Evidence-based decision making to strengthen local governance : nutritional health interventions in Bantul and Gunungkidul

Since 2001, district governments have had the main responsibility for providing public health care in Indonesia. One of the main public health challenges facing many district governments is improving nutritional standards, particularly among poorer segments of the population. Developing effective policies and strategies for improving nutrition requires a multi-sectoral approach encompassing agricultural development policy, access to markets, food security (storage) programs, provision of public health facilities, and promotion of public awareness of nutritional health. This implies a strong need for a coordinated approach involving multiple government agencies at the district level. Due to diverse economic, agricultural, and infrastructure conditions across the country, district governments’ ought to be better placed than central government both to identify areas of greatest need for public nutrition interventions, and devise policies that reflect local characteristics. However, in the two districts observed in this study—Bantul and Gunungkidul—it was clear that local government capacity to generate, obtain and integrate evidence about local conditions into the policy-making process was still limited. In both districts, decision-makers tended to rely more on intuition,anecdote, and precedent in formulating policy. The potential for evidence-based decision making was also severely constrained by a lack of coordination and communication between agencies, and current arrangements related to central government fiscal transfers, which compel local governments to allocate funding to centrally determined programs and priorities.

Evidence based decision making to strenghten local governance : nutritional health interventions

Since 2001, district governments have had the main responsibility for providing public health care in Indonesia. One of the main public health challenges facing many district governments is improving nutritional standards, particularly among poorer segments of the population. Developing effective policies and strategies for improving nutrition requires a multi-sectoral approach encompassing agricultural development policy, access to markets, food security (storage) programs, provision of public health facilities, and promotion of public awareness of nutritional health. This implies a strong need for a coordinated approach involving multiple government agencies at the district level. Due to diverse economic, agricultural,and infrastructure conditions across the country, district governments’ ought to be better placed than central government both to identify areas of greatest need for public nutrition interventions, and devise policies that reflect local characteristics. However, in the two districts observed in this study—Bantul and Gunungkidul—it was clear that local government capacity to generate, obtain and integrate evidence about local conditions into the policy-making process was still limited. In both districts, decision-makers tended to rely more on intuition,anecdote, and precedent in formulating policy. The potential for evidence-based decision making was also severely constrained by a lack of coordination and communication between agencies, and current arrangements related to central government fiscal transfers, which compel local governments to allocate funding to centrally determined programs and priorities.

Seasonal activity and abundance of Orosius orientalis (Hemiptera : Cicadellidae) at agricultural sites in Southeastern Australia

Orosius orientalis is a leafhopper vector of several viruses and phytoplasmas affecting a broad range of agricultural crops. Sweep net, yellow pan trap and yellow sticky trap collection techniques were evaluated. Seasonal distribution of O. orientalis was surveyed over two successive growing seasons around the borders of commercially grown tobacco crops. Orosius orientalis seasonal activity as assessed using pan and sticky traps was characterised by a trimodal peak and relative abundance as assessed using sweep nets differed between field sites with peak activity occurring in spring and summer months. Yellow pan traps consistently trapped a higher number of O. orientalis than yellow sticky traps.

Exercise and activity – how it helps lymphoedema?

Research investigating the role of exercise in the prevention and/or management of lymphoedema is lacking. For fear of initiating or exacerbating lymphoedema, and its associated symptoms, those with lymphoedema have traditionally been cautioned against engaging in physical activity rather than encouraged to be regularly active. However, recent preliminary findings suggest that being inactive may increase risk of developing lymphedema, and that for those with lymphoedema, participation in an exercise program does not exacerbate the condition. This presentation will address why engaging in regular physical activity is important, what we know about the role of exercise with respect to lymphoedema prevention and management, and will provide some practical recommendations about becoming and staying regularly active for those with lymphoedema.

Issues in multidisciplinary training of cognitive-behavioural interventions

Argues that if brief workshop training is used as the primary method of disseminating behavior therapy skills across professions, it will provide an inadequate preparation, especially for higher levels of behavioral practice. In some circumstances, brief training may lead to an overestimation of behavioral skills by the trainees. These issues are discussed in the context of current moves toward providing health professionals with multiple skills. Examples are provided of situations in which generic health professionals received brief workshop training in behavior therapy and attempted to make use of that training in their jobs. There is no substitute for ongoing training and consultation by senior clinical psychologists who are expert in behavior therapy.

Age-related differences in exercise and quality of life among breast cancer survivors

Purpose: Physical activity has become a focus of cancer recovery research as it has the potential to reduce treatment-related burden and optimize health-related quality of life (HRQoL). However, the potential for physical activity to influence recovery may be age-dependent. This paper describes physical activity levels and HRQoL among younger and older women after surgery for breast cancer and explores the correlates of physical inactivity. Methods: A population-based sample of breast cancer patients diagnosed in South-East Queensland, Australia, (n=287) were assessed once every three months, from 6 to 18 months post-surgery. The Functional Assessment of Cancer Therapy-Breast questionnaire (FACTB+4) and items from the Behavioral Risk Factor Surveillance System (BRFSS) questionnaire were used to measure HRQoL and physical activity, respectively. Physical activity was assigned metabolic equivalent task (MET) values, and categorized as < 3, 3 to 17.9 and 18+ MET-hours/weeks. Descriptive statistics, generalized linear models with age stratification (<50 years versus 50+ years), and logistic regression were used for analyses (p=0.05, two-tailed). Results: Younger women who engaged in 3 or more MET-hours/week of physical activity reported a higher HRQoL at 18 months compared to their more sedentary counterparts (p<0.05). Older women reported similar HRQoL irrespective of activity level and consistently reported clinically higher HRQoL than younger women. Increasing age, being overweight or obese, and restricting use of the treated side at six months post-surgery increased the likelihood of sedentary behavior (OR>3, p<0.05). Conclusions: Age influences the potential to observe HRQoL benefits related to physical activity participation. These results also provide relevant information for the design of exercise interventions for breast cancer survivors and highlights that some groups of women are at greater risk of long-term sedentary behavior.

Relationship over time between psychological distress and physical activity in colorectal cancer survivors

Purpose Increased physical activity in colorectal cancer patients is related to improved recurrence free and overall survival. Psychological distress after cancer may place patients at risk of reduced physical activity; but paradoxically also act as a motivator for positive lifestyle change. The relationship between psychological distress and physical activity after cancer over time has not been described. Methods A prospective survey of 1966 (57% response) colorectal cancer survivors assessed the psychological distress variables of anxiety, depression, somatisation, cancer threat appraisal as predictors of physical activity five, 12, 24 and 36 months post-diagnosis 978 respondents had valid data for all time points. Results Higher somatisation was associated with greater physical inactivity (Relative risk ratio (RRR) =1.12; 95% CI=[1.1, 1.2]) and insufficient physical activity (RRR=1.05; [0.90, 1.0]). Respondents with a more positive appraisal of their cancer were significantly (p=0.031) less likely to be inactive (RRR=0.95; [0.90, 1.0]) or insufficiently active (RRR=0.96). Fatigued and obese respondents and current smokers were more inactive. Respondents whose somatisation increased between two time periods were less likely to increase their physical activity over the same period (p<0.001). Respondents with higher anxiety at one time period were less likely to have increased their activity at the next assessment (p=0.004). There was no association between depression and physical activity. Conclusions Cancer survivors who experience somatisation and anxiety are at greater risk of physical inactivity. The lack of a clear relationship between higher psychological distress and increasing physical activity argues against distress as a motivator to exercise in these patients.

Anti-cancer activity of zoledronic acid in breast cancer

Background: Zoledronic acid is used to prevent the bone loss associated with antioestrogen treatments in subjects with breast cancer. Preclinical studies suggest that zoledronic acid may have anticancer activity in its own right. This anticancer possibility with zoledronic acid has not been investigated extensively in clinical trials. Objectives/methods: This evaluation is of a large clinical trial that investigated the effect of zoledronic acid on cancer outcomes in premenopausal women with breast cancer. Results: The trial showed that after 4 years, 94.0% of subjects who were treated with zoledronic acid were disease-free compared with 90.8% of those not treated with zoledronic acid. Recurrence survival was a secondary end point; this occurred in 94.0% with, and 90.9% without, zoledronic acid treatment. Conclusions: Zoledronic acid does have anticancer activity in premenopausal women with cancer.

Resistance training for obese, type 2 diabetic adults: A review of the evidence

In both developed and developing countries, increased prevalence of obesity has been strongly associated with increased incidence of type 2 diabetes mellitus (T2DM) in the adult population. Previous research has emphasized the importance of physical activity in the prevention and management of obesity and T2DM, and generic exercise guidelines originally developed for the wider population have been adapted for these specific populations. However, the guidelines traditionally focus on aerobic training without due consideration to other exercise modalities. Recent reviews on resistance training in the T2DM population have not compared this modality with others including aerobic training, or considered the implications of resistance training for individuals suffering from both obesity and T2DM. In short, the optimal mix of exercise modalities in the prescription of exercise has not been identified for it benefits to the metabolic, body composition and muscular health markers common in obesity and T2DM. Similarly, the underlying physical, social and psychological barriers to adopting and maintaining exercise, with the potential to undermine the efficacy of exercise interventions, have not been addressed in earlier reviews. Because it is well established that aerobic exercise has profound effects on obesity and T2DM risk, the purpose of this review was to address the importance of resistance training to obese adults with T2DM.

Information interventions for orienting patients and their carers to cancer care facilities (Protocol)

To assess the effects of information interventions which orient patients and their carers/family to a cancer care facility and the services available in the facility.

Measurement properties of the Australian Women's Activity Survey

Purpose: The Australian Women’s Activity Survey (AWAS) was developed based on a systematic review and qualitative research on how to measure activity patterns of women with young children (WYC). AWAS assesses activity performed across five domains (planned activities, employment, childcare, domestic responsibilities and transport), and intensity levels (sitting, light-intensity, brisk walking, moderate-intensity and vigorous-intensity) in a typical week in the past month. The purpose of this study was to assess the test-retest reliability and criterion validity of the AWAS. Methods: WYC completed the AWAS on two occasions 7-d apart (test-retest reliability protocol) and/or wore an MTI ActiGraph accelerometer for 7-d in between (validity protocol). Forty WYC (mean age 35 ± 5yrs) completed the test-retest reliability protocol and 75 WYC (mean age 33 ± 5yrs) completed the validity protocol. Interclass Correlation Coefficients (ICC) between AWAS administrations and Spearman’s Correlation Coefficients (rs) between AWAS and MTI data were calculated. Results: AWAS showed good test-retest reliability (ICC=0.80 (0.65-0.89)) and acceptable criterion validity (rs= 0.28, p=0.01) for measuring weekly health-enhancing physical activity. AWAS also provided repeatable and valid estimates of sitting time (test-retest reliability ICC=0.42 (0.13-0.64), and criterion validity (rs= 0.32, p=0.006)). Conclusion: The measurement properties of the AWAS are comparable to those reported for existing self-report measures of physical activity. However, AWAS offers a more comprehensive and flexible alternative for accurately assessing different domains and intensities of activity relevant to WYC. Future research should investigate whether the AWAS is a suitable measure of intervention efficacy by examining its sensitivity to change.

Remote interaction and user research : anaesthetic preadmission activity

In the absence of telehealth technology, rural patients must travel to a regional or metropolitan hospital for a preadmission consultation one week before their surgery. Currently, examination of the patient’s chest using a stethoscope (auscultation) is not possible over a telehealth network as existing digital stethoscopes have been designed for in-person auscultation. We report on the initial phase of research which ultimately aims to design a digital stethoscope for use in the telehealth context. This initial research phase describes the complexity of the activity of preadmission clinics and the implications for the design of the stethoscope. The research is conducted through field studies of existing face-to-face and remote consultations.