A conduit between epidemiological research and regional health policy

OBJECTIVE: To transform data from a research setting into a format that could be used to support strategies encouraging healthy lifestyle choices and service planning within local government. METHODS: Details of the health status and lifestyle behaviours of the Geelong, Victoria, population were generated independently by the Geelong Osteoporosis Study (GOS), a prospective population-based cohort study. Recent GOS follow-up phases provided evidence about patterns of unhealthy diet, physical inactivity, smoking and harmful alcohol use. These factors are well-recognised modifiable risk factors for chronic disease; the dataset was complemented with prevalence estimates for musculoskeletal disease, obesity, diabetes, cardiovascular disease, asthma and cancer. RESULTS: Data were provided to Healthy Together Geelong in aggregate form according to age, sex and suburb. A population statistics company used the data to project health outcomes by suburb for use by local council. This data exchange served as a conduit between epidemiological research and policy development. CONCLUSION AND IMPLICATIONS: Regional policy makers were informed by local evidence, rather than national or state health survey, thereby optimising potential intervention strategies.

Rural health systems change

Much effort has been expended in recent years attempting to reform the Australian health system in order to deliver more efficient and effective systems of care for an ageing and increasingly chronically ill population. Rural health care systems in particular have been a focus of reform programs, and new initiatives such as University Departments of Rural Health, Regional Health Service structures and Commonwealth primary care initiatives have been designed to improve service provision and health status for rural people. However, with these attempts to reform the way rural communities understand and manage their health care, surprisingly little has changed in the day-to-day business of health care in rural and regional areas. Paradoxically, while rural communities have moved to embrace new farming technologies and environmental perspectives along with modern land management practices, revegetation and sustainable production systems, the same enthusiasm for change does not appear to have been kindled in relation to health system reforms. Rural communities, in terms of health care, are still using the equivalent of outmoded farming practices and other environmentally and economically unsustainable approaches to managing their affairs. Why might this be and what can be done to improve the current state of health reform in our rural and regional areas? The paper explores systems change in relation to health reform in rural communities and highlights several strategies for bringing about a functional synthesis of research and health service practice to create a more effective health care system in rural South Australia.

Tantalus and the tyranny of territory : pursuing the dream of parity in rural and metropolitan population health outcomes through primary health care programs

Many health professionals and rural health academics are motivated by the challenge of achieving equitable access to health care in rural communities with the implicit vision that fairer access to services might ultimately lead to more equitable health outcomes for people living in rural and remote settings. The purpose of this paper is to put the issue of rural and urban health outcome parity into perspective and assess recent progress towards achieving the ultimate goal of improving rural health status. I will also explore ways in which rural communities might increase their access to and use of primary health care revenue in the future to improve community health outcomes. While some improvements have been achieved across the rural health system in recent times, the fundamental problem of maintaining infrastructure to service community needs in rural areas remains as daunting as ever. Extensive evidence has now been assembled to show that rural people generally enjoy a much lower standard of health care, health outcomes and life expectancy than their urban cousins. The question underlying all of this evidence, however, is... must this always be so? Is it possible to redress the current inequities between rural and urban populations and could new primary health care initiatives, such as the Enhanced Primary Care (EPC) program, be vehicles for achieving more equitable health care arrangements and health outcomes for people living in rural communities?

A bit of a dirty word: 'feminism' and female teachers identifying as feminist

Following the identification of a gap in the literature around reasons for contemporary women’s self-identification as ‘feminist’ (Swirsky & Angelone, 2015), this paper discusses an empirical study of an intergenerational group of contemporary Australian female teachers collaboratively designing English curriculum around girls’ media. The paper explores the group’s shared conversations around feminism, over a series of meetings, as we (teachers and researcher) plan curriculum and negotiate broader subject positions possible for girls and women. These contexts include the competing discourses of feminism and postfeminism and how these mediate texts chosen for study, our pedagogical approaches, and the ways we experience our own lives. In this study, we struggle to find a shared language, across generations, with which to work collaboratively in a community of practice committed to the critical study of media, but involving different individual orientations to ‘feminism’. This is a space in which impediments to the feminist study of girls’ media quickly emerge. The paper also serves as a reminder that feminist scholarship takes place in schools, as well as in the academy, and that the gender studies work teachers do in schools is potentially whole population work, worthy of keen attention in the gender studies academic mainstream.

The association between alcohol outlet density and alcohol use among urban and regional Australian adolescents

AIMS: While recent evidence suggests that higher alcohol outlet density is associated with greater alcohol use among adolescents, influence of the four main outlet types on youth drinking within urban and regional communities is unknown. This study provides the first investigation of this relationship. DESIGN: Repeated cross-sectional surveys with random samples of secondary students clustered by school. Mixed-effects logistic regression analyses examined the association between each outlet type and the drinking outcomes, with interaction terms used to test urban/regional differences. SETTING: Australia, 2002-11. PARTICIPANTS: Respondents participating in a triennial survey (aged 12-17 years); 44 897 from urban settings, 23 311 from regional settings. MEASUREMENTS: The key outcome measures were past month alcohol use, risky drinking among all students and risky drinking among past week drinkers. For each survey year, students were assigned a postcode-level outlet density (number of licences per 1000 population) for each outlet type (general, on-premise, off-premise, clubs). FINDINGS: Interaction terms revealed a significant association between off-premises outlet density and risky drinking among all adolescents in urban (odds ratio = 1.36, 95% confidence interval CI = 1.05-1.75, P < 0.05) but not regional areas. Similarly, club density was associated with the drinking outcomes in urban communities only. General and on-premises density was associated with alcohol use and risky drinking among all adolescents. CONCLUSIONS: Higher densities of general, on- and off-premises outlets in an adolescent's immediate neighbourhood are related to increased likelihood of alcohol consumption among all adolescents. The density of licensed clubs is associated more strongly with drinking for urban than for regional adolescents.

Ageing, chronic disease and injury: a study in western Victoria (Australia)

Background : An increasing burden of chronic disease and associated health service delivery is expected due to the ageing Australian population. Injuries also affect health and wellbeing and have a long-term impact on health service utilisation. There is a lack of comprehensive data on disease and injury in rural and regional areas of Australia. The aim of the Ageing, Chronic Disease and Injury study is to compile data from various sources to better describe the patterns of chronic disease and injury across western Victoria.

Design : Ecological study.

Methods : Information on demographics, socioeconomic indicators and lifestyle factors are obtained from health surveys and government departments. Data concerning chronic diseases and injuries will be sourced from various registers, health and emergency services, local community health centres and administrative databases and compiled to generate profiles for the study region and for sub-populations within the region.

Expected impact for public health: This information is vital to establish current and projected population needs to inform policy and improve targeted health services delivery, care transition needs and infrastructure development. This study provides a model that can be replicated in other geographical settings.

Sustainable initiatives focused on social responsibility and regional development: a study of the leader of the petrochemical industry

The present work will investigate the issue of environmental responsibility actions in the ABC Paulista region, of a leading company in the petrochemical sector. In this context, the problem has been to see how the leading company in the domestic petrochemical industry conducts itself relative to the concept of sustainability and what the consequences of these initiatives in the ABC Paulista are. Thus, the objectives are to identify these consequences and practices with regard to regional development in areas where the leader of the national petrochemical company has significant performance, with highlights on economic, social and environmental impacts. The present investigation is justified by the fact that the company is among the world leaders in the production of biopolymers. The methodology used was qualitative descriptive because this methodological procedure makes it possible to observe and analyze the facts relating to social responsibility initiatives undertaken by the company under study without manipulating them , in establishing correlations on perception of other stakeholders before the actions addressed in this research. Therefore, the results obtained indicate that environmental responsibility initiatives taken by the company satisfy the paradigm of Sustainability and Social Responsibility, in the promotion of regional development in its geographic area.

A cooperative pedagogical program linking preschool and preparatory teachers: a pilot study

THE TRANSITION TO FORMAL schooling is a significant milestone for young children and their families. Congruence between an early childhood setting and school experience is known to impact on children’s positive start to school. Despite policy efforts at the Victorian state level, preschool educators and Foundation teachers do not have a strong understanding of the curriculum, pedagogical and assessment practices used in the alternate setting. This paper reports on the ‘Alliance Project’ that sought to support preschool educators and Foundation teachers to work cooperatively to better understand each other’s practices. Drawing from sociocultural theory, the Alliance Project employed an interventionist methodology to work with preschool educator and Foundation teacher pairings on a joint planning initiative. Participants on the Alliance Project gained increased familiarity with the alternate setting’s curriculum, pedagogy and assessment practices, and an increased capacity to work cooperatively across both settings to address the needs of transitioning children.

LATIN AMERICA; ECONOMIC DEVELOPMENT AND REGIONAL DIFFERENTIATION

Trata sobre el estudio realizado por Arthur Morris del desarrollo y la planificacion regional referido a America Latina.

Panicum maximum cv. Tanzânia: climate trends and regional pasture production in Brazil.

Projected change in forage production under a range of climate scenarios is important for the evaluation of the impacts of global climate change on pasture-based livestock production systems in Brazil. We evaluated the effects of regional climate trends on Panicum maximum cv. Tanzânia production, predicted by agro-meteorological model considering the sum of degree days and corrected by a water availa bility index. Data from Brazilian weather stations (1963?2009) were considered as the current climate (baseline), and future scenarios, based on contrasting scenarios interms of increased temperature and atmospheric CO2 concentrations (high and low increases), were determined for 2013?2040 (2025 scenario) and for 2043?2070 (2055 scenario). Predicted baseline scenarios indicated that there are regional and seasonal variations in P. maximum production related to variation intemperature and water availability during the year. Production was lower in the Northeast region and higher in the rainforest area. Total annual productionunder future climate scenarios was predicted toincrease by up to 20% for most of the Brazilian area, mainly due to temperature increase, according to each climate model and scenario evaluated. The highest increase in forage production is expected to be in the South, Southeast and Central-west areas of Brazil. In these regions, future climate scenarios will not lead to changes in the seasonal production, with largerincreases in productivity during the summer. Climate risk is expected to decrease, as the probability of occurrence of low forage productions will be lower. Due to the predicted increase in temperature and decrease in rainfall in the Northeast area, P. maximum production is expected to decrease, mainly when considering scenarios based on the PRECIS model for the 2055 scenario.