Investigating the links between muscle strength, sun exposure, dietary vitamin D intake and the vitamin D status of ambulatory older adults in South East Queensland

Vitamin D deficiency and insufficiency are now seen as a contemporary health problem in Australia with possible widespread health effects not limited to bone health1. Despite this, the Vitamin D status (measured as serum 25-hydroxyvitamin D (25(OH)D)) of ambulatory adults has been overlooked in this country. Serum 25(OH)D status is especially important among this group as studies have shown a link between Vitamin D and fall risk in older adults2. Limited data also exists on the contributions of sun exposure via ultraviolet radiation and dietary intake to serum 25(OH)D status in this population. The aims of this project were to assess the serum 25(OH)D status of a group of older ambulatory adults in South East Queensland, to assess the association between their serum 25(OH)D status and functional measures as possible indicators of fall risk, obtain data on the sources of Vitamin D in this population and assess whether this intake was related to serum 25(OH)D status and describe sun protection and exposure behaviors in this group and investigate whether a relationship existed between these and serum 25(OH)D status. The collection of this data assists in addressing key gaps identified in the literature with regard to this population group and their Vitamin D status in Australia. A representative convenience sample of participants (N=47) over 55 years of age was recruited for this cross-sectional, exploratory study which was undertaken in December 2007 in south-east Queensland (Brisbane and Sunshine coast). Participants were required to complete a sun exposure questionnaire in addition to a Calcium and Vitamin D food frequency questionnaire. Timed up and go and handgrip dynamometry tests were used to examine functional capacity. Serum 25(OH)D status and blood measures of Calcium, Phosphorus and Albumin were determined through blood tests. The Mean and Median serum 25-Hydroxyvitamin D (25(OH)D) for all participants in this study was 85.8nmol/L (Standard Deviation 29.7nmol/L) and 81.0nmol/L (Range 22-158nmol/L), respectively. Analysis at the bivariate level revealed a statistically significant relationship between serum 25(OH)D status and location, with participants living on the Sunshine Coast having a mean serum 25(OH)D status 21.3nmol/L higher than participants living in Brisbane (p=0.014). While at the descriptive level there was an apparent trend towards higher outdoor exposure and increasing levels of serum 25(OH)D, no statistically significant associations between the sun measures of outdoor exposure, sun protection behaviors and phenotypic characteristics and serum 25(OH)D status were observed. Intake of both Calcium and Vitamin D was low in this sample with sixty-eight (68%) of participants not meeting the Estimated Average Requirements (EAR) for Calcium (Median=771.0mg; Range=218.0-2616.0mg), while eighty-seven (87%) did not meet the Adequate Intake for Vitamin D (Median=4.46ug; Range=0.13-30.0ug). This raises the question of how realistic meeting the new Adequate Intakes for Vitamin D is, when there is such a low level of Vitamin D fortification in this country. However, participants meeting the Adequate Intake (AI) for Vitamin D were observed to have a significantly higher serum 25(OH)D status compared to those not meeting the AI for Vitamin D (p=0.036), showing that meeting the AI for Vitamin D may play a significant role in determining Vitamin D status in this population. By stratifying our data by categories of outdoor exposure time, a trend was observed between increased importance of Vitamin D dietary intake as a possible determinant of serum 25(OH)D status in participants with lower outdoor exposures. While a trend towards higher Timed Up and Go scores in participants with higher 25(OH) D status was seen, this was only significant for females (p=0.014). Handgrip strength showed statistically significant association with serum 25(OH)D status. The high serum 25(OH)D status in our sample almost certainly explains the limited relationship between functional measures and serum 25(OH)D. However, the observation of an association between slower Time Up and Go speeds, and lower serum 25(OH)D levels, even with a small sample size, is significant as slower Timed Up and Go speeds have been associated with increased fall risk in older adults3. Multivariable regression analysis revealed Location as the only significant determinant of serum 25(OH)D status at p=0.014, with trends (p=>0.1) for higher serum 25(OH)D being shown for participants that met the AI for Vitamin D and rated themselves as having a higher health status. The results of this exploratory study show that 93.6% of participants had adequate 25(OH)D status-possibly due to measurement being taken in the summer season and the convenience nature of the sample. However, many participants do not meet their dietary Calcium and Vitamin D requirements, which may indicate inadequate intake of these nutrients in older Australians and a higher risk of osteoporosis. The relationship between serum 25(OH)D and functional measures in this population also requires further study, especially in older adults displaying Vitamin D insufficiency or deficiency.

"Get new lawyers!"

In James Rubin's account of the Kosovo war, he describes an exchange between Secretary Albright and Robin Cook (the British Foreign Secretary). Cook was explaining that it is difficult for Britain to commit to the war without UN Security Council approval because the legal advice he had received was that such action would be illegal under international law. Albright's response was, simply, "get new lawyers". Rubin "credits" Blair with a "push" that swung the British to "finally agree" that a UN Security Council resolution was "not legally required". Robin Cook later stated in Parliament and that the war was legal. Interestingly, Blair did not. This article does not look at whether or not such an exchange took place; rather look at the ethical issues that such a situation would generate. The article suggests what the ethical obligations of the key legal players in such institutional dramas should be—including governments seeking advice, the lawyers giving it, the ministers reporting it and the opposition in Parliament. The article sets out the particular responsibilities of the lawyers and officials of a Westminster system. It also sets out some of the institutional mechanisms for making it more likely that those obligations are fulfilled—as always through the interaction of obligations by different players that make it more risky for any player to breach his or her ethical obligations. Analogous duties would be faced by the relevant actors in other systems.

Educating the public health workforce : issues and challenges

Background: In public health, as well as other health education contexts, there is increasing recognition of the transformation in public health practice and the necessity for educational providers to keep pace. Traditionally, public health education has been at the postgraduate level; however, over the past decade an upsurge in the growth of undergraduate public health degrees has taken place. Discussion: This article explores the impact of these changes on the traditional sphere of Master of Public Health programs, the range of competencies required at undergraduate and postgraduate levels, and the relevance of these changes to the public health workforce. It raises questions about the complexity of educational issues facing tertiary institutions and discusses the implications of these issues on undergraduate and postgraduate programs in public health. Conclusion: The planning and provisioning of education in public health must differentiate between the requirements of undergraduate and postgraduate students – while also addressing the changing needs of the health workforce. Within Australia, although significant research has been undertaken regarding the competencies required by postgraduate public health students, the approach is still somewhat piecemeal, and does not address undergraduate public health. This paper argues for a consistent approach to competencies that describe and differentiate entry-level and advanced practice.

Introduction to Public Health

"An Introduction to Public Health is about the discipline of public health and the nature and scope of public health activity set within the challenges of the twenty first century. It is an introductory text to the principles and practice of public health written in a way that is easy to understand. Of what relevance is public health to the many allied health disciplines who contribute to it? How might an understanding of public health contribute to a range of health professionals who use the principles and practices of public health in their professional activities? These are the questions that this book addresses. An Introduction to Public Health leads the reader on a journey of discovery that concludes with not only an understanding of the nature and scope of public health but the challenges that face the field into the future." Provided by publisher.

Regulating roles of the use of the balanced scorecard in shaping corporate identities

The literature on corporate identity management suggests that managing corporate identity is a strategically complex task embracing the shaping of a range of dimensions of organisational life. The performance measurement literature and its applications likewise now also emphasise organisational ability to incorporate various dimensions considering both financial and non-financial performance measures when assessing success. The inclusion of these soft non-financial measures challenges organisations to quantify intangible aspects of performance such as corporate identity, transforming unmeasurables into measurables. This paper explores the regulatory roles of the use of the balanced scorecard in shaping key dimensions of corporate identities in a public sector shared service provider in Australia. This case study employs qualitative interviews of senior managers and employees, secondary data and participant observation. The findings suggest that the use of the balanced scorecard has potential to support identity construction, as an organisational symbol, a communication tool of vision, and as strategy, through creating conversations that self-regulate behaviour. The development of an integrated performance measurement system, the balanced scorecard, becomes an expression of a desired corporate identity, and the performance measures and continuous process provide the resource for interpreting actual corporate identities. Through this process of understanding and mobilising the interaction, it may be possible to create a less obtrusive and more subtle way to control “what an organisation is”. This case study also suggests that the theoretical and practical fusion of the disciplinary knowledge around corporate identities and performance measurement systems could make a contribution to understanding and shaping corporate identities.

Public sector evaluation of festivals and special events

This research project set out to explore Unitary Authority (UA) involvement in festivals and special events across Wales. It considers the level and nature of UA involvement and investigates activity by event purpose; reasons for, and characteristics of, UA engagement; and, crucially, the extent and nature of event evaluation. The study’s aim was to begin the development of a baseline of information for further research into the growing use of festivals and special events as a strategy for local economic development in Wales. A quantitative survey approach facilitated a comprehensive snapshot of UA responses whilst also incorporating discursive elements. A telephone survey was designed and undertaken with representatives of all 22 UA departments responsible for festivals and events in Wales. The research reveals a significant level of festival and special event activity across Wales, supported primarily for its perceived socio-cultural value. However, evaluation would appear to be focused on improving processes and measuring economic outputs rather than assessing whether socio-cultural objectives are being achieved. Whilst overwhelmingly positive about efforts to improve approaches to evaluation, respondents held clear views about the complications most likely to hamper any such efforts. These responses focused upon the need for flexibility, cost effectiveness and comparability across festival and special event typologies.

Public knowledge beyond journalism : infotainment, satire and Australian television

This thesis examines the changing relationships between television, politics, audiences and the public sphere. Premised on the notion that mediated politics is now understood “in new ways by new voices” (Jones, 2005: 4), and appropriating what McNair (2003) calls a “chaos theory” of journalism sociology, this thesis explores how two different contemporary Australian political television programs (Sunrise and The Chaser’s War on Everything) are viewed, understood, and used by audiences. In analysing these programs from textual, industry and audience perspectives, this thesis argues that journalism has been largely thought about in overly simplistic binary terms which have failed to reflect the reality of audiences’ news consumption patterns. The findings of this thesis suggest that both ‘soft’ infotainment (Sunrise) and ‘frivolous’ satire (The Chaser’s War on Everything) are used by audiences in intricate ways as sources of political information, and thus these TV programs (and those like them) should be seen as legitimate and valuable forms of public knowledge production. It therefore might be more worthwhile for scholars to think about, research and teach journalism in the plural: as a series of complementary or antagonistic journalisms, rather than as a single coherent entity.

Digital storytelling as participatory public history in Australia

This chapter discusses digital storytelling as a methodology for participatory public history through a detailed reflection on an applied research project that integrated both public history and digital storytelling in the context of a new master-planned urban development: the Kelvin Grove Urban Village Sharing Stories project.

Encouraging ethics and challenging corruption : reforming governance in public institutions

Encouraging Ethics and Preventing Corruption brings theory and practice together in addressing the question: How are we to be ethical in public life and through public institutions? It is a major contribution to public sector ethics within Australia and internationally because it provides an exhaustive analysis of reform across a decade in one jurisdiction, Queensland, and then proceeds to itemise a best practice integrity system or ethics regime. Drawing on the extensive research of two of Australia's leading practical ethicists, this text is essential reading for all students and practitioners of applied and professional ethics in the public sphere. Part A of the text provides a preferred theoretical and conceptual framework which both justifies and guides the development of a public sector ethics regime. Part B examines the place of the individual within a world of institutional ethics. Part C outlines the Queensland governance reforms introduced since 1989 following the Fitzgerald Inquiry which exposed corruption in the police and ministry. The final chapter, the 'Epilogue', gathers the insights of earlier chapters and suggests a more explicitly ethics-centred approach to governance reform that may take us 'beyond best practice'. Clearly, while it is the Australian context we have in mind, we are confident that this is a text which addresses the quest for integrity and ethics in government wherever society is committed to social and liberal democratic ideals.

Negotiating multiple identities between school and the outside world : A critical discourse analysis

This article examines interview talk of three students in an Australian high school to show how they negotiate their young adult identities between school and the outside world. It draws on Bakhtin’s concepts of dialogism and heteroglossia to argue that identities are linguistically and corporeally constituted. A critical discourse analysis of segments of transcribed interviews and student-related public documents finds a mismatch between a social justice curriculum at school and its transfer into students’ accounts of outside school lived realities. The article concludes that a productive social justice pedagogy must use its key principles of (con)textual interrogation to engage students in reflexive practice about their positioning within and against discourses of social justice in their student and civic lives. An impending national curriculum must decide whether or not it negotiates the discursive divide any better.

Management, organisation, and ethics in the public sector

Since the 1980s, in Australia and other developed nations, public sector management philosophies and how the public sector is organized have changed dramatically. At the same time, there have been many demands, and several attempts, to preserve and promote ethical behaviour within the public sector - though few go much beyond the publication of a code. Both developments require an understanding of how public organizations operate in this new environment. Organizational and management theory are seen as providing important potential insights into the opportunities and pitfalls for building ethics into the practices, culture and norms of public organizations. This book brings together the experience and research of a range of "reflective practitioners" and "engaged academics" in public sector management, organizational theory, management theory, public sector ethics and law. It addresses what management and organization theory might suggest about the nature of public organizations and the institutionalization of ethics.