Outcome data from the LEAP (Live, Eat and Play) trial: a randomized controlled trial of a primary care intervention for childhood overweight/mild obesity

OBJECTIVES: To reduce gain in body mass index (BMI) in overweight/mildly obese children in the primary care setting.
DESIGN: Randomized controlled trial (RCT) nested within a baseline cross-sectional BMI survey.
SETTING: Twenty nine general practices, Melbourne, Australia.
PARTICIPANTS: (1) BMI survey: 2112 children visiting their general practitioner (GP) April-December 2002; (2) RCT: individually randomized overweight/mildly obese (BMI z-score <3.0) children aged 5 years 0 months-9 years 11 months (82 intervention, 81 control).
INTERVENTION: Four standard GP consultations over 12 weeks, targeting change in nutrition, physical activity and sedentary behaviour, supported by purpose-designed family materials.
MAIN OUTCOME MEASURES: Primary: BMI at 9 and 15 months post-randomization. Secondary: Parent-reported child nutrition, physical activity and health status; child-reported health status, body satisfaction and appearance/self-worth.
RESULTS: Attrition was 10%. The adjusted mean difference (intervention-control) in BMI was -0.2 kg/m(2) (95% CI: -0.6 to 0.1; P=0.25) at 9 months and -0.0 kg/m(2) (95% CI: -0.5 to 0.5; P=1.00) at 15 months. There was a relative improvement in nutrition scores in the intervention arm at both 9 and 15 months. There was weak evidence of an increase in daily physical activity in the intervention arm. Health status and body image were similar in the trial arms.
CONCLUSIONS: This intervention did not result in a sustained BMI reduction, despite the improvement in parent-reported nutrition. Brief individualized solution-focused approaches may not be an effective approach to childhood overweight. Alternatively, this intervention may not have been intensive enough or the GP training may have been insufficient; however, increasing either would have significant cost and resource implications at a population level.

Clinical supervision in child protection for community nurses

Community nurses have been recognized as having a key role in the protection and care of children, particularly in relation to the identification and detection of child abuse. In order to fulfill this role in a competent manner, they need to have access to appropriate supervision. The aim of this paper is to explore community nurses' and health care managers' understanding and experience of clinical supervision in child protection. The findings presented here were collected as part of a larger study commissioned by the Greater Glasgow Primary Health Care National Health Service (NHS) Trust. Ninety-nine nurses and nursing managers were interviewed, either individually or in groups, about their professional involvement in child protection issues and support for their involvement in child protection work, as well as their current knowledge and perceived training needs. The interview data was subjected to a thematic analysis. A lack of consensus was found among nurses and managers in Glasgow as to what constitutes clinical supervision and a good deal of variation in nurses' experiences of clinical supervision in the field of child protection. The historical difficulties with regard to supervision were attributed to several aspects of nursing culture. However, both nurses and managers emphasized the need for formal, regular, systematic supervision for all nurses regardless of their specific role with regard to child protection.

Sculptural abstraction of landscape

The purpose of my Senior Scholar project was to create a series of sculptures that are based on the interaction of natural forms within a selected landscape setting. I hope to convey a sense of how I view and interpret the landscape and to create works that stimulate a sense of wonder in the mind of the viewer. This fascination, perhaps even obsession, with the power of the landscape has kept me going throughout the year. As a source of ideas and imagery, the landscape can never be depleted. There will always be new combinations of landscape elements, different light conditions, and changing seasons to provide me with fresh ideas. Research for the project took me to many different places, be it my trip to Monhegan Island or driving to New York City to study the cityscape. I began the year working in steel and plaster, combining the two in works that explore the interaction between living tree roots and inanimate rocks. This led to a series entitled Landscape Recollections, comprised of welded steel forms housed in protective wooden boxes and lit from inside. After visiting New York City, architecture began to playa role in my work, as seen in the two Roadcut pieces and the Cathedral Woods series. Roadcut #1 and Roadcut #2 explore the relationship between a man-made road and the landscape that lies beneath and around it. The Cathedral Woods pieces incorporate architecture in a more abstract manner, using imagery derived from Gothic cathedrals to convey a sense of quiet peacefulness. The soaring verticality of Gothic architecture integrates with the tall tree forms in each piece, enabling me to intertwine these two elements into one another and create a harmonious relationship between architecture and nature. Throughout the year I have kept a sketchbook in which I draw from life, jot down ideas, and take notes on how the project is progressing. I have also completed several large charcoal drawings of my sculptures in which I explore different ways of viewing the steel forms. I am grateful to have had the opportunity to undertake this project, as it has been a very difficult but rewarding process of observing, interpreting, and manifesting the landscape according to my personal vision and experiences.

History, memory, and the politics of programming : the video work of Richard Fung

Richard Fung, a Toronto-based video artist and cultural critic, was born in Trinidad in 1954, and attended school in Ireland before immigrating to Canada to study at the University of Toronto. Richard Fung has taught at the Ontario College of Art and Design, and has been a visiting professor in the Department of Media Study at the State University of New York in Buffalo. He is currently the coordinator of the Centre for Media and Culture in Education, Ontario Institute for Studies in Education, University of Toronto.

Social policy for sport events : leveraging (relationships with) teams from other nations for community benefit

Recent work on sport events has argued that host governments should do more to leverage events in order to obtain and spread the benefits. This study uses ethnographic methods to compare two cities' implementation of a programme designed to leverage the presence of visiting teams training for the 2006 Commonwealth Games. Whereas one city formulated and implemented a detailed strategic plan to obtain benefits from its relationship with its adopted visiting team (Papua New Guinea), the other made no effort to benefit from adopting a visiting team (Wales). The city that leveraged its visiting team obtained new relationships, cultural insights, and improved organisational networks, whereas the city that did not leverage obtained no comparable benefits. The difference was due to the disparity in strategic vision by the two city governments and the vague mandate of the state programme which had caused each city to adopt its chosen team. Future work should explore factors that foster and that inhibit effective leverage before and during sport events.

Older people's relationships with companion animals : a pilot study

When older people enter residential care facilities, disruption to social networks may occur, with detrimental effects on health and wellbeing. This article reports on a study undertaken in an aged care facility in Melbourne, Australia, that explored the potential for a visiting companion animal programme to improve the health and wellbeing of residents and to promote their capacity for building relationships. Results back assertions in the literature that companion animals foster relationships by giving people opportunities to interact with others, but further study is needed to verify the link

The effects of an area-based intervention on the uptake of maternal and child health assessments in Australia : a community trial

Background
Recognition of the importance of the early years in determining health and educational attainment and promotion of the World Health Organization Health for All (HFA) principles has led to an international trend towards community-based initiatives to improve developmental outcomes among socio-economically disadvantaged children. In this study we examine whether, Best Start, an Australian area-based initiative to improve child health was effective in improving access to Maternal and Child Health (MCH) services.

Methods
The study compares access to information, parental confidence and annual 3.5 year Ages and Stages visiting rates before (2001/02) and after (2004/05) the introduction of Best Start. Access to information and parental confidence were measured in surveys of parents with 3 year old children. There were 1666 surveys in the first wave and 1838 surveys in the second wave. The analysis of visiting rates for the 3.5 year Ages and Stages visit included all eligible Victorian children. Best Start sites included 1,739 eligible children in 2001/02 and 1437 eligible children in 2004/05. The comparable figures in the rest of the state were and 45, 497 and 45, 953 respectively.

Results
There was a significant increase in attendance at the 3.5 year Ages and Stages visit in 2004/05 compared to 2001/02 in all areas. However the increase in attendance was significantly greater at Best Start sites than the rest of the state. Access to information and parental confidence improved over the course of the intervention in Best Start sites with MCH projects compared to other Best Start sites.

Conclusion
These results suggest that community-based initiatives in disadvantaged areas may improve parents' access to child health information, improve their confidence and increase MCH service use. These outcomes suggest such programmes could potentially contribute to strategies to reduce child health inequalities.

Outcomes and costs of primary care surveillance and intervention for overweight or obese children : the LEAP 2 randomised controlled trial

Objective To determine whether ascertainment of childhood obesity by surveillance followed by structured secondary prevention in primary care improved outcomes in overweight or mildly obese children.

Design Randomised controlled trial nested within a baseline cross sectional survey of body mass index (BMI). Randomisation and outcomes measurement, but not participants, were blinded to group assignment.

Setting 45 family practices (66 general practitioners) in Melbourne, Australia.

Participants 3958 children visiting their general practitioner in May 2005-July 2006 were surveyed for BMI. Of these, 258 children aged 5 years 0 months up to their 10th birthday who were overweight or obese by International Obesity Taskforce criteria were randomised to intervention (n=139) or control (n=119) groups. Children who were very obese (UK BMI z score 3.0) were excluded.

Intervention Four standard consultations over 12 weeks targeting change in nutrition, physical activity, and sedentary behaviour, supported by purpose designed family materials.

Main outcomes measures Primary measure was BMI at 6 and 12 months after randomisation. Secondary measures were mean activity count/min by 7-day accelerometry, nutrition score from 4-day abbreviated food frequency diary, and child health related quality of life. Differences were adjusted for socioeconomic status, age, sex, and baseline BMI.

Results Of 781 eligible children, 258 (33%) entered the trial; attrition was 3.1% at 6 months and 6.2% at 12 months. Adjusted mean differences (intervention – control) at 6 and 12 months were, for BMI, –0.12 (95% CI –0.40 to 0.15, P=0.4) and –0.11 (–0.45 to 0.22, P=0.5); for physical activity in counts/min, 24 (–4 to 52, P=0.09) and 11 (–26 to 49, P=0.6); and, for nutrition score, 0.2 (–0.03 to 0.4, P=0.1) and 0.1 (–0.1 to 0.4, P=0.2). There was no evidence of harm to the child. Costs to the healthcare system were significantly higher in the intervention arm.

Conclusions Primary care screening followed by brief counselling did not improve BMI, physical activity, or nutrition in overweight or mildly obese 5-10 year olds, and it would be very costly if universally implemented. These findings are at odds with national policies in countries including the US, UK, and Australia.

The lifestyle of our kids (LOOK) project : outline of methods

This methods paper outlines the overall design of a community-based multidisciplinary longitudinal study with the intent to stimulate interest and communication from scientists and practitioners studying the role of physical activity in preventive medicine. In adults, lack of regular exercise is a major risk factor in the development of chronic degenerative diseases and is a major contributor to obesity, and now we have evidence that many of our children are not sufficiently active to prevent early symptoms of chronic disease. The lifestyle of our kids (LOOK) study investigates how early physical activity contributes to health and development, utilizing a longitudinal design and a cohort of eight hundred and thirty 7–8-year-old (grade 2) school children followed to age 11–12 years (grade 6), their average family income being very close to that of Australia. We will test two hypotheses, that (a) the quantity and quality of physical activity undertaken by primary school children will influence their psychological and physical health and development; (b) compared with existing practices in primary schools, a physical education program administered by visiting specialists will enhance health and development, and lead to a more positive perception of physical activity. To test the first hypothesis we will monitor all children longitudinally over the 4 years. To test the second we will involve an intervention group of 430 children who receive two 50 min physical education classes every week from visiting specialists and a control group of 400 who continue with their usual primary school physical education with their class-room teachers. At the end of grades 2, 4, and 6 we will measure several areas of health and development including blood risk factors for chronic disease, cardiovascular structure and function, physical fitness, psychological characteristics and perceptions of physical activity, bone structure and strength, motor control, body composition, nutritional intake, influence of teachers and family, and academic performance.

Marketing across cultures : an investigation into place specific dimensions of service quality in sport

Abstract The purpose of this study was to identify place-specific dimensions of service quality in spectator sport settings and determine if the importance of these dimensions differed across cultures. The study was limited to the soccer industry and involved the collection of responses from identified soccer spectators to a range of items presented in a survey instrument. The survey was distributed to respondents face-to-face on a match day of the club they supported, or mailed to their home address. Responses were obtained from spectators from two clubs from Australia (n=277), one club from the USA (n=199), one club from the Netherlands (n=245) and one federation from Malaysia (n= 100). Based on the findings of a number of authors, six categories of potential place-specific dimensions of service quality in spectator sport settings were created and the research instrument contained a number of items that could be categorised under one of these headings. These categories were Home, Religion, Social facilitation, Sensory, Uncertainty of outcome, and Personal attention. In this thesis it was assumed that place-specific service quality issues are similar for sport spectators of different cultures, although differences in degree of importance of these dimensions (etic approach) were likely to emerge. In other words, although it was expected dimensions per country to be similar, differences in degree of importance of these dimensions were expected. Given the lack of confirmatory statistical evidence pertaining to the specific country samples, it was concluded that differences per country are likely to be more than just differences in degree. Both the overall structure and structures per country could not be confirmed, and hence the conclusion was drawn that differences in nature between the countries were present. In other words, what is a dimension of place-specific service quality in one country is not necessarily a dimension in another country. The results of a content analysis of ‘core component’ structures per country compared with a (full sample) core component structure delivered six components (referred to as place-specific dimensions of service quality) that were defined as Home, Hedonist, Religious follower, Safe atmosphere, Hospitality and Personal Attention. It was found that in most cases the cultural orientation of soccer spectators reflects the cultural orientation of the country as a whole as proposed by Hofstede (1991). However, in line with Huntington (1997), it was also argued that grouping people based on their country of origin as a proxy for their cultural orientation, will increasingly lead to flawed and incomplete research findings. As noted by Yoo etal. (1999), the identification of a person's cultural orientation is likely to deliver more direct results when measured at the individual level In that regard it is concluded that it may seem prudent to view Hofstede's dimensions of culture with increased conceptual scrutiny. Although having been replicated in multiple studies, it becomes increasingly unlikely that Hofstede's dimensions cover the complete spectrum of an individual person's cultural orientation. In conclusion, this study identified that soccer spectators (from a number of clubs) from Australia, the USA, the Netherlands and to a lesser extent Malaysia, perceive a range of place-specific service quality dimensions in spectator spoil settings to be important when visiting a soccer match. Before research into satisfaction with and value of place-specific dimensions of the spectator sport service product is initiated, it is pertinent the identified dimensions are further explored and confirmed in different country (culture) settings. The confusion that still exists about the place of the value concept (in relation to quality and satisfaction), where Holbrook (1994) defines quality as a type of value and Chelladurai and Chang (2000) argue that value is a type of quality, further underpins this necessity. It needs to be clear what are the targets of service quality before this information is integrated in larger holistic research frameworks. In the final section of the thesis a conceptual model for international services marketing research in the sport industry was presented as a first attempt to integrate the findings of this research and other researchers.

The use of the web as a marketing tool by selected arts organisations in Vietnam : a preliminary investigation

This paper presents exploratory findings into the use of the web as a marketing tool by arts organisations in Vietnam. The uniform resource locators (URLs) of Vietnamese arts organisations listed in the cultural profiles category of the directory of Vietnamese Cultural Organisations/Departments created by Visiting Arts (UK) for the Ministry of Culture, Sport and Tourism, Vietnam (MCST) (formerly Ministry of Culture and Information – MOCI) were accessed. 17 of these websites were ‘live’ at the time of the study and were evaluated to determine current levels of marketing functionality utilised within the sites. The findings of the evaluation were analysed from the perspective of the four elements of marketing mix (price, place, product and promotion). The study found that all 17 Vietnamese arts organisations analysed were less sophisticated in the usage of the web as a marketing tool compared with their Western counterparts, and that such organisations’ websites contained basic information catalogues and contact details but had limited multimedia functionality. The implications to audience development will be explored further through a survey with stakeholders of the 17 arts organisations in Vietnam as a future research stream.

Beliefs, practices, and expectations of oral teachers of the deaf

This study investigated the beliefs and practices of 28 teachers of the deaf about their practices. The teachers were all working in oral settings either as visiting teachers or teachers in a mainstream school facility supporting groups of students with hearing loss. Teachers who used an Auditory Verbal approach largely adopted a positivist paradigm, whereas those using an Auditory Oral approach were more likely to adopt a constructivist paradigm. Those using a mixed approach (AV/AO) adopted a paradigm that was a mix of both positivist and constructivist. Results suggest that there is a strong relationship between the underlying beliefs of teachers and the model of practice that they adopt, and that professional experience, professional development and the inclusion movement exert an influence on those beliefs and practices.

Utilizing and adapting leisure constraints models to enhance 'short-break' vacations : case study of Melbourne, Australia

Short-break tourism is likely to continue as a popular vacation for time-, income- and special interest conscious tourists. With the competition for visitors, destinations need to consider the constraints and facilitators associated with tourist decision-making for short-break vacations. This study presents the application of a leisure model toward better explaining such vacation choices. This study found key constraints, such as time and awareness, inhibited visitors from visiting attractions. The importance and influence of word-of-mouth recommendations plays a key role in gaining the attention of future visitors.

Placing parks on the tourism agenda : promoting Melbournes' metropolitan parks to metropolitan and regional Victorian visitors

This study establishes a strategy aimed at raising interest in visiting Melbourne’s metropolitan parks based upon interviews and focus group responses in both regional Victoria and Melbourne. As the majority of regional visitors planning a short-break collect their information prior to departure, park information needs to be available before they embark. Whilst visiting Melbourne, regional visitors agreed that they would utilise local knowledge of their host to fill any of their limited spare time. Melbournians should be seen as a potential prime source of information for visitors, but this study found that many Melburnians were often unaware of local attractions. Consequently, part of the strategy to raise interest in visiting Melbourne’s parks must be targeted at Melburnians. This leads to the conclusion that a well informed host is the key to increased visitation
to metropolitan parks.

Looking to Sweden in order to reconstruct Australia

The most prominent interest in the 'Swedish model' in Australian political history came after a high-level union delegation visit in 1986 produced a major report titled Australia Reconstructed, which had the nominal endorsement of the Labor Government then in office. However, at this very time, the characteristics of the Swedish policy approach which were most admired by the visiting Australian unionists were undergoing important changes, to which they paid little attention but which critics from the Right strongly emphasized in response.

The Australian labour movement interest in Sweden in the 1980s had some distinctive features. It focused on manufacturing industry and skills training policy, reflecting priorities of the main participating unionists. It was also particularly concerned with industrial democracy and work design, as a result of important earlier links between Swedish, Norwegian and Australian industrial relations scholars and practitioners which were forged from the late 1960s. Increased interest in Sweden partly arose from the search for a new political vision by particular elements of the Australian Left following their disillusionment with the Soviet Union after the 1968 Prague Spring.

This article presents the results of interviews with participants and extensive archival research to provide new information and perspective on Scandinavian influences on the Australian labour movement; and the political background of the main people involved.

It also analyzes how discussion of the 'Swedish model' receded in Australia following the economic setbacks of the early 1990s amid a perception that 'the model' had collapsed, but how policy interest in the continuing evident achievements of Sweden and the other Nordic nations has gradually re-emerged in Australia since then, though in a somewhat different way to before.