Modelling the economic benefits of gold standard care for chronic wounds in a community setting

Chronic leg ulcers are costly to manage for health service providers. Although evidence-based care leads to improved healing rates and reduced costs, a significant evidence-practice gap is known to exist. Lack of access to specialist skills in wound care is one reason suggested for this gap. The aim of this study was to model the change to total costs and health outcomes under two versions of health services for patients with leg ulcers: routine health services for community-living patients; and care provided by specialist wound clinics. Mean weekly treatment and health services costs were estimated from participants’ data (n=70) for the twelve months prior to their entry to a study specialist wound clinic, and prospectively for 24 weeks after entry. For the retrospective phase mean weekly costs of care were $AU130.30 (SD $12.64) and these fell to $AU53.32 (SD $6.47) for the prospective phase. Analysis at a population level suggests if 10,000 individuals receive 12 weeks of specialist evidence-based care, the cost savings are likely to be AU$9,238,800. Significant savings could be made by the adoption of evidence-based care such as that provided by the community and outpatient specialist wound clinics in this study.

Will the new ABC Arts Council Win Back the Arts Community?

The ABC’s major arts announcement this month appears at first glance to be good news for one of its core constituencies. The national broadcaster will establish an Arts Council and will roll out several new arts programming initiatives. The Corporation’s relationship with the arts community has been strained in recent years, so the new programming initiatives should be greeted positively. But without significant new funding, coupled with the uncertainties of a looming federal budget, some commentators are seeing this as little more than a shuffling of the deckchairs.

Dry tropics water smart : a community based approach to residential outdoor water consumption

This paper discusses the Townsville City Council Dry Tropics Water Smart (DTWS) initiative, developed by TCC Integrated Sustainability Services (ISS) and Townsville Water, and informed by The University of Adelaide. The program draws on many years of experience by the TCC team to blend key community-based research approaches in order to develop this residential outdoor water conservation program. Several community pilots have been conducted to test different behaviour change strategies and messages. This paper outlines recent steps taken to develop the community trials, as guided by a combination of behaviour change theories including community-based social marketing and thematic communications methods. Some preliminary results are outlined focused on community uptake of different strategies, community perceptions of communication materials, and some insights into the effectiveness of outdoor water hardware.

Improving construction management : an investigation into the influences of effective stakeholder involvement on project quality outcomes

This research has developed a framework to improve the effectiveness and efficiency of stakeholder involvement during the early planning stages of residential construction projects, in order to improve many of the quality issues that occur during the construction phases of such projects. A mixed methods approach (survey, interviews and case studies) was employed to collect the required data. It is expected that with development, this framework can bring some significant benefits to future construction projects in terms of reducing rework and wastage, improving timely delivery and avoiding disputes. The research is also anticipated to produce three high impact journal articles.

Physical activity and determinants of physical activity in obese and non-obese children

OBJECTIVE To compare the physical activity (PA) patterns and the hypothesized psychosocial and environmental determinants of PA in an ethnically diverse sample of obese and non-obese middle school children. DESIGN Cross-sectional study. SUBJECTS One-hundred and thirty-three non-obese and 54 obese sixth grade children (mean age of 11.4 +/-0.6). Obesity status determined using the age-, race- and gender-specific 95th percentile for BMI from NHANES-1. MEASUREMENTS Objective measurements were collected of PA over a 7-day period using the CSA 7164 accelerometer: total daily counts; daily moderate (3-5.9 METs) physical activity (MPA); daily vigorous physical activity (greater than or equal to 6 METs; VPA); and weekly number of 5, 10 and 20 min bouts of moderate-to-vigorous physical activity (greater than or equal to 3 METs, MVPA). Self-report measures were collected of PA self-efficacy; social influences regarding PA, beliefs about PA outcomes; perceived PA levels of parents and peers, access to sporting and/or fitness equipment at home, involvement in community-based PA organizations; participation in community sports teams; and hours spent watching television or playing video games. RESULTS Compared to their non-obese counterparts, obese children exhibited significantly lower daily accumulations of total counts, MPA and VPA as well as significantly fewer 5, 10 and 20 min bouts of MVPA. Obese children reported significantly lower levels of PA self-efficacy, were involved in significantly fewer community organizations promoting PA and were significantly less likely to report their father or male guardian as physically active. CONCLUSIONS The results are consistent with the hypothesis that physical inactivity is an important contributing factor in the maintenance of childhood obesity. Interventions to promote PA in obese children should endeavor to boost self-efficacy perceptions regarding exercise, increase awareness of, and access to, community PA outlets, and increase parental modeling of PA.

An outcome evaluation of the ‘Skipper’ designated driver program

The general aim of designated driver programs is to reduce the level of drink driving by encouraging potential drink drivers to travel with a driver who has abstained from (or at least limited) consuming alcohol. Designated driver programs appear to be quite widespread around the world, however a limited number have been subject to rigorous evaluation. This paper reports results from an outcome evaluation of a designated driver program called ‘Skipper’, which was trialled in a provincial city in Queensland, Australia. The outcome evaluation included surveys three weeks prior to (baseline), four months following (1st follow-up), and 16 months following (2nd follow-up) the commencement of the trial in both the ‘intervention area’ (baseline, n = 202; 1st follow-up, n = 211; 2nd follow-up, n = 200) and a ‘comparison area’(baseline, n = 203; 1st follow-up, n = 199; 2nd follow-up, n = 201); and a comparison of random breath testing and crash data before and after the trial. The survey results indicate that awareness of the program in the intervention area was quite high four months following its introduction and that this was maintained at 16 months. The results also suggest that the ‘Skipper’ program and the related publicity had positive impacts on behaviour with an increase in the proportion of people participating in designated driver as a passenger. It is less clear, however, whether the ‘Skipper’ program impacted on other behaviours of interest, such as drink driving or involvement in alcohol-related crashes. Suggestions for further research and program improvement are discussed as well as limitations of the research.

Alternate healing and medicine : the roles of naturopathy, homeopathy, osteopathy, chiropractic and medical practice in the health system

This thesis is concerned with understanding the roles of four alternate healing systems and medical practice in the community's health behaviour. The four alternate systems are naturopathy, homoeopathy, osteopathy and chiropractic. The research reported developed from work supported by the Committee of Inquiry into Chiropractic, Osteopathy, Homoeopathy and Naturopathy conducted under the chairmanship of Professor E. C. Webb set up by the Australian Government in 1975. The study concentrates on the factors which influence individual clients in their decisions to consult healers for treatment. An underlying assumption is that an analysis of the processes that effect such decisions will lead to further knowledge of the community's attitudes towards the functions of alternate healing and medicine. A review of the historical backgrounds and current status of the four alternate healing systems leads to the conclusion that they differ in a variety of areas. These areas include treatment modalities, historical backgrounds, occupational development and rapprochement with medicine. Homoeopathy, osteopathy and chiropractic emerged as distinct approaches to healing late in the nineteenth century. Naturopathy tends to be a philosophy or style of life as much as a health system in its own right. Their relationships with medicine also vary; osteopathy and naturopathy receive some acceptance, some homoeopaths are tolerated, whilst chiropractic is ostracised and vilified. A common paradigm of treatment underlies all four alternate approaches to healing. They all eschew the use of synthetic pharmaceuticals and invasive treatments and accept an indigenous theory of disease and a belief in the vis medicatrix naturae or the healing power of nature. An inevitable concomitant of this paradigm is that they believe that healing and health must be self-engendered. They rest within the client and his or her actions, not within the hands, skills or power of the healer. It is these characteristics combined with the alternate healers ' claims to espouse a similar scientific rationale for their approaches, and their functioning as parallel healers to medicine, that establishes their special relationship with medicine. This relationship become s more problematic in the face of medicine's hegemony and claim to unique legitimacy as the community's sole healing system. The interaction between these systems and medical practice can be gauged through articles related to the four alternate healing systems that have appeared in the medical literature. Interest has been cyclical but appears to have markedly increased in the past two decades. In this period it has included exploratory and descriptive writing; concern with controlling and/or eradicating the healers; desire to protect an ignorant and vulnerable public and. finally understanding and exploration of what the alternate healers might have to offer. At the same time, the public or institutionalized role has been one of denial and suppression through ostracism and legal constraints. In spite of medicine's position the alternate healing systems have found growing community acceptance so that it is problematical and probably unacceptable now to consider their use as a 'deviant ' health action. Increasing interest in the characteristics of clients has provided a consensus that they are similar to the adult population and are more likely to suffer from musculoskeletal and chronic illnesses. They are no more likely to be neurotic or gullible than the general community, but probably more practical and more oriented towards an active involvement in the healing process. The impact of these issues is explored, through comparing the strategies taken into account when choosing a treatment. These include attending one of the alternate healers exclusively for a condition; attending an alternate healer and a medical practitioner for the same problem; attending a medical practitioner solely or not consulting any healer. Respondents from surveys of alternate healer clients and the general community were classified according to their use of these four strategies, and the influences on their decisions at different stages of the treatment decision making process were compared.

A systematic review of community-based interventions for emerging zoonotic diseases in Southeast Asia

Background Southeast Asia has been at the epicentre of recent epidemics of emerging and re-emerging zoonotic diseases. Community-based surveillance and control interventions have been heavily promoted but the most effective interventions have not been identified. Objectives This review evaluated evidence for the effectiveness of community-based surveillance interventions at monitoring and identifying emerging infectious disease; the effectiveness of community-based control interventions at reducing rates of emerging infectious disease; and contextual factors that influence intervention effectiveness. Inclusion criteria Participants Communities in Brunei, Cambodia, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Singapore, Thailand and Viet Nam. Types of intervention(s) Non-pharmaceutical, non-vaccine, and community-based surveillance or prevention and control interventions targeting rabies, Nipah virus , dengue, SARS or avian influenza. Types of outcomes Primary outcomes: measures: of infection or disease; secondary outcomes: measures of intervention function. Types of studies Original quantitative studies published in English. Search strategy Databases searched (1980 to 2011): PubMed, CINAHL, ProQuest, EBSCOhost, Web of Science, Science Direct, Cochrane database of systematic reviews, WHOLIS, British Development Library, LILACS, World Bank (East Asia), Asian Development Bank. Methodological quality Two independent reviewers critically appraised studies using standard Joanna Briggs Institute instruments. Disagreements were resolved through discussion. Data extraction A customised tool was used to extract quantitative data on intervention(s), populations, study methods, and primary and secondary outcomes; and qualitative contextual information or narrative evidence about interventions. Data synthesis Data was synthesised in a narrative summary with the aid of tables. Meta-analysis was used to statistically pool quantitative results. Results Fifty-seven studies were included. Vector control interventions using copepods, environmental cleanup and education are effective and sustainable at reducing dengue in rural and urban communities, whilst insecticide spraying is effective in urban outbreak situations. Community-based surveillance interventions can effectively identify avian influenza in backyard flocks, but have not been broadly applied. Outbreak control interventions for Nipah virus and SARS are effective but may not be suitable for ongoing control. Canine vaccination and education is more acceptable than culling, but still fails to reach coverage levels required to effectively control rabies. Contextual factors were identified that influence community engagement with, and ultimately effectiveness of, interventions. Conclusion Despite investment in community-based disease control and surveillance in Southeast Asia, published evidence evaluating interventions is limited in quantity and quality. Nonetheless this review identified a number of effective interventions, and several contextual factors influencing effectiveness. Identification of the best programs will require comparative evidence of effectiveness acceptability, cost-effectiveness and sustainability.

Using value-based partnerships to support community engaged learning : benefits, challenges, stakeholder perspectives

Increasingly, the not-for-profit sector, as an emerging contributor to the creative economy, is creating a context for engaging creative practitioners in developing solutions to complex problems, triggering a demand for skills and knowledge needed to address this complexity. Across the university and community contexts alternative models of engagement are emerging to support this dynamic. This paper presents a case study of a creative project in which a value-based approach is used to foster a collaborative partnership between community partners and a multidisciplinary team of final year Creative Industries students who in the course of the project developed a range of communication resources, including a social media campaign, an interactive game and a series of short films to support volunteer engagement and leadership initiatives. The paper considers the implications this values approach has for the design of service learning curriculum for multidisciplinary creative teams and the potential it has to support meaningful collaboration between creatives and the not-for-profit sector. It further explores how it impact on student and partner engagement, learning outcomes and the benefits for the partner organisation. The paper concludes that a value-based approach to university-community engagement has the potential to support and enable a greater degree of reciprocity, deeper engagement between stakeholders and greater relevance of the final outcome.

Correlates of objectively measured physical activity in preadolescent youth

Objective The purpose of this study was to identify the psychosocial and environmental correlates of objectively measured physical activity behavior in a diverse sample of sixth-grade students. Design Cross-sectional. Participants and Setting One hundred ninety-eight sixth-grade students from 4 public middle schools in Columbia, South Carolina. The study group was 52.0% female, 55.1% African-American, with a mean age of 11.4 +/- 0.6 years. Main Outcome Measures Time spent in moderate physical activity (MPA) and vigorous physical activity (VPA) was assessed using a uniaxial accelerometer (CSA WAM 7164) (Computer Science and Applications Inc., Shalimar, FL). Determinant variables included: age, gender, race/ethnicity (demographic); physical activity self-efficacy, social norms related to physical activity, and beliefs regarding physical activity outcomes (psychosocial); and perceived physical activity habits of parents and peers, involvement in community physical activity organizations, involvement in community-based sports programs, access to fitness/sporting equipment at home, and self-reported hours spent watching television or playing video games (environmental). Results For boys, physical activity self-efficacy, social norms related to physical activity, and involvement in community physical activity organizations were salient predictors of MPA and VPA. Among girls, only physical activity self-efficacy emerged as a clear predictor of objectively measured physical activity. Conclusions These findings are consistent with previous studies using self-reported physical activity and suggest that interventions to increase physical. activity in preadolescent youth should endeavor to boost physical activity self-efficacy by offering a wide selection of enjoyable, developmentally-appropriate physical activity options.

Community media production : access, institutions, and ethics

In policy terms, community media are known as the “third sector” of the media. The description reflects the historical expectation that community media can fulfill a need not met by the commercial and public service broadcasters. A defining element of this “need” has been the means to production for nonprofessionals, particularly groups not represented in the mainstream media. The historical construction of community media reveals production to be a guiding principle; both a means and an end in itself. This chapter examines the various rationales underpinning community media production, including empowerment, media diversity, and the independent producer movement. Using case studies from youth media, the chapter critiques producer-centric models of community media. In the contemporary media environment, production alone cannot meet the social needs that community media were established to address. Instead, I propose a rationale that combines both production and consumption ethics.

The rurality of sex : community resistance and objection to prostitution in rural and regional areas throughout Queensland

Queensland legislation currently defines two legally recognised forms of prostitution: sex work conducted in a licensed brothel; or, sex work conducted privately by a sole operator.Despite prostitution’s legality in these contexts, it continues to be heavily controlled and restricted by authorities, while also being rejected by surrounding communities. Such resistance towards prostitution is demonstrated in Queensland where over 200 towns with populations of less than 25,000 have been successful in applying for exemption from the development of licensed brothels in those jurisdictions (Prostitution Licensing Authority 2012). Queensland’s legislative acknowledgement of prostitution as a legal act, while simultaneously allowing small communities to reject such activity, seems somewhat contradictory. This paper will provide a theoretical examination of common community objections to prostitution in modern society, determining whether such attitudes are applicable to communities in rural and regional Queensland towns. Additionally, this paper will incorporate an analysis of rural and urban areas via the ‘gemeinschaft‐gesellschaft’ dichotomy to understand the potential justification for opposing areas being subject to differential treatment under the law.

A cisgender girl in a transgender world : The methodological challenges of researching in the transgender community

The available research literature on intimate partner violence is often centred around a heteronormative understanding of gender, relationships and violence. When it comes to intimate partner violence in the transgender community, the research is limited or nonexistent due in part to the methodological issues of visibility and access by those outside this community. Drawing from Renzetti (1992, 1995), McClennen (2003), and the feminist participatory research model, this paper examines the techniques for overcoming the methodological barriers as a cisgender or 'normatively gendered' woman in a transgender community. Throughout the research with the transgender community, five strategies for overcoming methodological barriers were developed: Cultural Immersion, Commitment and Visibility, Sensitivity and Acceptance, Honesty, and Communication. This paper explores how utilising these strategies enabled access to the transgender community in order to conduct effective research.

Randomized trial of a clinic-based, community-supported, lifestyle intervention to improve physical activity and diet : The North Carolina enhanced WISEWOMAN project

Objective To determine if a clinic-based behavioral intervention program for low-income mid-life women that emphasizes use of community resources will increase moderate intensity physical activity (PA) and improve dietary intake. Methods Randomized trial conducted from May 2003 to December 2004 at one community health center in Wilmington, NC. A total of 236 women, ages 40–64, were randomized to receive an Enhanced Intervention (EI) or Minimal Intervention (MI). The EI consisted of an intensive phase (6 months) including 2 individual counseling sessions, 3 group sessions, and 3 phone calls from a peer counselor followed by a maintenance phase (6 months) including 1 individual counseling session and 7 monthly peer counselor calls. Both phases included efforts to increase participants' use of community resources that promote positive lifestyle change. The MI consisted of a one-time mailing of pamphlets on diet and PA. Outcomes, measured at 6 and 12 months, included the comparison of moderate intensity PA between study groups as assessed by accelerometer (primary outcome) and questionnaire, and dietary intake assessed by questionnaire and serum carotenoids (6 months only). Results For accelerometer outcomes, follow-up was 75% at 6 months and 73% at 12 months. Though moderate intensity PA increased in the EI and decreased in the MI, the difference between groups was not statistically significant (p = 0.45; multivariate model, p = 0.08); however, moderate intensity PA assessed by questionnaire (92% follow-up at 6 months and 75% at 12 months) was greater in the EI (p = 0.01; multivariate model, p = 0.001). For dietary outcomes, follow-up was 90% for questionnaire and 92% for serum carotenoids at 6 months and 74% for questionnaire at 12 months. Dietary intake improved more in the EI compared to the MI (questionnaire at 6 and 12 months, p < 0.001; serum carotenoid index, p = 0.05; multivariate model, p = 0.03). Conclusion The EI did not improve objectively measured PA, but was associated with improved self-reported and objective measures of dietary intake.