Malnutrition and chemotherapy-induced nausea and vomiting : implications for practice

PURPOSE/OBJECTIVES: To determine the prevalence of malnutrition and chemotherapy-induced nausea and vomiting (CINV) limiting dietary intake in a chemotherapy unit. DESIGN Cross sectional descriptive audit. SETTING: Chemotherapy ambulatory care unit in an Australian teaching hospital. SAMPLE 121 patients receiving chemotherapy for malignancies, ≥18yrs and able to provide verbal consent. METHODS: An Accredited Practicing Dietitian collected all data. Chi-square tests were used to determine the relationship of malnutrition with variables and demographic data. MAIN RESEARCH VARIABLES: Nutritional status, weight change, BMI, prior dietetic input, CINV and CINV that limited dietary intake. FINDINGS Thirty one (26%) participants were malnourished, 12 (10%) had intake-limiting CINV, 22 (20%) reported significant weight loss and 20 (18%) required improved nutrition symptom management. High nutrition risk diagnoses, CINV, BMI and weight loss were significantly associated with malnutrition. Thirteen (35%) participants with malnutrition, significant weight loss, intake-limiting CINV and/or critically requiring improved symptom management reported no dietetic input; the majority of whom were overweight or obese. CONCLUSIONS: This audit determined over one quarter of patients receiving chemotherapy in this ambulatory setting were malnourished and the majority of patients reporting intake-limiting CINV were malnourished. IMPLICATIONS FOR NURSING Patients with malnutrition and/or intake-limiting CINV and in need of improved nutrition symptom management may be overlooked, especially patients who are overweight or obese - an increasing proportion of the Australian population. Evidence-based practice guidelines recommend implementing validated nutrition screening tools, such as the Malnutrition Screening Tool, in patients undergoing chemotherapy to identify those at risk of malnutrition requiring dietitian referral.

'Any body is better than nobody?' Ethical questions around recruiting and/or retaining health professionals in rural areas

The literature on recruiting and/or retaining health professionals in rural areas focuses primarily on the development of recruitment and retention strategies and assessing whether such strategies are effective. The objective of this article is to argue that it is important for all stakeholders involved in rural recruitment and/or retention processes to consider their decisions and actions from an ethics perspective. Recruitment and/or retention processes are not value neutral and it is important to understand their ethical dimensions. Methods: From the literature, elements of the recruitment and/or retention strategies that have been employed were identified and organised in respect of levels of governance (namely, the levels of health system/government, community, and individual health professionals). The elements identified in these levels were subjected to analysis to identify their ethical dimensions and to determine whether a clash or complement of values arose at each level of governance or between governance levels. Results: There is very little literature in this area that considers the ethical dimensions of rural recruitment and/or retention processes. However, all policies and practices have ethical dimensions that need to be identified and understood as they may have significant implications for recruitment and/or retention processes. Conclusion: This article recommends the application of an ethics perspective when reflecting on rural recruitment and/or retention strategies. The collective decisions of all involved in rural recruitment and/or retention processes may fundamentally influence the 'health' (broadly understood) of rural communities.

Wound healing angiogenesis : the clinical implications of a simple mathematical model

Nonhealing wounds are a major burden for health care systems worldwide. In addition, a patient who suffers from this type of wound usually has a reduced quality of life. While the wound healing process is undoubtedly complex, in this paper we develop a deterministic mathematical model, formulated as a system of partial differential equations, that focusses on an important aspect of successful healing: oxygen supply to the wound bed by a combination of diffusion from the surrounding unwounded tissue and delivery from newly formed blood vessels. While the model equations can be solved numerically, the emphasis here is on the use of asymptotic methods to establish conditions under which new blood vessel growth can be initiated and wound-bed angiogenesis can progress. These conditions are given in terms of key model parameters including the rate of oxygen supply and its rate of consumption in the wound. We use our model to discuss the clinical use of treatments such as hyperbaric oxygen therapy, wound bed debridement, and revascularisation therapy that have the potential to initiate healing in chronic, stalled wounds.

Evaluation of an Australian solar community : implications for education and training

1.1 Background What is renewable energy education and training? A cursory exploration of the International Solar Energy Society website (www.ises.org) reveals numerous references to education and training, referring collectively to concepts of the transfer and exchange of information and good practices, awareness raising and skills development. The purposes of such education and training relate to changing policy, stimulating industry, improving quality control and promoting the wider use of renewable energy sources. The primary objective appears to be to accelerate a transition to a better world for everyone (ISEE), as the greater use of renewable energy is seen as key to climate recovery; world poverty alleviation; advances in energy security, access and equality; improved human and environmental health; and a stabilized society. The Solar Cities project – Habitats of Tomorrow – aims at promoting the greater use of renewable energy within the context of long term planning for sustainable urban development. The focus is on cities or communities as complete systems; each one a unique laboratory allowing for the study of urban sustainability within the context of a low carbon lifestyle. The purpose of this paper is to report on an evaluation of a Solar Community in Australia, focusing specifically on the implications (i) for our understandings and practices in renewable energy education and training and (ii) for sustainability outcomes. 1.2 Methodology The physical context is a residential Ecovillage (a Solar Community) in sub-tropical Queensland, Australia (latitude 28o south). An extensive Architectural and Landscape Code (A&LC) ‘premised on the interconnectedness of all things’ and embracing ‘both local and global concerns’ governs the design and construction of housing in the estate: all houses are constructed off-ground (i.e. on stumps or stilts) and incorporate a hybrid approach to the building envelope (mixed use of thermal mass and light-weight materials). Passive solar design, gas boosted solar water heaters and a minimum 1kWp photovoltaic system (grid connected) are all mandatory, whilst high energy use appliances such as air conditioners and clothes driers are not permitted. Eight families participated in an extended case study that encompassed both quantitative and qualitative approaches to better understand sustainable housing (perceived as a single complex technology) through its phases of design, construction and occupation. 1.3 Results The results revealed that the level of sustainability (i.e. the performance outcomes in terms of a low-carbon lifestyle) was impacted on by numerous ‘players’ in the supply chain, such as architects, engineers and subcontractors, the housing market, the developer, product manufacturers / suppliers / installers and regulators. Three key factors were complicit in the level of success: (i) systems thinking; (ii) informed decision making; and (iii) environmental ethics and business practices. 1.4 Discussion The experiences of these families bring into question our understandings and practices with regard to education and training. Whilst increasing and transferring knowledge and skills is essential, the results appear to indicate that there is a strong need for expanding our education efforts to incorporate foundational skills in complex systems and decision making processes, combined with an understanding of how our individual and collective values and beliefs impact on these systems and processes.

Cultural challenges to secondary prevention: Implications for Saudi women

Like other highly developed countries, cardiovascular disease (CVD) and coronary heart disease (CHD) are major health problems in Saudi Arabia. The aetiology of cardiovascular disease (CVD) burden within the Saudi population is similar to Western countries with atherosclerosis, hypertension, ischemic heart disease and diabetes highly prevalent with the main risk factors being smoking, obesity and inactivity. There are differences between Saudi men and women in epidemiology, risk factors and health service provision for CHD. These sex and gender based factors are important in considering the health and well-being of Saudi women. Currently, there is limited focus on the cardiovascular health of Saudi women. The aim of this paper is to examine culturally specific issues for Saudi women and the implications for secondary prevention.

Effective health communication in the mining industry

Historically, occupational health and safety has primarily presented as attempts to create a safer work environment for employees. The mining industry carries health and safety risks, often greater than other occupations. Whilst the mining industry is regulated by stringent workplace health and safety regulations, the very nature of the work and environmental influences expose employees to a greater number of injury risk factors than many other industries. The application of risk management techniques has resulted in a substantial decline in injury rates observed for mining operations in developed countries (Donoghue, 2004). This essential focus can be complemented by a more comprehensive approach to occupational health and safety that also supports the design and delivery of proactive health promotion programs...

Visual backward masking performance in young adult emmetropes and myopes

Purpose. To investigate how temporal processing is altered in myopia and during myopic progression. Methods. In backward visual masking, a target's visibility is reduced by a mask presented quickly after the target. Thirty emmetropes, 40 low myopes, and 22 high myopes aged 18 to 26 years completed location and resolution masking tasks. The location task examined the ability to detect letters with low contrast and large stimulus size. The resolution task involved identifying a small letter and tested resolution and color discrimination. Target and mask stimuli were presented at nine short interstimulus intervals (12 to 259 ms) and at 1000 ms (long interstimulus interval condition). Results. In comparison with emmetropes, myopes had reduced ability in both locating and identifying briefly presented stimuli but were more affected by backward masking for a low contrast location task than for a resolution task. Performances of low and high myopes, as well as stable and progressing myopes, were similar for both masking tasks. Task performance was not correlated with myopia magnitude. Conclusions. Myopes were more affected than emmetropes by masking stimuli for the location task. This was not affected by magnitude or progression rate of myopia, suggesting that myopes have the propensity for poor performance in locating briefly presented low contrast objects at an early stage of myopia development.

‘Show Me Your Wiki and I’ll Show you Mine’: Using Online Interactive Media to Improve Academic Writing and Research in a Public Health Under-Graduate Cohort

The number of Internet users in Australia has been steadily increasing, with over 10.9 million people currently subscribed to an internet provider (ABS, 2011). Over the past year, the most avid users of the Internet were 15 – 24 year olds, with approximately 95% accessing the internet on a regular basis (ABS, Social Trends, 2011). While the internet has been described as fundamental to higher education students, social and leisure internet tools are also increasingly being used by these students to generate and maintain their social and professional networks and interactions (Duffy & Bruns 2006). Rapid technological advancements have enabled greater and faster access to information for learning and education (Hemmi et al, 2009; Glassman and Kang, 2011). As such, we sought to integrate interactive, online social media into the assessment profile of a Public Health undergraduate cohort at the Queensland University of Technology (QUT). The aim of this exercise was to engage students to both develop and showcase their research on a range of complex, contemporary health issues within the online forum of Wikispaces (http://www.wikispaces.com/) for review and critique by their peers. We applied Bandura’s Social Learning Theory (SLT) to analyse the interactive processes from which students developed deeper and more sustained learning, and via which their overall academic writing standards were raised. This paper outlines the assessment task, and the students’ feedback on their learning outcomes in relation to the Attentional, Retentional, Motor Reproduction, and Motivational Processes outlined by Bandura in SLT. We conceptualise the findings in a theoretical model, and discuss the implications for this approach within the broader tertiary environment.

Falling through the web : implications for internet introverts

Is the brain evolving and adapting to new technological environments such as that of Silicon Valley? This paper examines changes that are being observed and studied relating to a possible correlation between ‘excessive’ focus on technology and the emergence of diagnosable social, physical and mental health dysfunction. The author explores the possible role of university staff and student services in the duty of care toward students. Would it not be more ethical to provide education on healthy technology use and to provide evidence based therapy for those students who fall through the web? Currently students end up being excluded from their courses. Many suffer from social anxiety and depression and lack confidence and social skills to find or hold down a job. Currently many “hibernate” in their rooms for months or years frequently in a state of despair.

Geostatistical analysis of adult Rhyzopertha dominica (F.) (Coleoptera: Bostrichidae) in wheat stored at constant temperatures

Insect monitoring and sampling programmes are used in the stored grains industry for the detection and estimation of insect pests. At the low pest densities dictated by economic and commercial requirements, the accuracy of both detection and abundance estimates can be influenced by variations in the spatial structure of pest populations over short distances. Geostatistical analysis of Rhyzopertha dominica populations in 2 dimensions showed that, in both the horizontal and vertical directions and at all temperatures examined, insect numbers were positively correlated over short (0-5cm) distances, and negatively correlated over longer (≥10cm) distances. Analysis in 3 dimensions showed a similar pattern, with positive correlations over short distances and negative correlations at longer distances. At 35°C, insects were located significantly further from the grain surface than at 25 and 30°C. Dispersion metrics showed statistically significant aggregation in all cases. This is the first research using small sample units, high sampling intensities, and a range of temperatures, to show spatial structuring of R. dominica populations over short distances. This research will have significant implications for sampling in the stored grains industry.

Promoting Adult Resilience (PAR): Group Leaders Manual

RAP-A was developed to meet the need for a universal resilience building program for teenagers which could be readily implemented in a school setting. A universal program targets all teenagers in a particular grade as opposed to those at higher risk for depression (indicated or selective approaches) or a treatment group. It is easier to recruit and engage adolescents in a universal approach where students do not face the risk of stigmatisation by being singled out for intervention. The Resourceful Adolescent Program (RAP: Shochet, Holland & Whitefield, 1997) was developed to meet this need.

Promoting Adult Resilience (PAR): Participant Workbook

The RAP-A Workbook comprises all of the handouts required for the program's individual and group activities. A Participant Workbook is required for each adolescent to write in, and keep at the end of the program.

Using mobile social media and GIS in health and place research

This paper presents new research methods that combine the use of location-based, social media on mobile phones with geographic information systems (GIS) to explore connections between people, place and health. It discusses the feasibility, limitations, and benefits of using these methods, which enable real-time, location-based, quantitative data to be collected on the recreation, consumption, and physical activity patterns of urban residents in Brisbane, Queensland. The study employs mechanisms already inherent in popular mobile social media applications (Facebook, Twitter and Foursquare) to collect this data. The research methods presented in this paper are innovative and potentially applicable to an increasing number of academic research areas, as well as to a growing range of service providers that benefit from monitoring consumer behaviour, and responding to emerging changes in these patterns and trends. The ability to both collect and map objective, real-time data about the consumption, leisure, recreation, and physical activity patterns amongst urban communities has direct implications for a range of research disciplines including media studies, advertising, health promotion, social marketing, public health inequalities, and urban design.

Australian children with special health care needs: Social-emotional and learning competencies in the early years

This study examined the relationship between special health care needs and social-emotional and learning competence in the early years, reporting on two waves of data from the Kindergarten Cohort of Growing up in Australia: The Longitudinal Study of Australian Children (LSAC). Six hundred and fifty children were identified through the 2-question Special Health Care Needs Screener as having special health care needs. Children with special health care needs were more likely to be male, to have been of low birth weight, to be taking prescription medications, to be diagnosed with a specific health condition and to be from families where the mother was less well educated. These children scored significantly lower on teacher-rated social-emotional and learning competencies prior to school compared to a control group of children without special health care needs. Multiple regression analyses indicated that being identified with a special health care need prior to school predicted lower social-emotional and learning competencies in the early years of school. Results are discussed in terms of the implications for policy and practice.

Theoretical perspectives on motorcycle training: reducing risk taking

Little past empirical support has been found for the efficacy of motorcycle rider training as a road safety countermeasure. However, it has been argued that rider training should focus more particularly on the psychosocial factors that influence risk taking behaviour in addition to the traditional practice of developing vehicle-handling skills. This paper examines how rider training to reduce risk taking could be guided by appropriate theories. Two fundamental perspectives are examined: firstly training can be considered in terms of behaviour change, and secondly in terms of adult learning. Whilst behaviour change theories assume some pre-existing level of dysfunctional behaviour, an adult learning perspective does not necessarily carry this assumption. This distinction in perspectives conceptually aligns with the notions of intervention and prevention (respectively), with possible implications for specific target groups for pre-licence and post-licence training. The application of the Theory of Reasoned Action (Ajzen & Fishbein, 1975, 1980) and Transformative Learning Theory (Mezirow, 1997) to a pre-licence rider training program in Queensland, Australia is discussed.