The effectiveness of dietary counselling versus oral nutrition supplements in improving nutritional intake in malnourished patients with Chronic Obstructive Pulmonary Disease (COPD)

The evidence for nutritional support in COPD is almost entirely based on oral nutritional supplements (ONS) yet despite this dietary counseling and food fortification (DA) are often used as the first line treatment for malnutrition. This study aimed to investigate the effectiveness of ONS vs. DA in improving nutritional intake in malnourished outpatients with COPD. 70 outpatients (BMI 18.4 SD 1.6 kg/m2, age 73 SD 9 years, severe COPD) were randomised to receive a 12-week intervention of either ONS or DA (n 33 ONS vs. n 37 DA). Paired t-test analysis revealed total energy intakes significantly increased with ONS at week 6 (+302 SD 537 kcal/d; p = 0.002), with a slight reduction at week 12 (+243 SD 718 kcal/d; p = 0.061) returning to baseline levels on stopping supplementation. DA resulted in small increases in energy that only reached significance 3 months post-intervention (week 6: +48 SD 623 kcal/d, p = 0.640; week 12: +157 SD 637 kcal/d, p = 0.139; week 26: +247 SD 592 kcal/d, p = 0.032). Protein intake was significantly higher in the ONS group at both week 6 and 12 (ONS: +19.0 SD 25.0 g/d vs. DA: +1.0 SD 13.0 g/d; p = 0.033 ANOVA) but no differences were found at week 26. Vitamin C, Iron and Zinc intakes significantly increased only in the ONS group. ONS significantly increased energy, protein and several micronutrient intakes in malnourished COPD patients but only during the period of supplementation. Trials investigating the effects of combined nutritional interventions are required.

Creating new folk opera forms of applied theatre for HIV and AIDS education in Papua New Guinea

This research investigated the potential of folk opera as a tool for HIV and AIDS education in Papua New Guinea. It began with an investigation on the indigenous performativities and theatricalities of Papua New Guineans, conducting an audit of eight selected performance traditions in Papua New Guinea. These traditions were analysed, and five cultural forms and twenty performance elements were drawn out for further exploration. These elements were fused and combined with theatre techniques from western theatre traditions, through a script development process involving Australians, Papua New Guineans and international collaborators. The resulting folk opera, entitled Kumul, demonstrates what Murphy (2010) has termed story force, picture force, and feeling force, in the service of a story designed to educate Papua New Guinean audiences about HIV and the need to adopt safer sexual practices. Kumul is the story of a young man faced with decisions on whether or not to engage in risky sexual behaviours. Kumul's narrative is carefully framed within selected Papua New Guinean beliefs drawn from the audit to deliver HIV and AIDS messages using symbolic and metaphoric communication techniques without offending people. The folk opera Kumul was trialled in two communities in Papua New Guinea: a village community and an urban settlement area. Kumul is recognisable to Papua New Guinean audiences because it reflects their lifestyle and a worldview, which connects them to their beliefs and spirituality, and the larger cosmological order. Feedback from audience members indicated that the performance facilitated HIV and AIDS communication, increased people's awareness of HIV and AIDS, and encouraged behaviour change. Tellingly, in one performance venue, forty people queued for Voluntary Testing and Counseling immediately after the performance. Twenty of these people were tested on that night and the other twenty were tested the following day. Many of the volunteers were young men – a demographic historically difficult to engage in HIV testing. This encouraging result indicates that the Kumul folk opera form of applied theatre could be useful for facilitating communication and education regarding sexual health and safer sexual behaviours in Papua New Guinea. Feedback from participants, audience members and other research stakeholders suggests that the form might also be adapted to address other social and development issues, particularly in the areas of health and social justice.

An individual-based versus group-based exercise and counselling intervention for improving quality of life in breast cancer survivors. A feasibility and efficacy study

Background Cancer and its treatments produce lingering side-effects that undermine the quality of life (QOL) of survivors. Exercise and psycho-therapies increase QOL among survivors, however, research is needed to identify intervention characteristics most associated with such improvements. Objective This research aimed to assess the feasibility of a 9 week individual or group based exercise and counselling program, and to examine if a group based intervention is as effective at improving the QOL of breast cancer survivors as an individual-based intervention. Methods A three group design was implemented to compare the efficacy of a 9 week individual (IEC n = 12) and group based exercise and counselling (GEC n = 14) intervention to a usual care (UsC n = 10) group on QOL of thirty-six breast cancer survivors. Results Across all groups, 90% of participants completed the interventions, with no adverse effects documented. At the completion of the intervention, there was a significant difference between groups for change in global QOL across time (p < 0.023), with IEC improving significantly more (15.0 points) than the UsC group (1.8 points). The effect size was moderate (0.70). Although the GEC improved QOL by almost 10.0 points, this increase did not reach significance. Both increases were above the minimally important difference of 7–8 points. Conclusion These preliminary results suggest a combined exercise and psychological counseling program is both a feasible and acceptable intervention for breast cancer survivors. Whilst both the individual and group interventions improved QOL above the clinically important difference, only the individual based intervention was significant when compared to UsC.

Factors associated with mental health of medical students in Vietnam: A national study

This project was the first national study of the health and wellbeing of medical students in Vietnam. Data from over 2,000 students from eight universities indicate that, while the majority are healthy, significant proportions have poor mental and/or physical health and other life adversities. For many students, heavy academic demands were not a major stressor; rather, difficulties within their family, interpersonal relations, dissatisfaction with career choice and housing and financial problems appear to cause the most strain. This study provides evidence that will be useful for the development of professional counseling services in Vietnamese universities.

Education in stroke prevention: Efficacy of an educational counselling intervention to increase knowledge in stroke survivors

BACKGROUND Motivational interviewing and stages of change are approaches to increasing knowledge and effecting behavioural change. This study examined the application of this approach on stroke knowledge acquisition and changing individual lifestyle risk factors in an outpatient clinic. METHODS RCT in which 200 participants were allocated to an education-counselling interview (ECI) or a control group. ECI group participants mapped their individual risk factors on a stage of change model and received an appointment to the next group lifestyle class. Participants completed a stroke knowledge questionnaire at baseline (T1), post-appointment, and three months (T3) post-appointment. Passive to active changes in lifestyle behaviour were self-reported at three months. RESULTS There was a statistically significant difference between groups from T1 toT3 in stroke knowledge (p < 0.001). While there was a significant shift from a passive to active stage of change for the overall study sample (p < 0.000), there was no significant difference between groups on the identified risk factors. CONCLUSIONS Although contact with patients in ambulatory clinical settings is limited due to time constraints, it is still possible to improve knowledge and initiate lifestyle changes utilizing motivational interviewing and a stage of change model. Stroke nurses may wish to consider these techniques in their practice setting.

Adoption of alternative habitats by a threatened, "obligate" forest-dwelling bat in a fragmented landscape

While they are among the most ecologically important animals within forest ecosystems, little is known about how bats respond to habitat loss and fragmentation. The threatened lesser short-tailed bat (Mystacina tuberculata), considered to be an obligate deep-forest species, is one of only 2 extant land mammals endemic to New Zealand; it plays a number of important roles within native forests, including pollination and seed dispersal, and rarely occurs in modified forests. We used radiotelemetry to study the movements, roosting behavior, and habitat use of M. tuberculata within a fragmented landscape comprised of 3 main habitat types: open space (harvested forest and pastoral land), native forests, and exotic pine plantations. We found that the bats had smaller home-range areas and travelled shorter nightly distances than populations investigated previously from contiguous native forest. Furthermore, M. tuberculata occupied all 3 habitat types, with native forest being preferred overall. However, individual variation in habitat selection was high, with some bats preferring exotic plantation and open space over native forest. Roosting patterns were similar to those previously observed in contiguous forest; individual bats often switched between communal and solitary roosts. Our findings indicate that M. tuberculata exhibit some degree of behavioral plasticity that allows them to adapt to different landscape mosaics and exploit alternative habitats. To our knowledge, this is the first such documentation of plasticity in habitat use for a bat species believed to be an obligate forest-dweller.

Breast and prostate cancer survivor responses to group exercise and supportive group Psychotherapy

This study qualitatively examined an 8 week group exercise and counseling intervention for breast and prostate cancer survivors. Groups exercised 3 days per week, 50 minutes per session,performing moderate intensity aerobic and resistance training. Groups also underwent 90 minute supportive group psychotherapy sessions once per week. Survivors discussed their experiences in focus groups post intervention. Transcripts were analyzed using interpretative phenomenological analysis. Survivors described how exercise facilitated counseling by creating mutual aid and trust, and counseling helped participants with self-identity, sexuality, and returning to normalcy. When possible, counselors and fitness professionals should create partnerships to optimally support cancer survivors.

Design theory for innovation of classroom-based information systems

This research used design science research methods to develop, instantiate, implement, and measure the acceptance of a novel software artefact. The primary purpose of this software artefact was to enhance data collection, improve its quality and enable its capture in classroom environments without distracting from the teaching activity. The artefact set is an iOS app, with supporting web services and technologies designed in response to teacher and pastoral care needs. System analysis and design used Enterprise Architecture methods. The novel component of the iOS app implemented proximity detection to identify the student through their iPad and automatically link to that student's data. The use of this novel software artefact and web services was trialled in a school setting, measuring user acceptance and system utility. This integrated system was shown to improve the accuracy, consistency, completeness and timeliness of captured data and the utility of the input and reporting systems.

Living well with diabetes: 24-month outcomes from a randomized trial of telephone-delivered weight loss and physical activity intervention to improve glycemic control

OBJECTIVE: To evaluate the effectiveness of a telephone-delivered behavioral weight loss and physical activity intervention targeting Australian primary care patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: Pragmatic randomized controlled trial of telephone counseling (n = 151) versus usual care (n = 151). Reported here are 18-month (end-of-intervention) and 24-month (maintenance) primary outcomes of weight, moderate-to-vigorous-intensity physical activity (MVPA; via accelerometer), and HbA1c level. Secondary outcomes include dietary energy intake and diet quality, waist circumference, lipid levels, and blood pressure. Data were analyzed via adjusted linear mixed models with multiple imputation of missing data. RESULTS: Relative to usual-care participants, telephone counseling participants achieved modest, but significant, improvements in weight loss (relative rate [RR] -1.42% of baseline body weight [95% CI -2.54 to -0.30% of baseline body weight]), MVPA (RR 1.42 [95% CI 1.06-1.90]), diet quality (2.72 [95% CI 0.55-4.89]), and waist circumference (-1.84 cm [95% CI -3.16 to -0.51 cm]), but not in HbA1c level (RR 0.99 [95% CI 0.96-1.02]), or other cardio-metabolic markers. None of the outcomes showed a significant change/deterioration over the maintenance period. However, only the intervention effect for MVPA remained statistically significant at 24 months. CONCLUSIONS: The modest improvements in weight loss and behavior change, but the lack of changes in cardio-metabolic markers, may limit the utility, scalability, and sustainability of such an approach.

Cultural-Evolution of Ecological Prudence

Animals often behave in a profligate fashion and decimate the populations of plants and animals they depend upon. They may, however, evolve prudent behaviour under special conditions, namely when such prudence greatly enhances the success of populations that are not too prone to invasions by profligate individuals. Cultural evolution in human societies can also lead to the adoption of prudent practices under similar conditions. These are more likely to be realized in stable environments in which the human populations tend to grow close to the carrying capacity, when the human groups are closed, and when the technology is stagnant. These conditions probably prevailed in the hunter—gatherer societies of the tropics and subtropics, and led to the adoption of a number of socially imposed restraints on the use of plant and animal resources. Such practices were rationalized in the form of Nature-worship. The Indian caste society became so organized as to fulfill these conditions, and gave rise to two religions, Buddhism and Jainism, which emphasize compassion towards all forms of life. The pastoral nomads of the middle east, on the other hand, lived in an environment which militated against prudence, and these societies gave rise to religions like Christianity, which declared war on nature. As the ruling elite and state have grown in power, they have tried to wrest control of natural resources from the local communities. This has sometimes resulted in conservation and prudent use under guidance from the state, but has often led to conflicts with local populations to the detriment of prudent behaviour. Modern technological progress has also often removed the need for conservation, as when availability of coal permitted the deforestation of England. While modern scientific understanding has led to a better appreciation of the need for prudence, the prevailing social and economic conditions often militate against any implementation of the understanding, as is seen from the history of whaling. However, the imperative for survival of the poor from the Third-World countries may finally bring about conditions in which ecological prudence may once again come to dominate human cultures as it might once have done with stable societies of hunter—gatherers.

Medicines information sources and services for consumers : A special focus on the Internet and people with depression

The range of consumer health and medicines information sources has diversified along with the increased use of the Internet. This has led to a drive to develop medicines information services and to better incorporate the Internet and e-mail into routine practice in health care and in community pharmacies. To support the development of such services more information is needed about the use of online information by consumers, particularly of those who may be the most likely to use and to benefit from the new sources and modes of medicines communication. This study explored the role and utilization of the Internet-based medicines information and information services in the context of a wider network of information sources accessible to the public in Finland. The overall aim was to gather information to develop better and more accessible sources of information for consumers and services to better meet the needs of consumers. Special focus was on the needs and information behavior among people with depression and using antidepressant medicines. This study applied both qualitative and quantitative methods. Consumer medicines information needs and sources were identified by analyzing the utilization of the University Pharmacy operated national drug information call center (Study I) and surveying Finnish adults (n=2348) use of the different medicines information sources (Study II). The utilization of the Internet as a source of antidepressant information among people with depression was explored by focus group discussions among people with depression and with current or past use of the antidepressant(s) (n=29, Studies III & IV). Pharmacy response to the needs of consumers in term of providing e-mail counseling was assessed by conducting a virtual pseudo customer study among the Finnish community pharmacies (n=161, Study V). Physicians and pharmacists were the primary sources of medicines information. People with mental disorders were more frequent users of telephone- and Internet-based medicines information sources and patient information leaflets than people without mental disorders. These sources were used to complement rather than replace information provided face-to-face by health professionals. People with depression used the Internet to seek facts about antidepressants, to share experiences with peers, and for the curiosity. They described that the access to online drug information was empowering. Some people reported lacking the skills necessary to assess the quality of online information. E-mail medication counseling services provided by community pharmacies were rare and varied in quality. Study results suggest that rather than discouraging the use of the Internet, health professionals should direct patients to use accurate and reliable sources of online medicines information. Health care providers, including community pharmacies should also seek to develop new ways of communicating information about medicines with consumers. This study determined that people with depression and using antidepressants need services enabling interactive communication not only with health care professionals, but also with peers. Further research should be focused on developing medicines information service facilitating communication among different patient and consumer groups.

Reproductive Performance of Caprine Feral Does Mated to Boer or Feral Bucks in Semi-Arid Queensland

A strong world demand and current firm prices for goat meat provides opportunities for some wool/beef production enterprises in western Queensland to increase farm viability through diversification. In particular, there is rising interest in the use of Boer goats to improve productive performance of the Australian feral goat. Pastoral graziers have noted the high prolificacy of feral goats grazed in semi-arid areas, but there is no information on the breeding ability of feral does mated to Boer bucks. Animal production for a consuming world : proceedings of 9th Congress of the Asian-Australasian Association of Animal Production Societies [AAAP] and 23rd Biennial Conference of the Australian Society of Animal Production [ASAP] and 17th Annual Symposium of the University of Sydney, Dairy Research Foundation, [DRF]. 2-7 July 2000, Sydney, Australia.

Adaptability of Damara, Dorper and Traditional Meat Sheep Breeds in Semi-Arid Queensland

Reproductive rate is a major contributing factor to the profitability of a sheep meat enterprise. Low reproduction rate is a feature of sheep husbandry in semi-arid Queensland. High ambient temperatures are implicated in poor fertility (Moule 1970) where variation in response can be due to breed and to animals within a breed (Hopkins and Stephenson 1978). Breeds recently imported from South Africa were selected in arid environments and may be better adapted to pastoral conditions of northern Australia than traditional breeds. Animal production for a consuming world : proceedings of 9th Congress of the Asian-Australasian Association of Animal Production Societies [AAAP] and 23rd Biennial Conference of the Australian Society of Animal Production [ASAP] and 17th Annual Symposium of the University of Sydney, Dairy Research Foundation, [DRF]. 2-7 July 2000, Sydney, Australia. This study will investigate (a) the thermoregulatory ability of Damara, Dorper, Poll Dorset, Rambouillet, South African Meat Merino and Queensland medium wool Merino rams prior to joinings in the autumn and spring of 1999, 2000 and 2001 and (b) the association between thermoregulatory parameters (rectal temperature and respiration rate) and ewe fertility. Results for the initial autumn joining are reported in this paper.

Simulation of the supply capability of sheep on the Mitchell grass downs of north west Queensland

Sheep in western Queensland have been predominantly reared for wool. When wool prices became depressed interest in the sheep meat industry, increased. For north west Queensland producers, opportunities may exist to participate in live sheep and meat export to Asia. A simulation model was developed to determine whether this sheep producing area has the capability to provide sufficient numbers of sheep under variable climatic conditions while sustaining the land resources. Maximum capacity for sustainability of resources (as described by stock numbers) was derived from an in-depth study of the agricultural and pastoral potential of Queensland. Decades of sheep production and climatic data spanning differing seasonal conditions were collated for analysis. A ruminant biology model adapted from Grazplan was used to simulate pregnancy rate. Empirical equations predict mortalities, marking rates, and weight characteristics of sheep of various ages from simple climatic measures, stocking rate and reproductive status. The initial age structure of flocks was determined by running the model for several years with historical climatic conditions. Drought management strategies such as selling a proportion of wethers progressively down to two-tooth and oldest ewes were incorporated. Management decisions such as time of joining, age at which ewes were cast-for-age, wether turn-off age and turning-off rate of lambs vary with geographical area and can be specified at run time. The model is run for sequences of climatic conditions generated stochastically from distributions based on historical climatic data correlated in some instances. The model highlights the difficulties of sustaining a consistent supply of sheep under variable climatic conditions.