Resilience in chronic disease : the relationships among risk factors, protective factors, adaptive outcomes, and the level of resilience in adults with diabetes

Background: There are innumerable diabetes studies that have investigated associations between risk factors, protective factors, and health outcomes; however, these individual predictors are part of a complex network of interacting forces. Moreover, there is little awareness about resilience or its importance in chronic disease in adulthood, especially diabetes. Thus, this is the first study to: (1) extensively investigate the relationships among a host of predictors and multiple adaptive outcomes; and (2) conceptualise a resilience model among people with diabetes. Methods: This cross-sectional study was divided into two research studies. Study One was to translate two diabetes-specific instruments (Problem Areas In Diabetes, PAID; Diabetes Coping Measure, DCM) into a Chinese version and to examine their psychometric properties for use in Study Two in a convenience sample of 205 outpatients with type 2 diabetes. In Study Two, an integrated theoretical model is developed and evaluated using the structural equation modelling (SEM) technique. A self-administered questionnaire was completed by 345 people with type 2 diabetes from the endocrine outpatient departments of three hospitals in Taiwan. Results: Confirmatory factor analyses confirmed a one-factor structure of the PAID-C which was similar to the original version of the PAID. Strong content validity of the PAID-C was demonstrated. The PAID-C was associated with HbA1c and diabetes self-care behaviours, confirming satisfactory criterion validity. There was a moderate relationship between the PAID-C and the Perceived Stress Scale, supporting satisfactory convergent validity. The PAID-C also demonstrated satisfactory stability and high internal consistency. A four-factor structure and strong content validity of the DCM-C was confirmed. Criterion validity demonstrated that the DCM-C was significantly associated with HbA1c and diabetes self-care behaviours. There was a statistical correlation between the DCM-C and the Revised Ways of Coping Checklist, suggesting satisfactory convergent validity. Test-retest reliability demonstrated satisfactory stability of the DCM-C. The total scale of the DCM-C showed adequate internal consistency. Age, duration of diabetes, diabetes symptoms, diabetes distress, physical activity, coping strategies, and social support were the most consistent factors associated with adaptive outcomes in adults with diabetes. Resilience was positively associated with coping strategies, social support, health-related quality of life, and diabetes self-care behaviours. Results of the structural equation modelling revealed protective factors had a significant direct effect on adaptive outcomes; however, the construct of risk factors was not significantly related to adaptive outcomes. Moreover, resilience can moderate the relationships among protective factors and adaptive outcomes, but there were no interaction effects of risk factors and resilience on adaptive outcomes. Conclusion: This study contributes to an understanding of how risk factors and protective factors work together to influence adaptive outcomes in blood sugar control, health-related quality of life, and diabetes self-care behaviours. Additionally, resilience is a positive personality characteristic and may be importantly involved in the adjustment process among people living with type 2 diabetes.

The application of the Park & Ride and TOD concepts to develop a new framework that can maximise public transport patronage

With growing concern over the use of the car in our urbanized society, there have emerged a number of lobby groups and professional bodies promoting a return to public transport, walking and cycling, with the urban village as the key driving land use, as a means of making our cities’ transportation systems more sustainable. This research has aimed at developing a framework applicable to the Australian setting that can facilitate increased passenger patronage of rail based urban transport systems from adjacent or associated land uses. The framework specifically tested the application of the Park & Ride and Transit Oriented Development (TOD) concepts and their applicability within the cultural, institutional, political and transit operational characteristics of Australian society. The researcher found that, although the application of the TOD concept had been limited to small pockets of town houses and mixed use developments around stations, the development industry and emerging groups within the community are posed to embrace the concept and bring with it increased rail patronage. The lack of a clear commitment to infrastructure and supporting land uses is a major barrier to the implementation of TODs. The research findings demonstrated significant scope for the size of a TOD to expand to a much greater radius of activity from the public transport interchange, than the commonly quoted 400 to 600 meters, thus incorporating many more residents and potential patrons. The provision of Park & Rides, and associated support facilities like Kiss & Rides, have followed worldwide trends of high patronage demands from the middle and outer car dependent suburbs of our cities. The data collection and analysis gathered by the researcher demonstrated that in many cases Park & Rides should form part of a TOD to ensure ease of access to rail stations by all modes and patron types. The question, however, remains how best to plan the incorporation of a Park & Ride within a TOD and still maintain those features that attract and promote TODs as a living entity.

Land Use & Public Transport Accessibility Index (LUPTAI) tool : the development and pilot application of LUPTAI for the Gold Coast

LUPTAI is a decision-aiding tool to enable local and state governments to optimise land use and transport integration. In contrast to mobility between land uses (typically via road), accessibility represents opportunity and choice to reach common land use destinations by public transport and/or walking. LUPTAI uses a GIS-based methodology to quantify and map accessibility to common land use destinations by walking and/or public transport. The tool can be applied to small or large study areas. It can be applied to the current situation in a study area or to future scenarios (such as scenarios involving changes to public transport services, public transport corridors or stations, population density or land use). The tool has been piloted on the Gold Coast and the results are encouraging. This paper outlines the GIS-based methodology and the findings related to this pilot study. The paper demonstrates benefits and possible application of LUPTAI to other urbanised local government areas in Queensland. It also discusses how this accessibility indexing approach could be developed into a decision-support tool to assist local and state government agencies in a range of transport and land-use planning activities.

Can book-to-market and size be risk factors that predict economic growth in Asia's emerging economies?

We investigate whether the two 2 zero cost portfolios, SMB and HML, have the ability to predict economic growth for markets investigated in this paper. Our findings show that there are only a limited number of cases when the coefficients are positive and significance is achieved in an even more limited number of cases. Our results are in stark contrast to Liew and Vassalou (2000) who find coefficients to be generally positive and of a similar magnitude. We go a step further and also employ the methodology of Lakonishok, Shleifer and Vishny (1994) and once again fail to support the risk-based hypothesis of Liew and Vassalou (2000). In sum, we argue that search for a robust economic explanation for firm size and book-to-market equity effects needs sustained effort as these two zero cost portfolios do not represent economically relevant risk.

The land use and public transport accessibility index : phase two final report

The Urban Research Program (URP) was established in 2003 as strategic research and community engagement initiative of Griffith University. The strategic foci of the Urban Research Program are research and advocacy in an urban regional context. The Urban Research Program seeks to improve understanding of, and develop innovative responses to Australia's urban challenges and opportunities by providing training assistance. The authors aim to make the results of their research and advocacy work available as freely and widely as possible.

Non-motorised public transport : the past, the present, the future

Non-motorized public transport (NMPT) involves cycle-powered vehicles that carry several passengers and a small amount of goods; and provide flexible hail-and-ride services. Effectively they are non-motorized taxis. NMPT is widespread in developing countries, where it caters for a wide range of mobility needs. Common forms include cycle-rickshaw (Bangladesh, India), becak (Indonesia), cyclos (Vietnam, Cambodia), bicitaxi (Columbia, Cuba). Over the last 10-15 years there has also been a re-emergence of NMPT in the form of pedicabs in many developed countries because of the operating flexibility of NMPT, its eco-sustainability, and its ability to operate where use of motorized vehicles is restricted. In particular, in cities such as Berlin, London, New York and Vancouver, pedicabs are making the transition from ‘novelty’ to ‘serious’ transport mode. This is creating new transport policy/planning questions about pedicab operation and integration. This paper examines the phenomenon of NMPT and where it is heading. It uses case studies from Asia/Latin America and Europe/North America to examine emerging NMPT issues and possible responses, and how this may affect NMPT in Australia and New Zealand where it is still somewhat a ‘novelty’ but has potential as both an opportunity and a challenge.

Enhancing the experience of public transport users with urban screens and mobile applications

Public transportation is an environment with great potential for applying location-based services through mobile devices. This paper provides the underpinning rationale for research that will be looking at how the real-time passenger information system deployed by the Translink Transit Authority across all of South East Queensland in Australia can provide a core platform to improve commuters’ user experiences. This system relies on mobile computing and GPS technology to provide accurate information on transport vehicle locations. The proposal builds on this platform to inform the design and development of innovative social media, mobile computing and geospatial information applications. The core aim is to digitally augment the public transport environment to enhance the user experience of commuters for a more enjoyable journey.

Evaluation of risk factors leading to cost overrun in delivery of highway construction projects

Accurate owner budget estimates are critical to the initial decision-to-build process for highway construction projects. However, transportation projects have historically experienced significant construction cost overruns from the time the decision to build has been taken by the owner. This paper addresses the problem of why highway projects overrun their predicted costs. It identifies the owner risk variables that contribute to significant cost overrun and then uses factor analysis, expert elicitation, and the nominal group technique to establish groups of importance ranked owner risks. Stepwise multivariate regression analysis is also used to investigate any correlation of the percentage of cost overrun with risks, together with attributes such as highway project type, indexed cost, geographics location, and project delivery method. The research results indicate a correlation between the reciprocal of project budgets size and percentage cost overrun. This can be useful for owners in determining more realistic decision-to-build highway budget estimates by taking into account the economies of scale associated with larger projects.

Diarrhoea risk factors in enterally tube fed critically ill patients : a retrospective audit

Objective: Diarrhoea in the enterally tube fed (ETF) intensive care unit (ICU) patient is a multifactorial problem. Diarrhoeal aetiologies in this patient cohort remain debatable; however, the consequences of diarrhoea have been well established and include electrolyte imbalance, dehydration, bacterial translocation, peri anal wound contamination and sleep deprivation. This study examined the incidence of diarrhoea and explored factors contributing to the development of diarrhoea in the ETF, critically ill, adult patient. ---------- Method: After institutional ethical review and approval, a single centre medical chart audit was undertaken to examine the incidence of diarrhoea in ETF, critically ill patients. Retrospective, non-probability sequential sampling was used of all emergency admission adult ICU patients who met the inclusion/exclusion criteria. ---------- Results: Fifty patients were audited. Faecal frequency, consistency and quantity were considered important criteria in defining ETF diarrhoea. The incidence of diarrhoea was 78%. Total patient diarrhoea days (r = 0.422; p = 0.02) and total diarrhoea frequency (r = 0.313; p = 0.027) increased when the patient was ETF for longer periods of time. Increased severity of illness, peripheral oxygen saturation (Sp02), glucose control, albumin and white cell count were found to be statistically significant factors for the development of diarrhoea. ---------- Conclusion: Diarrhoea in ETF critically ill patients is multi-factorial. The early identification of diarrhoea risk factors and the development of a diarrhoea risk management algorithm is recommended.

Acute exercise improves postprandial cardiovascular risk factors in overweight and obese individuals

Objectives The effects of 30 min of exercise on postprandial lipaemia in the overweight and obese are unknown as previous studies have only investigated bouts of at least 60 min in lean, healthy individuals. The aim of this study was to investigate whether a single 30-min bout of resistance, aerobic or combined exercise at moderate-intensity would decrease postprandial lipaemia, glucose and insulin levels as well as increase resting energy expenditure and increase fat oxidation following a high fat meal consumed 14 h after the exercise bout, in overweight and obese individuals compared to no exercise. We also compared the effects of the different exercise modalities. Methods This study was a randomized cross-over design which examined the postprandial effects of 30 min of different types of exercise in the evening prior to a breakfast meal in overweight and obese men and women. Participants were randomized on four occasions, each one-week apart, to each condition; either no exercise, aerobic exercise, resistance exercise or a combination of aerobic exercise and resistance exercise. Results An acute bout of combination training did not have any significant effect on postprandial measurements compared to no exercise. However, aerobic exercise significantly reduced postprandial triglyceride levels by 8% compared to no exercise (p = 0.02) and resistance exercise decreased postprandial insulin levels by 30% compared to aerobic exercise (p = 0.01). Conclusion These results indicate that a single moderate-intensity 30 min bout of aerobic or resistance exercise improves risk factors associated with cardiovascular disease in overweight and obese individuals.