Motivational interviewing in the prevention and management of chronic disease : improving physical activity and exercise in line with choice theory

Discusses the relationship between motivational interviewing and choice theory in working with chronically ill clients/patients.

Towards a cyclical framework for the investigation and management of elite level sponsorships

Sponsorship is a growing marketing communications tool which can produce unmatched results when used effectively. As such, rigid and applicable management frameworks are of critical importance as the discipline continues to develop. A conceptual review of existing sponsorship management frameworks and their common components are presented before an alternate cyclical management framework is derived. A series of case studies with organizations investing in elite level, million dollar sport sponsorship was used as the research strategy. Data was collected through qualitative interviews with within and cross case analysis used to identify trends. Five pillars of evidence supported the view that sponsorships were viewed and managed by corporate sponsors under a cyclical framework. The cyclical framework allows for interrelations between sponsorship management components to be better identified and investigated, and demonstrate how a cyclical view of management can aid the ongoing creation of value in long term sponsorships.

Continence prevalence and management in an acute hospital

Learning Objective 1: describe the prevalence of incontinence within an Australian acute care hospital

Learning Objective 2: describe the current management practices for incontinence with regard to patients in an acute care hospital
Introduction: In 1998 the World Health Organisation recognised the international problem of incontinence. However, incontinence remains a major problem that affects more than 3.8 million Australians. Currently, there are no Australian guidelines governing the management of continence within the acute healthcare setting. Cabrini Health sought to identify the prevalence of incontinence in the acute inpatient setting and pilot a Continence Management Program to improve patient safety and patient outcomes.

Aim: The aim of this study was to determine the prevalence of and current management practices for incontinence with regard to Cabrini Health inpatients.

Method: The sample comprised 392 inpatients across three campuses of Cabrini Health (mean age= 68.3 years). Continence prevalence was assessed using a validated Continence Point Prevalence Tool.

Results: Urinary incontinence prevalence was 14%. The resulting overall faecal incontinence prevalence was 7.4%. There were 113 (52.3%) patients who were not incontinent and were using a continence product/device. Fifteen (25.9%) patients were incontinent and were not using any form of continence product/device. There were 43 (74.1%) patients who were incontinent and were using a continence product/device. For the large majority of patients, the admission notes contained documentation of their bladder and bowel function. Specifically, 46 (11.8%) patients had no form of admission documentation relating to bowel function and 45 (11.5%) patients had no form of admission documentation regarding to bladder function.

Conclusions: This study provided baseline continence prevalence for Cabrini Health. There is a need for evidence-based guidelines to support the management of incontinent patients. These interventions will assist staff to educate patients on appropriate choice of continence products and enable patients to maintain or regain continence. Thereby, leading to improved outcomes for patients and improved risk management.

Taking environmental water requirements and climate change into account in the designation and management of protected areas for floodplain ecosystems

In 2005, the Victorian government asked the Victorian Environmental Assessment Council (VEAC) to 1) identify and evaluate the extent, condition, values, management, resources and uses of riverine red gum forests and associated fauna, wetlands, floodplain ecosystems and vegetation communities in northern Victoria; and 2) make recommendations relating to the conservation, protection and ecological sustainable use of public land. The design of a comprehensive, adequate and representative (CAR) reserve system was a key part of the recommendations made by VEAC. In order to assist in the decision-making for environmental water allocation for protected areas and other public land, a process for identifying flood-dependent natural values on the Victorian floodplains of the River Murray and its tributaries was developed.

Although some areas such as the Barmah forest are very well known, there have been few comprehensive inventories of important natural values along the Murray floodplains. For this project, VEAC sought out and compiled data on flood requirements (natural flood frequency, critical interval between floods, minimum duration of floods) for all flood-dependent ecological vegetation classes (EVCs) and threatened species along the Goulburn, Ovens, King and Murray Rivers in Victoria. The project did not include the Kerang Lakes and floodplains of the Avoca, Loddon and Campaspe Rivers. 186 threatened species and 110 EVCs (covering 224,247 ha) were identified as flood-dependent and therefore at risk from insufficient flooding.

Past environmental water allocations have targeted a variety of different natural assets (e.g. stressed red gum trees, colonial nesting waterbirds, various fish species), but consideration of the water requirements of the full suite of floodplain ecosystems and significant species has been limited. By considering the water requirements of the full range of natural assets, the effectiveness of water delivery for biodiversity can be maximised. This approach highlights the species and ecosystems most in need of water and builds on the icon sites approach to view the Murray floodplains as an interconnected system. This project also identified for the first time the flood-frequency and duration requirements for the full suite of floodplain ecosystems and significant species.

This project is the most comprehensive identification of water requirements for natural values on the floodplain to date, and is able to be used immediately to guide prioritisation of environmental watering. As more information on floodplain EVCs and species becomes available, the water requirements and distribution of values can be refined by ecologists and land and water managers. That is, the project is intended as the start of an adaptive process allowing for the incorporation of monitoring and feedback over time. The project makes it possible to transparently and easily communicate the extent to which manipulated or natural flows benefit various natural values. Quantitative and visual outputs such as maps will enable environmental managers and the public to easily see which values do and do not receive water (see http://www.veac.vic.gov.au/riverredgumfinal.htm for further details).

The role of loneliness in prison suicide prevention and management

Suicide in prisons has been seen as a public health concern reaching crisis proportions around the world. In this study, data from 60 inmates in a South Australian remand facility were used to examine the relationship between loneliness and known predictors of self-harm, such as depression and hopelessness. As predicted, the results suggested that prisoners who scored higher on a measure of loneliness reported higher levels of depression, hopelessness and indicators of suicidal behaviour. The implications of these findings for suicide management are discussed. It is concluded that whilst specialist mental health services are needed to treat problems such as depression, loneliness is something that may be managed by correctional staff with no professional experience or training.

Cadaveric vs. live-donor kidney transplants : theoretical foundations of interaction between institutions and inequality

In 1991, the World Health Assembly approved a set of Guiding Principles which emphasize voluntary donation, non-commercialization and a preference for cadavers over living donors” (World Health Organization). The objective of this paper is to identify the factors that affect the ratio of cadaveric transplants to all transplants. This paper first provides informational background on problems surrounding kidney transplants and then uses a theoretical framework which employs standard economic assumptions but incorporates a setup where the persons needing kidneys can obtain it from their compatible relatives or purchase it from individuals who are willing to sell one of their kidneys. The methods of economic theoretical analyses are used where following definitions and assumptions some conclusions are drawn. This paper finds that factors such as inequality, rule of law and religion have significant effect on the ratio of cadaveric transplants to all transplants. The paper concludes that improvement in equality and in rule of law will increase the use of cadaveric kidney transplants. In addition, fighting religious beliefs against cadaveric kidney transplants too will lead to a higher ratio of cadaveric transplants to all transplants.

The assessment and management of common male sexual difficulties in family practice

Sexual problems are distressing for patients, and their doctors need to feel comfortable giving advice about and treating the more common conditions. Treatment of sexual problems can prevent much anxiety and the development of depression. This article outlines approaches useful in managing the more common male sexual difficulties encountered in family practice.

Australian dental policy reform and the use of dental therapists and hygienists

Oral diseases including dental caries and periodontal disease are among the most prevalent and costly diseases in Australia today. Around 5.4% of Australia’s health dollar is spent on dental services totalling around $2.6 billion, 84% of which are delivered through the private sector (AIHW 2001). The other 16% is spent providing public sector services in varied and inadequate ways. While disease rates among school children have declined significantly in the past 20 years the gains made among children are not flowing on to adult dentitions and our aging population will place increasing demands on an inadequate system into the future (AHMAC 2001). Around 50% of adults do not received regular care and this has implications for widening health inequalities as the greatest burden falls on lower income groups (AIHW DSRU 2001). The National Competition Policy agenda has initiated, Australia-wide, reviews of dental legislation applying to delivery of services by dentists, dental specialists, dental therapists and hygienists and dental technicians and prosthetists. The review of the Victorian Dentists Act 1972, was completed first in 1999, followed by the other Australian states with Queensland, the ACT and the Northern Territory still developing legislation. One of the objectives of the new Victorian Act is to ‘…promote access to dental care’. This study has grown out of the need to know more about how dental therapists and hygienists might be utilised to achieve this and the legislative frameworks that could enable such roles. This study used qualitative methods to explore dental health policy making associated with strategies that may increase access to dental care using dental therapists and hygienists. The study used a multiple case study design to critically examine the dental policy development process around the Review of the Dentists Act 1972 in Victoria; to assess legislative and regulatory dental policy reforms in other states in Australia and to conduct a comparative analysis of dental health policy as it relates to dental auxiliary practice internationally. Data collection has involved (I) semi-structured interviews with key participants and stakeholders in the policy development processes in Victoria, interstate and overseas, and (ii) analysis of documentary data sources. The study has taken a grounded theory approach whereby theoretical issues that emerged from the Victorian case study were further developed and challenged in the subsequent interstate and international case studies. A component of this study has required the development of indicators in regulatory models for dental hygienists and therapists that will increase access to dental care for the community. These indicators have been used to analyse regulation reform and the likely impacts in each setting. Despite evidence of need, evidence of the effectiveness and efficiency of dental therapists and hygienists, and the National Competition Policy agenda of increasing efficiency, the legislation reviews have mostly produces only minor changes. Results show that almost all Australian states have regulated dental therapists and hygienists in more prescriptive ways than they do dentists. The study has found that dental policy making is still dominated by the views of private practice dentists under elitist models that largely protect dentist authority, autonomy and sovereignty. The influence of dentist professional dominance has meant that governments have been reluctant to make sweeping changes. The study has demonstrated alternative models of regulation for dental therapists and hygienists, which would allow wider utilisation of their skills, more effective use of public sector funding, increased access to services and a grater focus on preventive care. In the light of theses outcomes, there is a need to continue to advocate for changes that will increase the public health focus of oral health care.

Nutrients in Pirron Yallock Creek, southwestern Victoria : paleolimnological and management considerations

The concentrations of various forms of nitrogen and phosphorus in the main stream and selected tributaries of Pirron Yallock Creek, southwestern Victoria were examined over a two-year period. Exceedingly high levels of both nutrients were found within a particular tributary, while generally high nutrient levels were observed throughout the catchment. The speciation results indicated that dairy effluent was the primary source of nutrients to Pirron Yallock Creek. A palaeolimnological study was undertaken to determine the impact of European settlement upon waterway nutrient concentrations within the region. The palaeolimnological study focused primarily on the diatom flora preserved within the sediments of nearby Lakes Corangamite and Bullen Merri. Lack of preservation of diatoms within the sediments of Lake Corangamite resulted in no water quality inferences for this lake. The preserved diatoms within Lake Bullen Merri suggested an increase in trophic status of this lake during the last 500 years. While a change in the diatom flora of Lake Bullen Merri was evident, it was not possible to differentiate the impact of European settlement upon nutrient status of this waterway from long-term trophic status change. In light of the particularly high nutrient concentrations observed in Pirron Yallock Creek, improved nutrient management strategies are proposed for the catchment. These strategies, which consider current nutrient management activities, are predominantly focussed on the dairy industry, which occupies the majority of the catchment.

The teacher's role in the research-policy-praxis nexus

What kinds of relationships exist between educational policy, research and the professional knowledge of the teachers that implement these policies in practice? This article reports research that examined the role of teachers working in an environment formed by links between research, policy and practice. By adopting a contextual focus upon the Victorian Early Years Literacy Program, its research and teachers who implement the program, the study analysed how early years reading is being constructed. Critical issues are identified about the impact of policy and research upon the teaching profession and the links that are present in the research-policy-praxis nexus.

An integrated observation network for the Gippsland Lakes, Victoria, Australia : balancing the needs of science and management

The Gippsland Lakes region in eastern Victoria is a partially flushed coastal lake system within a diverse catchment of rural and urban communities. Pressure from lakeside developments, re-occurring blue-green algal blooms, declining fisheries, sedimentation and infilling of the ocean entrance, has borne several decades of focussed studies and routine monitoring programs, along with a variety of engineering and management solutions. A recent review recommended that these disparate studies should be enhanced to formulate a coordinated monitoring network that could improve both spatial and temporal coverage, develop a capacity to trigger responsive investigations and was able to serve the needs of system management. Through a series of partnerships an integrated network was developed that comprises event and baseline monitoring of catchment loads, local meteorological forcing and an array of water quality sampling sites within the lakes system. A majority of these sites are incorporated with real-time telemetry that provides up to the minute information to stakeholders via a web-based information management system and vital operational status to technical system management.