Pilot study of an individualised early post partum intervention to increase physical activity in women with previous gestational diabetes

Background: Whilst the benefits of physical activity in preventing progression from impaired glucose tolerance to overt diabetes in older adults are well recognised, it is not clear which strategies may prevent progression to overt diabetes in women with recent gestational diabetes. We sought to devise and pilot test a convenient, home based exercise program with telephone support, suited to the early post partum period. Twenty eight women with recent gestational diabetes were enrolled six weeks post partum into a 12 week randomised controlled trial of Usual Care ("UC" Controls (n= 13)) vs. Supported Care ("SC" individualised exercise program with regular telephone support (n= 15)). Findings: Baseline characteristics for the whole cohort at six weeks post partum (Mean ± SD) were Age 33 ± 4 years, Weight 80 ± 20 kg and Body Mass Index (BMI) 30.0 ± 9.7 kg / m2. The primary outcome, planned physical activity, increased by Median (Range) 60 (0-540) mins/wk in the SC group vs. 0 (0-580) mins/wk in the UC group (p = 0.234, Mann Whitney U test). The change in planned physical activity predominantly comprised planned walking. Body weight, BMI, waist circumference, % body fat (measured by bioimpedance), fasting glucose and insulin did not change significantly over time in either group. Conclusions: The intervention designed to increase physical activity in post partum women with previous gestational diabetes was feasible. However, no evidence to suggest that this type of program provides any measurable improvement in metabolic or biometric parameters over a three month post partum follow up was observed.

Social cognitive mediators of the effect of the MobileMums intervention on physical activity

Objective To explore whether improvements in physical activity following the MobileMums intervention were mediated by changes in Social Cognitive Theory (SCT) constructs targeted in the intervention (barrier self efficacy, goal setting skills, outcome expectancy, social support, and perceived environmental opportunity for exercise). This paper also examined if the mediating constructs differed between initial (baseline to 6 weeks) and overall (baseline to 13 weeks) changes in physical activity. Methods Secondary analysis of data from a randomized controlled trial involving 88 postnatal women (<12 months postpartum). Participants were randomized to receive either the 12-week MobileMums intervention or a minimal-contact control condition. Physical activity and proposed mediators were assessed by self-report at baseline, 6 weeks, and 13 weeks. Walking for Exercise frequency was assessed using the Australian Women's Activity Survey and frequency of moderate-to-vigorous physical activity (MVPA) was assessed using a single-item question. Results Initial improvements in goal-setting skills mediated the relationship between experimental condition and initial changes in MVPA, αβ (95% CI) = 0.23(0.01, 0.59), and Walking for Exercise, αβ (95% CI) = 0.34(0.06, 0.73). Initial improvements in barrier self efficacy mediated the relationship between experimental condition and initial change in MVPA, αβ (95% CI) = 0.36(0.12, 0.65), but not Walking for Exercise. None of the SCT outcomes significantly mediated the relationship between experimental condition and overall (baseline to 13 weeks) change in frequency of MVPA or Walking for Exercise. Conclusion Future interventions with postnatal women using SCT should target barrier self-efficacy and goal setting skills in order to increase physical activity. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

The impact of surgical ward nurses practicing respiratory assessment on positive patient outcomes

Objective: A literature review to examine the incorporation of respiratory assessment into everyday surgical nursing practice; possible barriers to this; and the relationship to patient outcomes. Primary argument: Escalating demands on intensive care beds have led to highly dependent patients being cared for in general surgical ward areas. This change in patient demographics has meant the knowledge and skills required of registered nurses in these areas has expanded exponentially. The literature supported the notion that postoperative monitoring of vital signs should include the fundamental assessment of respiratory rate; depth and rhythm; work of breathing; use of accessory muscles and symmetrical chest movement; as well as auscultation of lung fields using a stethoscope. Early intervention in response to changes in a patient's respiratory health status impacts positively on patient health outcomes. Substantial support exists for the contention that technologically adept nurses who also possess competent respiratory assessment skills make a difference to respiratory care. Conclusions: Sub-clinical respiratory problems have been demonstrated to contribute to adverse events. There is a paucity of research knowledge as to whether respiratory education programs and associated inservice make a difference to nursing clinical practice. Similarly, the implications for associated respiratory educational needs are not well documented, nor has a research base been sufficiently developed to guide nursing practice. Further research has the potential to influence the future role and function of the registered nurse by determining the importance of respiratory education programs on post-operative patient outcomes.

Physical activity amongst people with chronic back pain : an investigation of perceived barriers and facilitators to inform intervention development

Previous research has indicated people with non-specific low back pain who are physically inactive face a poorer prognosis than people with back pain who participate in low or moderate intensity physical activity. They also face a greater risk of other lifestyle related health conditions, such as diabetes and heart disease. For these reasons, contemporary non-surgical interventions for low back pain aim to incorporate a return to physical activity. However, there is a lack of empirical evidence supporting physical activity interventions for this purpose. It is likely that people with low back pain face additional challenges when trying to commence (or return to) regular physical activity. This exploratory qualitative research aimed to map out perceived barriers and facilitators to undertaking physical activity among people with non-specific low back pain to inform future intervention development.

Consumer guarantees and the supply of educational services by higher education providers

The higher education sector is undergoing a number of significant changes, the implications of which have yet to emerge. One such change is the increasing reliance by higher education providers on the revenue generated by full fee paying international students to fund their operating expenses. The report by the Victorian Ombudsman, Investigation into how Universities Deal with International Students ('Victorian Ombudsman's Report') tabled in the Victorian Parliament on 27 October 2011, provides evidence that Australian higher education providers may be failing to meet their legal obligations to international students. The Victorian Ombudsman's Report is the result of an investigation into four Victorian universities teaching international students with a focus on accounting and nursing schools. The report contains evidence that the universities were admitting students with scores below, or at the lower end of, the International English Language Testing System ('IELTS') score considered acceptable. Alternatively, they were relying upon their own language testing admission standards and not on an independent test like the IELTS test. While the universities provided English language support services for their international students after they had been admitted, the Ombudsman was concerned that the universities 'have not dedicated sufficient resources to meet the level of need amongst international students'.

When does change begin following screening and brief intervention among depressed problem drinkers?

Brief interventions are effective for problem drinking and reductions are known to occur in association with screening and assessment. The present study sought to assess, among participants (N=202) in a clinical trial, how much change occurred between baseline assessment and a one-session brief intervention (S1), and the predictors of early change. The primary focus was on changes in the Beck Depression Inventory Fast Screen scores and alcohol consumption (standard drinks per week) prior to random allocation to nine further sessions addressing either depression, alcohol, or both problems. There were large and clinically significant reductions between baseline and S1, with the strongest predictors being baseline scores in the relevant domain and change in the other domain. Client engagement was also predictive of early depression changes. Monitoring progress in both domains from first contact, and provision of empathic care, followed by brief intervention appear to be useful for this high prevalence comorbidity.

School-based programs for increasing connectedness and reducing risk behavior : a systematic review

School connectedness has a significant impact on adolescent outcomes, including reducing risk taking behavior. This paper critically examines the literature on school-based programs targeting increased connectedness for reductions in risk taking. Fourteen articles describing seven different school-based programs were reviewed. Programs drew on a range of theories to increase school connectedness, and evaluations conducted for the majority of programs demonstrated positive changes in school connectedness, risk behavior, or a combination of the two. Many of the reviewed programs involved widespread school system change, however, which is frequently a complex and time consuming task. Future research is needed to examine the extent of intervention complexity required to result in change. This review also showed a lack of consistency in definitions and measurement of connectedness as well as few mediation analyses testing assumptions of impact on risk taking behavior through increases in school connectedness. Additionally, this review revealed very limited evaluation of the elements of multi-component programs that are most effective in increasing school connectedness and reducing adolescent risk taking.

Iterative development of MobileMums : a physical activity intervention for women with young children.

Background To describe the iterative development process and final version of ‘MobileMums’: a physical activity intervention for women with young children (<5 years) delivered primarily via mobile telephone (mHealth) short messaging service (SMS). Methods MobileMums development followed the five steps outlined in the mHealth development and evaluation framework: 1) conceptualization (critique of literature and theory); 2) formative research (focus groups, n= 48); 3) pre-testing (qualitative pilot of intervention components, n= 12); 4) pilot testing (pilot RCT, n= 88); and, 5) qualitative evaluation of the refined intervention (n= 6). Results Key findings identified throughout the development process that shaped the MobileMums program were the need for: behaviour change techniques to be grounded in Social Cognitive Theory; tailored SMS content; two-way SMS interaction; rapport between SMS sender and recipient; an automated software platform to generate and send SMS; and, flexibility in location of a face-to-face delivered component. Conclusions The final version of MobileMums is flexible and adaptive to individual participant’s physical activity goals, expectations and environment. MobileMums is being evaluated in a community-based randomised controlled efficacy trial (ACTRN12611000481976).

A Reliability test system for educational purposes-basic data

The IEEE Subcommittee on the Application of Probability Methods (APM) published the IEEE Reliability Test System (RTS) [1] in 1979. This system provides a consistent and generally acceptable set of data that can be used both in generation capacity and in composite system reliability evaluation [2,3]. The test system provides a basis for the comparison of results obtained by different people using different methods. Prior to its publication, there was no general agreement on either the system or the data that should be used to demonstrate or test various techniques developed to conduct reliability studies. Development of reliability assessment techniques and programs are very dependent on the intent behind the development as the experience of one power utility with their system may be quite different from that of another utility. The development and the utilization of a reliability program are, therefore, greatly influenced by the experience of a utlity and the intent of the system manager, planner and designer conducting the reliability studies. The IEEE-RTS has proved to be extremely valuable in highlighting and comparing the capabilities (or incapabilities) of programs used in reliability studies, the differences in the perception of various power utilities and the differences in the solution techniques. The IEEE-RTS contains a reasonably large power network which can be difficult to use for initial studies in an educational environment.

A Reliability test system for educational purposes-basic data

The IEEE Reliability Test System (RTS) developed by the Application of Probability Method Subcommittee has been used to compare and test a wide range of generating capacity and composite system evaluation techniques and subsequent digital computer programs. A basic reliability test system is presented which has evolved from the reliability education and research programs conducted by the Power System Research Group at the University of Saskatchewan. The basic system data necessary for adequacy evaluation at the generation and composite generation and transmission system levels are presented together with the fundamental data required to conduct reliability-cost/reliability-worth evaluation

A Reliability test system for educational purposes-basic results

A set of basic reliability indices at the generation and composite generation and transmission levels for a small reliability test system are presented. The test system and the results presented have evolved from reliability research and teaching programs. The indices presented are for fundamental reliability applications which should be covered in a power system reliability teaching program. The RBTS test system and the basic indices provide a valuable reference for faculty and students engaged in reliability teaching and research

An intervention study to improve pain management by nurses : normative beliefs and perceived control

Based on a predictive model of nurses' intentions regarding pain management, an intervention was developed to improve nurses' pain management. The intervention involved a series of workshops with cohorts of nurses working in acute care wards to address the important antecedents to their intentions: normative beliefs and perceived control. Pre- and post-intervention measures demonstrate the effectiveness of the intervention. The effectiveness of this intervention in improving the management of patients' pain is compared with a patient education program group and a control group. The findings provide support for further developing interventions based on the theory of planned behavior.

Impact of a novel nurse-led prechemotherapy education intervention (ChemoEd) on patient distress, symptom burden, and treatment-related information and support needs : results from a randomised, controlled trial

Background: High levels of distress and need for self-care information by patients commencing chemotherapy suggest that current prechemotherapy education is suboptimal. We conducted a randomised, controlled trial of a prechemotherapy education intervention (ChemoEd) to assess impact on patient distress, treatment-related concerns, and the prevalence and severity of and bother caused by six chemotherapy side-effects. Patients and methods: One hundred and ninety-two breast, gastrointestinal, and haematologic cancer patients were recruited before the trial closing prematurely (original target 352). ChemoEd patients received a DVD, question-prompt list, self-care information, an education consultation ≥24 h before first treatment (intervention 1), telephone follow-up 48 h after first treatment (intervention 2), and a face-to-face review immediately before second treatment (intervention 3). Patient outcomes were measured at baseline (T1: pre-education) and immediately preceding treatment cycles 1 (T2) and 3 (T3). Results: ChemoEd did not significantly reduce patient distress. However, a significant decrease in sensory/psychological (P = 0.027) and procedural (P = 0.03) concerns, as well as prevalence and severity of and bother due to vomiting (all P = 0.001), were observed at T3. In addition, subgroup analysis of patients with elevated distress at T1 indicated a significant decrease (P = 0.035) at T2 but not at T3 (P = 0.055) in ChemoEd patients. Conclusions: ChemoEd holds promise to improve patient treatment-related concerns and some physical/psychological outcomes; however, further research is required on more diverse patient populations to ensure generalisability.

Child rearing Inc : On the perils of political paralysis Down Under

In his 2007 PESA keynote address, Paul Smeyers discussed the increasing regulation of child-rearing through government intervention and the generation of “experts,” citing particular examples from Europe where cases of childhood obesity and parental neglect have stirred public opinion and political debate. In his paper (this issue), Smeyers touches on a number of tensions before concluding that child rearing qualifies as a practice in which liberal governments should be reluctant to intervene. In response, I draw on recent experiences in Australia and argue that certain tragic events of late are the result of an ethical, moral and social vacuum in which these tensions coalesce. While I agree with Smeyers that governments should be reluctant to “intervene” in the private domain of the family, I argue that there is a difference between intervention and support. In concluding, I maintain that if certain Western liberal democracies did a more comprehensive job of supporting children and their families through active social investment in primary school education, then both families and schools would be better equipped to deal with the challenges they now face.