Cross-cultural comparisons of health-related quality of life in Australian and Japanese midlife women

Objective: The purpose of this study was to address (1) the existence of an association between menopausal status and the health-related quality of life (HRQOL) in Australian and Japanese women and (2) the relative contributions of menopausal status, modifiable lifestyle risk factors, health, and sociodemographic factors on HRQOL. Design: The Australian and Japanese Midlife Women's Health Study (AJMWHS) was a multisite, population-based study conducted in 2001 to 2002. Measures were conducted on data collected from a survey questionnaire used for a sample of women from Australia and Japan. HRQOL was assessed with seven subscales from the Short Form-36. Results: The differences seen in physical functioning, general health, and vitality are significant. The results support an effect of country of residence on physical functioning and general health. The impact of menopausal status on HRQOL was significantly associated with bodily pain and role-emotional. The country of residence did have a modifying effect on the relationship between menopausal status and physical functioning. After control for confounders, there was a significant difference between Australian and Japanese women for HRQOL. Menopausal status was not associated with HRQOL in the areas of general health and physical functioning. Modifiable lifestyle risk factors contributed more highly to HRQOL for the Australian women than for the Japanese women. If the women had a lowered body mass index, undertook physical activity, consumed dietary phytoestrogens, and used alcohol, their physical functioning seemed to be better. Differences were seen in the contributions to HRQOL in these areas, with lower body mass index in the Australian women and physical activity in the Japanese women being the highest predictors. Somatic and psychological symptoms seem to negatively affect both Japanese and Australian women's physical functioning, contributing more than sociodemographic factors, menopausal status, and behavioral determinants combined to general health and physical functioning. Conclusions: It is important that that consideration be given to incorporating the same tool within the cross-cultural design of studies so that comparisons between cultures and patterns of healthy aging can be made. The research suggests that there seems to be variations across Australian and Japanese midlife women in some areas of HRQOL and some factors that contribute to these areas.

Methods used in cross-cultural comparisons of psychological symptoms and their determinants

This paper is the second in a series of reviews of cross-cultural studies of menopausal symptoms. The goal of this review is to compare and contrast methods which have been previously utilized in Cross-Cultural Midlife Women's Health Studies with a view to (1) identifying the challenges in measurement across cultures in psychological symptoms and (2) suggesting a set of unified questions and tools that can be used in future research in this area. This review also aims to examine the determinants of psychological symptoms and how those determinants were measured. The review included eight studies that explicitly compared symptoms in different countries or different ethnic groups in the same country and included: Australian/Japanese Midlife Women's Health Study (AJMWHS), Decisions At Menopause Study (DAMeS), Four Major Ethnic Groups (FMEG), Hilo Women's Health Survey (HWHS), Penn Ovarian Aging Study (POAS), Study of Women's Health Across the Nation (SWAN), Women's Health in Midlife National Study (WHiMNS), and the Women's International Study of Health and Sexuality (WISHeS). This review concludes that mental morbidity does affect vasomotor symptom prevalence across cultures and therefore should be measured. Based on the review of these eight studies it is recommended that the following items be included when measuring psychological symptoms across cultures, feeling tense or nervous, sleeping difficulty, difficulty in concentrating, depressed and irritability along with the CES-D Scale, and the Perceived Stress Scale. The measurement of these symptoms will provide an evidence based approach when forming any future menopause symptom list and allow for comparisons across studies.

Methods used in cross-cultural comparisons of sexual symptoms and their determinants

This is the fourth in a series of reviews of cross-cultural studies of menopausal symptoms. The purpose of this review is to examine methods used in cross-cultural comparisons of sexual symptoms among women at midlife, and to examine the determinants of sexual symptoms and how those determinants were measured. The goal of this review is to make recommendations that will improve cross-cultural comparisons in the future. The review included nine studies that explicitly examined symptoms in different countries or different ethnic groups in the same country and included: Australian/Japanese Midlife Women's Health Study (AJMWHS), Decisions At Menopause Study (DAMeS), Four Major Ethnic Groups (FMEG), Hilo Women's Health Survey (HWHS), Mid-Aged Health in Women from the Indian Subcontinent (MAHWIS), Penn Ovarian Aging Study (POAS), Study of Women's Health Across the Nation (SWAN), Women's Health in Midlife National Study (WHiMNS), and Women's International Study of Health and Sexuality (WISHeS). Although methods used for assessing sexual symptoms across cultures differed between studies, statistically significant differences were reported. Cross-cultural differences in sexual symptoms exist, and should be measured by including the following symptoms: loss of interest in sex, vaginal dryness, and the Females Sexual Function Index which covers desire, arousal, lubrication, orgasm, satisfaction, and pain on intercourse. The measurement of these symptoms will provide an evidence-based approach when forming any future menopause symptom list and allow for comparisons across studies.

Methods used in cross-cultural comparisons of vasomotor symptoms and their determinants

Methodological differences among studies of vasomotor symptoms limit rigorous comparison or systematic review. Vasomotor symptoms generally include hot flushes and night sweats although other associated symptoms exist. Prevalence rates vary between and within populations, but different studies collect data on frequency, bothersomeness, and/or severity using different outcome measures and scales, making comparisons difficult. We reviewed only cross-cultural studies of menopausal symptoms that explicitly examined symptoms in general populations of women in different countries or different ethnic groups in the same country. This resulted in the inclusion of nine studies: Australian/Japanese Midlife Women's Health Study (AJMWHS), Decisions At Menopause Study (DAMeS), Four Major Ethnic Groups (FMEG), Hilo Women's Health Survey (HWHS), Mid-Aged Health in Women from the Indian Subcontinent (MAHWIS), Penn Ovarian Aging Study (POAS), Study of Women's Health Across the Nation (SWAN), Women's Health in Midlife National Study (WHiMNS), and Women's International Study of Health and Sexuality (WISHeS). These studies highlight the methodological challenges involved in conducting multi-population studies, particularly when languages differ, but also highlight the importance of performing multivariate and factor analyses. Significant cultural differences in one or more vasomotor symptoms were observed in 8 of 9 studies, and symptoms were influenced by the following determinants: menopausal status, hormones (and variance), age (or actually, the square of age, age2), BMI, depression, anxiety, poor physical health, perceived stress, lifestyle factors (hormone therapy use, smoking and exposure to passive smoke), and acculturation (in immigrant populations). Recommendations are made to improve methodological rigor and facilitate comparisons in future cross-cultural menopause studies.

Overview of methods used in cross-cultural comparisons of menopausal symptoms and their determinants : Guidelines for Strengthening the Reporting of Menopause and Aging (STROMA) studies

This paper reviews the methods used in cross-cultural studies of menopausal symptoms with the goal of formulating recommendations to facilitate comparisons of menopausal symptoms across cultures. It provides an overview of existing approaches and serves to introduce four separate reviews of vasomotor, psychological, somatic, and sexual symptoms at midlife. Building on an earlier review of cross-cultural studies of menopause covering time periods until 2004, these reviews are based on searches of Medline, PsycINFO, CINAHL and Google Scholar for English-language articles published from 2004 to 2010 using the terms “cross cultural comparison” and “menopause.” Two major criteria were used: a study had to include more than one culture, country, or ethnic group and to have asked about actual menopausal symptom experience. We found considerable variation across studies in age ranges, symptom lists, reference period for symptom recall, variables included in multivariate analyses, and the measurement of factors (e.g., menopausal status and hormonal factors, demographic, anthropometric, mental/physical health, and lifestyle measures) that influence vasomotor, psychological, somatic and sexual symptoms. Based on these reviews, we make recommendations for future research regarding age range, symptom lists, reference/recall periods, and measurement of menopausal status. Recommendations specific to the cross-cultural study of vasomotor, psychological, somatic, and sexual symptoms are found in the four reviews that follow this introduction.

Methods used in cross-cultural comparisons of somatic symptoms and their determinants

This paper is the third in a series of reviews of cross-cultural studies of symptoms at midlife. The goal of this review is to examine methods used previously in cross-cultural studies of menopause and women's health at midlife to (1) identify challenges in the measurement of somatic symptoms across cultures and (2) recommend questions and tools that can be used in future research. This review also aims to examine the determinants of somatic symptoms. The review concludes that methods used for assessing somatic symptoms differ across studies. Somatic symptoms, particularly, aches, pain, and fatigue have a high prevalence. Statistically significant differences were seen in the prevalence of somatic symptoms across cultures. Based on the number of studies that demonstrated cross-cultural differences in symptom prevalence, we recommend that the following symptoms be included in future studies of symptoms at midlife: headaches, aches/pain, palpitations, dizziness, fatigue, breathing difficulties, numbness or tingling, and gastrointestinal difficulties. We also recommend that objective measures of physical function be administered when possible to supplement subjective self-evaluation.

The relationship between parents’ self-efficacy beliefs, outcome expectations, child behaviour, and management of atopic dermatitis

Atopic dermatitis (AD) is a chronic inflammatory skin condition, characterized by intense pruritis, with a complex aetiology comprising multiple genetic and environmental factors. It is a common chronic health problem among children, and along with other allergic conditions, is increasing in prevalence within Australia and in many countries worldwide. Successful management of childhood AD poses a significant and ongoing challenge to parents of affected children. Episodic and unpredictable, AD can have profound effects on children’s physical and psychosocial wellbeing and quality of life, and that of their caregivers and families. Where concurrent child behavioural problems and parenting difficulties exist, parents may have particular difficulty achieving adequate and consistent performance of the routine management tasks that promote the child’s health and wellbeing. Despite frequent reports of behaviour problems in children with AD, past research has neglected the importance of child behaviour to parenting confidence and competence with treatment. Parents of children with AD are also at risk of experiencing depression, anxiety, parenting stress, and parenting difficulties. Although these factors have been associated with difficulty in managing other childhood chronic health conditions, the nature of these relationships in the context of child AD management has not been reported. This study therefore examined relationships between child, parent, and family variables, and parents’ management of child AD and difficult child behaviour, using social cognitive and self-efficacy theory as a guiding framework. The study was conducted in three phases. It employed a quantitative, cross-sectional study design, accessing a community sample of 120 parents of children with AD, and a sample of 64 child-parent dyads recruited from a metropolitan paediatric tertiary referral centre. In Phase One, instruments designed to measure parents’ self-reported performance of AD management tasks (Parents’ Eczema Management Scale – PEMS) and parents’ outcome expectations of task performance (Parents’ Outcome Expectations of Eczema Management Scale – POEEMS) were adapted from the Parental Self-Efficacy with Eczema Care Index (PASECI). In Phase Two, these instruments were used to examine relationships between child, parent, and family variables, and parents’ self-efficacy, outcome expectations, and self-reported performance of AD management tasks. Relationships between child, parent, and family variables, parents’ self-efficacy for managing problem behaviours, and reported parenting practices, were also examined. This latter focus was explored further in Phase Three, in which relationships between observed child and parent behaviour, and parent-reported self-efficacy for managing both child AD and problem behaviours, were explored. Phase One demonstrated the reliability of both PEMS and POEEMS, and confirmed that PASECI was reliable and valid with modification as detailed. Factor analyses revealed two-factor structures for PEMS and PASECI alike, with both scales containing factors related to performing routine management tasks, and managing the child’s symptoms and behaviour. Factor analysis was also applied to POEEMS resulting in a three-factor structure. Factors relating to independent management of AD by the parent, involving healthcare professionals in management, and involving the child in management of AD were found. Parents’ self-efficacy and outcome expectations had a significant influence on self-reported task performance. In Phase Two, relationships emerged between parents’ self-efficacy and self-reported performance of AD management tasks, and AD severity, child behaviour difficulties, parent depression and stress, conflict over parenting issues, and parents’ relationship satisfaction. Using multiple linear regressions, significant proportions of variation in parents’ self-efficacy and self-reported performance of AD management tasks were explained by child behaviour difficulties and parents’ formal education, and self-efficacy emerged as a likely mediator for the relationships between both child behaviour and parents’ education, and performance of AD management tasks. Relationships were also found between parents’ self-efficacy for managing difficult child behaviour and use of dysfunctional parenting strategies, and child behaviour difficulties, parents’ depression and stress, conflict over parenting issues, and relationship satisfaction. While significant proportions of variation in self-efficacy for managing child behaviour were explained by both child behaviour and family income, family income was the only variable to explain a significant proportion of variation in parent-reported use of dysfunctional parenting strategies. Greater use of dysfunctional parenting strategies (both lax and authoritarian parenting) was associated with more severe AD. Parents reporting lower self-efficacy for managing AD also reported lower self-efficacy for managing difficult child behaviour; likewise, less successful self-reported performance of AD management tasks was associated with greater use of dysfunctional parenting strategies. When child and parent behaviour was directly observed in Phase Three, more aversive child behaviour was associated with lower self-efficacy, less positive outcome expectations, and poorer self-reported performance of AD management tasks by parents. Importantly, there were strong positive relationships between these variables (self-efficacy, outcome expectations, and self-reported task performance) and parents’ observed competence when providing treatment to their child. Less competent performance was also associated with greater parent-reported child behaviour difficulties, parent depression and stress, parenting conflict, and relationship dissatisfaction. Overall, this study revealed the importance of child behaviour to parents’ confidence and practices in the contexts of child AD and child behaviour management. Parents of children with concurrent AD and behavioural problems are at particular risk of having low self-efficacy for managing their child’s AD and difficult behaviour. Children with more severe AD are also at higher risk of behaviour problems, and thus represent a high-risk group of children whose parents may struggle to manage the disease successfully. As one of the first studies to examine the role and correlates of parents’ self-efficacy in child AD management, this study identified a number of potentially modifiable factors that can be targeted to enhance parents’ self-efficacy, and improve parent management of child AD. In particular, interventions should focus on child behaviour and parenting issues to support parents caring for children with AD and improve child health outcomes. In future, findings from this research will assist healthcare teams to identify parents most in need of support and intervention, and inform the development and testing of targeted multidisciplinary strategies to support parents caring for children with AD.

Substance-related expectancies among men who have sex with men : development of psychometric tools to predict unprotected sexual activity

Significant research has demonstrated direct and indirect associations between substance use and sexual behaviour. Substance use is related to sexual risk-taking and HIV seroconversion among some substance-using MSM. It remains unclear what factors mediate or underlie this relationship, and which substances are associated with greater harm. Substance-related expectancies are hypothesised as potential mechanisms. A conceptual model based on social-cognitive theory was tested, which explores the role of demographic factors, substance use, substance-related expectancies and novelty-seeking personality characteristics in predicting unprotected anal intercourse (UAI) while under the influence, across four commonly used substance types. Phase 1, a qualitative study (N = 20), explored how MSM perceive the effects of substance use on their thoughts, feelings and behaviours, including sexual behaviours. Information was attained through discussion and interviews, resulting in the establishment of key themes. Results indicated MSM experience a wide range of reinforcing aspects associated with substance use. General and specific effects were evident across substance types, and were associated with sexual behaviour and sexual risk-taking. Phase 2 consisted of developing a comprehensive profile of substance-related expectancies for MSM (SEP-MSM) regarding alcohol, cannabis, amyl nitrite and stimulants that possessed sound psychometric properties and was appropriate for use among this group. A cross-sectional questionnaire with 249 participants recruited through gay community networks was used to validate these measures, and involved online data collection, participants rating expectancy items and subsequent factor analysis. Results indicated expectancies can be reliably assessed, and predicted substance use patterns. Phase 3 examined demographic factors, substance use, substance-related expectancies, and novelty-seeking traits among another community sample of MSM (N = 277) throughout Australia, in predicting UAI while under the influence. Using a cross-sectional design, participants were recruited through gay community networks and completed online questionnaires. The SEP-MSM, and associated substance use, predicted UAI. This research extends social-cognitive theory regarding sexual behaviour, and advances understanding of the role of expectancies associated with substance use and sexual risk-taking. Future applications of the SEP-MSM in health promotion, prevention, clinical interventions and research are likely to contribute to reducing harm associated with substance-using MSM (e.g., HIV transmission).

Stop whining and make the best of it: a cross-national comparison of response to regional disadvantage in the wine industry

Our cross-national field study of wine entrepreneurship in the “wrong” places provides some redress to the focus of the “regional advantage” literature on places that have already won and on the firms that benefit from “clusters” and other centers of industry advantage. Regional “disadvantage” is at best a shadowy afterthought to this literature. By poking around in these shadows, we help to synthesize and extend the incipient yet burgeoning literature on entrepreneurial “resourcefulness” and we contribute to the developing body of insights and theory pertinent to the numerous but often ignored firms and startups that mostly need to worry about how they will compete at all now if they are ever to have of chance of “winning” in the future. The core of our findings suggests that understandable – though contested – processes of ingenuity underlie entrepreneurial responses to regional disadvantage. Because we study entrepreneurship that from many angles simply does not make sense, we are also able to proffer a novel perspective on entrepreneurial sensemaking.

Parsing the Australian curriculum English : grammar, multimodality and cross-cultural texts

The release of the Australian Curriculum English (ACE) by the Australian Curriculum, Assessment and Reporting Authority (ACARA) has revived debates about the role of grammar as English content knowledge. We consider some of the discussion circulating in the mainstream media vis-à-vis the intent of the ACE. We conclude that this curriculum draws upon the complementary tenets of traditional Latin-based grammar and systemic functional linguistics across the three strands of Language, Literature and Literacy in innovative ways. We argue that such an approach is necessary for working with contemporary multimodal and cross-cultural texts. To demonstrate the utility of this new approach, we draw out a set of learning outcomes from Year 6 and then map out a framework for relating the outcomes to the form and function of multimodal language. As a case in point, our analysis is of two online Coca-Cola advertising texts, one each from South Korea and Australia.

Phase two of the National Credit Reforms : examining the regulation of payday lenders

This study seeks to analyse the adequacy of the current regulation of the payday lending industry in Australia, and consider whether there is a need for additional regulation to protect consumers of these services. The report examines the different regulatory approaches adopted in comparable OECD countries, and reviews alternative models for payday regulation, in particular, the role played by responsible lending. The study also examines the consumer protection mechanisms now in existence in Australia in the National Consumer Credit Protection Act 2009 (Cth) (NCCP) and the National Credit Code (NCC) contained in Schedule 1 of that Act and in the Australian Securities and Investments Commission Act 2001 (Cth).

Creating better learning environments by cross-disciplinary collaboration : a civil engineering and surveying linkage

Many of the teaching elements in Civil and Environmental Engineering and Spatial Science/Surveying are strongly related to multidisciplinary real-world situations. Professionals in each discipline commonly work collaboratively, knowing each other’s professional and technical limitations and requirements. Replication of such real-world situations allows students to gain an insight and acquire knowledge of professional practice for both civil engineering and spatial science disciplines. However, replication of an authentic design project is not always possible in a single unit basis where empirical project situations are often created with controlled sets of constraints, inputs and outputs. A cross-disciplinary design-based project that is designed to promote active student learning, engagement and professional integration would be the preferred option. The central aim of this collaborative project was to create positive and inclusive environments to promote engaging learning opportunities that cater for a range of learning styles with a two-way linkage involving third-year civil engineering and spatial science (surveying) students. This paper describes the cross-disciplinary project developed and delivered in 2010 and 2011. A survey was conducted at completion of the project to assess the degree of improvement in student engagement and their learning experiences. Improvements were assessed in a range of dimensions including student motivation, learning by cross-disciplinary collaboration and learning by authentic design project experiences. In this specific cross-disciplinary linkage project, the study findings showed that teaching approaches utilised have been effective in promoting active student learning and increasing engagement.

Pharmacological consequence of the A118G μ opioid receptor polymorphism on morphine-and fentanyl-mediated modulation of Ca2+ channels in humanized mouse sensory neurons

Background: The most common functional single nucleotide polymorphism of the human OPRM1 gene, A118G, has been shown to be associated with interindividual differences in opioid analgesic requirements, particularly with morphine, in patients with acute postoperative pain. The purpose of this study was to examine whether this polymorphism would modulate the morphine and fentanyl pharmacological profile of sensory neurons isolated from a humanized mouse model homozygous for either the 118A or 118G allele. Methods: The coupling of wild-type and mutant μ opioid receptors to voltage-gated Ca channels after exposure to either ligand was examined by employing the whole cell variant of the patch-clamp technique in acutely dissociated trigeminal ganglion neurons. Morphine-mediated antinociception was measured in mice carrying either the 118AA or 118GG allele. RESULTS:: The biophysical parameters (cell size, current density, and peak current amplitude potential) measured from both groups of sensory neurons were not significantly different. In 118GG neurons, morphine was approximately fivefold less potent and 26% less efficacious than that observed in 118AA neurons. On the other hand, the potency and efficacy of fentanyl were similar for both groups of neurons. Morphine-mediated analgesia in 118GG mice was significantly reduced compared with the 118AA mice. Conclusions: This study provides evidence to suggest that the diminished clinical effect observed with morphine in 118G carriers results from an alteration of the receptor's pharmacology in sensory neurons. In addition, the impaired analgesic response with morphine may explain why carriers of this receptor variant have an increased susceptibility to become addicted to opioids. © 2011 the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins. Anesthesiology.