hospital admission, 4 weeks following hospital discharge, 12 weeks following hospital discharge, and 24 weeks following hospital discharge. Outcome assessors are blinded to group allocation. Primary outcomes are emergency hospital readmissions and health service use, functional status, psychosocial well-being and cost effectiveness. Discussion The acute hospital sector comprises the largest component of health care system expenditure in developed countries, and older adults are the most frequent consumers. There are few trials to demonstrate effective models of transitional care to prevent emergency readmissions, loss of functional ability and independence in this population following an acute hospital admission. This study aims to address that gap and provide information for future health service planning which meets client needs and lowers the use of acute care services.

Organic consumers' attitudes and preferences regarding alternatives to piglet castration without anaesthesia and analgesia in organic farming - an explorative analysis

In Germany and other European countries piglets are routinely castrated in order to avoid the occurrence of boar taint, an off-flavour and off-odour of pork. Sensory perception of boar taint varies; however, it is regarded as very unpleasant by many people. Surgical castration which is an effective means against boar taint has commonly been performed without anaesthesia or analgesia within the piglets’ first seven days of life. Piglet castration without anaesthesia has been heavily criticised, as the assumption that young piglets perceive less pain than older animals cannot be supported by scientific evidence. Consequently, surgical castration is only allowed with anaesthesia and/or analgesia in organic farming throughout the European Union since January 2012. Abandoning piglet castration without pain relief requires the implementation of alternative methods which improve animal welfare while maintaining sensory meat quality. There are three relevant alternatives: castration with anaesthesia and/or analgesia to reduce pain, a vaccination against boar taint (immunocastration) and the fattening of uncastrated male pigs (fattening of boars) combined with measures to reduce and detect boar taint in meat. Consumers’ attitudes and opinions regarding the alternatives are an important factor with regard to the implementation of alternatives, as they are finally supposed to buy the meat. The objective of this dissertation was to explore organic consumers’ attitudes, preferences and willingness-to-pay regarding piglet castration without pain relief and the three alternatives. Important aspects for the evaluation of the alternatives and influencing factors (e.g. information, taste) on preferences and willingness-to-pay should also be identified. In autumn 2009 nine focus group discussions were conducted each followed by a Vickrey auction including a tasting of boar salami. Overall, 89 consumers of organic pork participated in the study. Information on piglet castration and alternatives (in three variants) was provided as a basis for discussion. The focus group data were analysed using qualitative content analysis. In order to compare the focus group results with those from the auctions, an innovative approach applying an adapted scoring model to further analyse the data set was used. The majority of participants were not aware that piglets are castrated without anaesthesia in organic farming. They reacted shocked and disappointed on learning about this practice which did not fit into their image of animal welfare standards in organic farming. Overall, the results show, that for consumers of organic pork castration with anaesthesia and analgesia as well as the fattening of boars may be acceptable alternatives in organic farming. Considering the strong food safety concerns regarding immunocastration, acceptance of this alternative may be questioned. Communication regarding alternatives to piglet castration without anaesthesia and analgesia should take into account that the relevance of the aspects animal welfare, food safety, taste and costs differs between alternatives. Furthermore, it seems advisable not to address an unappetizing topic like piglet castration directly at the point of sale so as not to deter consumers from buying organic pork. The issue of piglet castration demonstrates exemplarily that it is important for the organic sector to implement and maintain high animal welfare standards and communicate them in an appropriate way, thereby trying to prevent strong discrepancies between consumers’ expectations regarding animal husbandry in organic farming and actual conditions. So, disappointment of consumers and a loss of image due to negative reports about animal welfare issues can be avoided.

The effects of an apparent breach of therapeutic regulations on consumers: the Pan Pharmaceuticals recall

The aim of this study was to assess how demographic variables and personal values are related to people's knowledge and cognitive and behavioural responses towards a major drug recall event that occurred in Australia in 2003. For this purpose, a survey was sent out in 2003 to 1000 households in Victoria, Australia. Households had been randomly selected from the electoral role. A total of 415 respondents participated. Results indicated that higher socioeconomic status was related to better information about the recall event and more trust in manufacturers. Respondents who held traditional or naturalistic values were likely to trust that faults in the system would be regulated by the government or consumers themselves. Parents and older respondents were more likely to be critical of the Therapeutic Goods Administration which co-ordinated the recall. Parental status, education and values were related to subsequent changes in respondents' use of complementary medicines. In light of the worth of the health supplement industry to the Australian economy, the results of this survey suggest that the Therapeutic Goods Administration should adopt a more transparent and accountable role towards the public.

Understanding the older food consumer, present day behaviours and future expectations

The main aim of this study was to determine whether Baby boomers know how they would manage to maintain a healthy diet on lower incomes in retirement. A cross-sectional survey was conducted at two shopping centres in Melbourne, Australia with 352 respondents. Contingency table analyses (using chi-square tests) were used to examine differences in present and future cooking habits between gender, age and socio-economic groups as well as anticipated changes to food shopping if they had less money in the future. The findings suggest that the most common food preparation behaviours were making meals from scratch ingredients (80% of participants) or using a combination of fresh and convenience foods (55% of participants), with socio-economic and demographic factors significantly influencing specific behaviours. Nearly 50% responded that if they had reduced income they would make a change to their food shopping habits. The most common changes were to the types of food purchased and seeking out special offers or cheaper brands. The results suggest that when faced with a lower standard of living, people will make changes to their food consumption habits. The challenge facing health promotion practitioners, is to ensure that these changes are well informed, leading to healthy options.

Australian consumers' food-related environmental beliefs and behaviours

The aim of this study was to examine Australians’ food-related environmental beliefs and behaviours. Questionnaires were posted to 500 randomly selected adults, with 223 questionnaires completed (58% response rate). Decreased use of packaging by food manufacturers was viewed as being the most important item to help the environment, while lower meat consumption was seen as least likely to help. Composting food scraps and purchase or consumption of locally produced foods were the most commonly performed food-related environmental behaviours, while use of organic products was the least commonly performed. Moderate consistency (r_s=0.54) was found between reported beliefs and behaviours. Older people were more likely to perform certain food-related environmental behaviours, such as composting. Awareness of the impact on the environment of meat production, organic compared to conventional farming, and food packaging was low even among those who were found to already believe that food-related actions are important to help the environment, suggesting widespread consciousness raising is needed.

The influence of materialism on consumption indebtedness in the context of low income consumers from the city of São Paulo

This research is in the domains of materialism, consumer vulnerability and consumption indebtedness, concepts frequently approached in the literature on consumer behavior, macro-marketing and economic psychology. The influence of materialism on consumer indebtedness is investigated within a context that is characterized by poverty and by factors that cause vulnerability, such as high interest rates, limited access to credit and to quality affordable goods. The objectives of this research are: to produce a materialism scale that is well adapted to its environment, characterizing materialism adequately for the population studied; to compare results obtained with results of other studies; and to measure the relationship between materialism, socio-demographic variables, attitude to debt and consumption indebtedness. The primary data used in the analyses were collected from field research carried out in August, 2005 that relied on a probabilistic household sample of 450 low income individuals who live in poor regions of the city of Sao Paulo. The materialism scale, adapted and translated into Portuguese from Richins (2004), proved to be very successful and encourages new work in the area. It was noted that younger adults tend to be more materialistic than older ones; that illiterate adults tend to be less materialistic than those who did literacy courses when they were already adults; and that gender, income and race are not associated with the materialism construct. Among the other results, a logistic regression model was developed in order to distinguish those individuals who have an installment plan payment booklet from those who do not, based on materialism, socio-demographic variables and purchasing and consumer habits. The proposed model confirms materialism as a behavioral variable useful for forecasting the probability of an individual getting into debt in order to consume, in some cases almost doubling the chance of occurrence of this event. Findings confirm the thesis that it is not only adverse economic factors that lead people to get into debt; and that the study of demand for credit for consumption purposes must, of necessity, include variables of a psychological nature. It is suggested that the low income materialistic consumer experiences feelings of powerlessness and exclusion because of the gap that exists between their possessions and their desires. Lines of conduct to combat this marginalization from the consumer society are drawn targeting marketing professionals, public policy makers and vulnerability researchers. Finally, the possibility of new studies involving the materialism construct, which is central to literature on consumer behavior, albeit little used in empirical studies in Brazil, are discussed.

The Influence of Informational and Emotional Advertising Appeals on Advertising Effectiveness – Consumers’ Perspective on the Over-the-Counter Product Advertisements in Finland

Consumers face enormous amounts of promotional messages daily whereas the pharmaceutical companies among other industries spend considerable time and money developing effective advertising strategies. There are multiple possible ways to appeal the target customer in order to increase the effectiveness of the advertisement. In spite of the various possibilities to categorize persuasive communication, the informational and the emotional appeals are the typical approaches. This study assesses the influence of the informational and emotional advertising appeals on the advertising effectiveness in the context of OTCs in Finland. The research method applied in this study is a quantitative survey. The data consists of 461 responses from the target population of 18–80 years old Finnish speaking consumers. The results from the marketing research indicate that the positive correlations of the emotional appeals are much stronger than the positive correlations of the informational appeals relating to the advertising effectiveness. However, on average the Finnish consumers experience the OTC advertisements relying on the informational appeals more effective than the OTC advertisements relying on the emotional appeals. Furthermore, within emotional appeals there is a much greater variety in the experienced advertising effectiveness not providing as stabile and consistent experienced advertising effectiveness compared to the informational appeals. Thus, the OTC advertisement relying more on the emotional appeals are much more risky in terms of advertising effectiveness. There are also differences with the experienced advertising effectiveness between the Finnish consumer groups and the information can be utilised when designing tailored OTC advertisements. The Finnish men consider humorous advertisements more effective than the Finnish women. In addition, the people living outside Uusimaa Region experience higher advertising effectiveness with the advertisements relying more on the informational advertisements compared to the people living in Uusimaa Region. In similar vein, the people with lower education experience higher advertising effectiveness with the advertisements relying more on the informational advertisements compared to the people with high education. Additionally, the older generation perceive an OTC advertisement with a middle-aged celebrity more effective than the younger consumers