Analysing health claims policy in Australia : a case study of evidence in food and nutrition policy-making

Purpose: Health claims generally describe an association between a food product and a health outcome. There is debate whether health claims promote or obstruct healthy food selection behaviour. This study investigates the role of evidence in food and nutrition policy-making. The research question is how and why was health claims policy made in Australia? The research is innovative in its critical analysis design and its focus on building theory to help improve food and nutrition policy-making processes and outcomes.

Methods: A case study design was adopted in which events, stakeholders and issues associated with the policy review were described from data generated from interviews and documentary sources. A content-analysis tool is being used to critically analyse textual data. Concepts in the text are being identified and relationships among the policy concepts, stakeholders and processes are being mapped.

Findings: The analysis of data associated with the policy review is revealing a pattern of relationships among stakeholders, processes and concepts around shared values, beliefs and interests towards food and health. Broader food regulation contexts have influenced the decision-making environment. The pattern of relationships shares common characteristics with Sabatier’s ‘Advocacy Coalition Framework’ theoretical explanation of policy-making.

Conclusions: The study findings have implications for health claims policy and practice in Australia. As a case study of evidence in food and nutrition policy-making, this research highlights the role of competing interests, beliefs and values in evidence interpretation. Challenges are identified in undertaking food policy research.

Overweight, obesity and metabolic syndrome in rural south-eastern Australia

Aims & rationale/Objectives : To measure the prevalence of overweight, obesity and the metabolic syndrome in rural Australia.</p>

Methods :Two cross-sectional population surveys of chronic disease risk factors were carried out in rural Victoria (Corangamite Shire) and South Australia (Limestone Coast) in 2004-05. For both surveys, a stratified random sample of the population aged 25 to 74 years was drawn from the electoral roll. The surveys comprised a self-administered questionnaire, physical measurements and laboratory tests.</p>

Principal findings : A total of 841 individuals had complete questionnaire, health check and measured MetS data. The prevalence of overweight and obesity was 75% in males and 64.7% in females defined by BMI. Using waist circumference, the prevalence of overweight and obesity was higher in females (72.9%) than in males (63.2%). The overall prevalence of obesity of was 30.1% when defined by BMI, but 44.8% when defined by waist circumference. The prevalence of metabolic syndrome according to NCEP ATP III 2005 criteria was 29.0% in males and 28.5% in females. According to IDF criteria, the prevalence for males and females were 30.5% and 36.3%, respectively. The prevalence of metabolic syndrome and central (abdominal) obesity, hyperglycaemia, hypertension, and hypertriglyceridaemia increased with age.

Discussion : The prevalence of overweight and obesity, in particular central obesity, in rural Australia is very high as is the prevalence of metabolic syndrome.

Implications : Urgent population wide action is required to turn this trend around and regular monitoring of the trends in response to such action is essential.

Underpricing of energy IPOs in Australia

The underpricing of initial public offerings (IPOs) has been discussed in the literature for over thirty years. Underpricing is the term used when the issue price of the shares of a company raising public equity capital and seeking to list on a stock exchange is below the closing price of the shares on the first day of listing. As such, underpricing theoretically allows subscribing investors the opportunity of making a return on the day of listing. The international evidence as examined in [4] and updated in [5] has documented that subscribing investors made handsome double-digit' (for example US IPOs - 15.7%, UK IPOs 12%, Turkish IPOs - 13.1 %, Greek IPOs -49.0%) or even triple-digit (for example Chinese IPOs 256.9%) statistically significant positive first day returns, on average. These studies are generally however of industrial company IPOs.

The purpose of this paper is to investigate the underpricing returns of Australian energy IPOs from January 1994 to June 2007. Two previous studies into natural resource IPOs in Australia only made fleeting mention of energy IPOs because of the small sample sizes. [3] identified 2 solid fuel IPOs and 13 oil and gas IPOs (amongst 130 other natural resource IPOs) during 1979 to 1990 and advised average underpricing returns of 106.5% and 47.3% respectively for investors subscribing to these IPOs. [2] investigated 19 energy IPOs (amongst 96 other natural resource IPOs) from 1994 to 1999 and reported an average underpricing return of 8.3%.

The sample set of 134 used in this study is significantly greater than previous Australian studies. These 134 energy IPOs raised over $1.945 billion of public equity capital from January 1994 to June 2007. [3] reports on the importance of the natural resources sectors to Australia's economy and the fact that companies working in these sectors constitute around one third of the entities listed on the Australian Stock Exchange.

This study also follows a highly influential paper in the IPO literature by [I]. They argue that the lower the uncertainty about the value of an IPO, the lower the underpricing needed to attract subscribers. Given the linkage between uncertainty and underpricing, this study seeks to identify the factors that might influence uncertainty and hence underpricing.

The study found that the mean underpricing return for these energy lPOs is 22.8% and statistically significant. The model used to investigate variables that might help explain the level of underpricing in this industry sector is also particularly useful. An important finding in the study for new issuers, underwriters and subscribing investors is that those energy IPO firms that used underwriters had substantially lower underpricing. The other finding that larger issues are likely to have lower underpricing is consistent with prior industrial company IPO studies.

The career development year : responding to the emergency nursing shortage in Australia

Background: The Career Development Year (CDY) is a 12 month supported entry program at one health care service in Victoria, Australia. The program targets Division One Registered Nurses with little or no emergency nursing experience. The intent of CDY is to improve recruitment to, and retention in, emergency nursing by educational and experiential preparation for emergency nursing practice.

Method: This study used a retrospective exploratory design to examine recruitment and retention of emergency nurses recruited via CDY (n = 72) and compare these findings with recruitment and retention data for a cohort of non-CDY participants (n = 15). CDY data was collected by self-report questionnaires. Descriptive statistics, correlations and inferential statistics were calculated using SPSS.

Results: CDY was found to promote recruitment of novice nurses to emergency nursing, with almost half the respondents (n = 25, 48.1%) reporting they would not have entered emergency nursing were it not for the supported entry program. Further, comparison with non-CDY participants revealed that CDY promoted retention within emergency nursing, with both short-term (n = 47, 90.4% vs. n = 8, 53.4%) and long-term retention doubling (n = 50, 96.1% vs. n = 7, 46.6%) following the introduction of CDY.

Conclusion: CDY was a valuable recruitment tool and successful retention strategy in the ED. Future research using a larger sample may demonstrate potential applicability to other clinical areas.

A longitudinal study of the commitment to business ethics of corporate Australia

This paper compares the results of a longitudinal study of ten years, conducted at five yearly intervals, from 1995 to 2005. The aim of the study was to examine the commitment to business ethics of the top 500 Australian companies. Primary data was obtained via a self-administered mail questionnaire distributed to a census of the top 500 Australian companies. This paper examines those responses that indicated that their company possessed a code of ethics. The paper finds that business ethics has continued to evolve and that, in most cases, such evolution has been positive. It would seem that codes of ethics have moved beyond a regulatory requirement and are now considered an integral component of corporate culture and commercial practice in many of Australia's top companies.

The early postnatal period : exploring women's views, expectations and experiences of care using focus groups in Victoria, Australia

Background: There is growing evidence from Australia and overseas that the care provided in hospital in the early postnatal period is less than ideal for both women and care providers. Many health services face increasing pressure on hospital beds and have limited physical space available to care for mothers and their babies. We aimed to gain a more in-depth understanding of women's views, expectations and experiences of early postnatal care.

Methods: We conducted focus groups in rural and metropolitan Victoria, Australia in 2006. Fifty-two people participated in eight focus groups and four interviews. Participants included eight pregnant women, of whom seven were pregnant with their first baby; 42 women who were in the postpartum period (some up to twelve months after the birth of their baby); and two partners. All participants were fluent in English. Focus group guides were developed specifically for the study and explored participants' experiences and/or expectations of early postnatal care in hospital and at home, with an emphasis on length of hospital stay, professional and social support, continuity of care, and rest. Discussions were audio-taped and transcribed verbatim. A thematic network was constructed to describe and connect categories with emerging basic, organizing, and global themes.

Results: Global themes that emerged were: anxiety and/or fear; and the transition to motherhood and parenting. The needs of first time mothers were considered to be different to the needs of women who had already experienced motherhood. The women in this study were generally concerned about the safety of their new baby, and lacked confidence in themselves as new mothers regarding their ability to care for their baby. There was a consistent view that the physical presence and availability of professional support helped alleviate these concerns, and this was especially the case for women having a first baby.

Conclusion: Women have anxieties and fears around early parenting and their changing role, and may consider that the physical availability of professional care providers will help during this time. Care providers should be cognisant of these potential issues. It is crucial that women's concerns and needs be considered when service delivery changes are planned. If anxiety around new parenting is a predominant view then care providers need to recognise this and ensure care is individualised to address each woman's/families particular concerns.

Satisfaction with services among people with progressive neurological illnesses and their careers in Australia

Abstract The current study investigated the types of support networks and services accessed by people with progressive neurological illness, as well as the assessment of the usefulness of these services. The participants were 25 people with multiple sclerosis, 15 people with motor neurone disease, 23 people with Parkinson's disease, and six people with Huntington's disease. Twenty-eight professionals who worked with people with these illnesses and 41 carers of people with these illnesses also were interviewed. The results demonstrate that all of the groups of respondents indicated a strong need for basic services (e.g. home help), as well as specialized services (e.g. support groups). These two services also were identified as the most useful services by all of the groups of respondents. The similarities and differences between the groups, as well as the patients and carers, are examined. These findings demonstrate the importance of providing basic services for people with progressive neurological illnesses.

Challenges facing housing affordability in Beijing in the Twenty-first century

Purpose – The purpose of this paper is analyse to what extent the high price had led to low levels of housing affordability in the period 2002-2006 in Beijing. Due to the importance of housing for local residents and the crucial position that real estate market in the Chinese economy is currently in, research into the housing affordability issues is now essential. It is important to consider the social circumstances that are predominantly related to both the standard of living and the national economy in Beijing.

Design/methodology/approach – The housing price to income ratio (PIR) method and Housing Affordability Index (HAI) model are used to measure housing affordability in Beijing. Then, the reasons for the high housing prices in Beijing are discussed and government homeownership-oriented policies to help citizen on housing issues are examined. Finally, future proposals which can contribute to ease the housing affordability problem are recommended.

Findings – The main findings in this research are that the PIR in the Beijing housing market (based on an average gross floor area of 60?m2) fluctuated between 6.69 and 9.12, respectively, between 2002 and 2006. Over the same period, the HAI was approximately 75 between 2002 and 2004, although decreasing sharply in 2005 (65.78) and 2006 (51.33). It appears that the Chinese government's new housing provision policies may be able to ease this affordability problem, especially with regards to the economic housing scheme.

Originality/value – China has experienced rapid growth in gross domestic product (GDP) with a substantial increase in house prices which have affected housing affordability for typical Beijing households. Since the housing reform in China commenced in 1998, Beijing residents, government officers and academics have been concerned about high housing prices in the city, which is considered beyond the buying capability of the ordinary residents. The results are designed to provide an insight into the level of housing affordability in Beijing and whether a trend exists.

Self-rated preparedness of Australian prevocational hospital doctors for emergencies

Objective: To determine perceived preparedness of Australian hospital-based prevocational doctors for resuscitation skills and management of emergencies, and to identify differences between doctors who perceive themselves well prepared and those who perceive themselves poorly prepared for emergencies, in demographics and exposure to desired learning methods.

Methods: Questionnaire consisting of a mix of graded Likert scales and free-text answers distributed to 36 Australian hospitals for secondary distribution to hospital medical officers.

Results: From 2607 questionnaires posted, 470 (18.1%) were returned. Thirty-one per cent (95% confidence interval [CI] 26–35%) felt well prepared for resuscitation and management of emergencies, 41% (CI 37–45%) felt adequately prepared and 28% (CI 24–32%) felt they were not well prepared. Those who felt well prepared reported that they had experienced more exposure to a range of educational methods, including consultant contact, supervisor feedback, clinical skills, high fidelity simulator sessions and unit meetings. Well-prepared and poorly prepared doctors had similar opinions of the usefulness of various learning methods, but the poorly prepared group more frequently expressed a desire for increased exposure to contact with registrars and consultants, clinical skills sessions and hospital and unit meetings. There were no differences in gender, age or country of origin (Australia vs international medical graduates) between those who felt well or poorly prepared.

Conclusions: Many prevocational hospital doctors feel inadequately prepared for the management of emergencies. Perceived preparedness is associated with more exposure to particular educational activities. Increasing exposure to learning of emergencies in undergraduate and prevocational years could reduce the number of junior doctors who feel poorly prepared for emergencies.

Estimating post-release survival and the influential factors for recreationally caught Black Bream (Acanthopagrus butcheri) in the Glenelg River, south eastern Australia

Black bream (Acanthopagrus butcheri) is the main target species amongst the estuarine recreational fisheries of Victoria, Australia. The A. butcheri fishery is managed through legal-minimum length and daily bag limits. The success of this management strategy requires that the survival rate for released fish is high. This study used the most common angling practices to estimate post-release survival and identify influential factors for undersized A. butcheri in Victoria. In total 1557 and 923 A. butcheri were caught and monitored for initial (≤1 h) and delayed (72 h) survival, respectively. Fish were caught across 3 years, with each year separated into cold and warm water periods with 8 fishing trial days in total. Only 1 of the 266 controls used to assess confinement effects died. Total survival was 95% (S.E. ± 0.8%) for shallow- and 74% (S.E. ± 3%) for deep-hooked fish and decreased as fish length increased. A post-mortem (PM) procedure was developed and showed that throat and gill injuries were the most frequent cause of deep-hooking death. It revealed that 97% of hooks left in fish remained there after 72 h and identified hooking location inaccuracies recorded at the time of capture. Total survival for deep-hooked fish was 20% higher when hooks were left in the fish. Deep-hooked fish were more likely to bleed when hooks were removed and total survival was lower for fish that bleed (58%) than fish that did not bleed (80%). Shallow-hooking rates decreased as fish length increased and were higher during warm water compared to cold water trials. The high shallow-hooking and survival rates observed suggest that A. butcheri survival in the fishery would be high, but deep-hooking has the potential to undermine the management strategy. Determining the shallow-hooking rate in the fishery would help clarify the impact of these findings at the fishery level.

Can a disease-specific education program augment self-management skills and improve Health-Related Quality of Life in people with hip or knee osteoarthritis?

Background: Patient education and self-management programs are offered in many countries to people with chronic conditions such as osteoarthritis (OA). The most well-known is the disease-specific Stanford Arthritis Self-Management Program (ASMP). While Australian and international clinical guidelines promote the concept of self-management for OA, there is currently little evidence to support the use of the ASMP. Several meta-analyses have reported that arthritis self-management programs had minimal or no effect on reducing pain and disability. However, previous studies have had methodological shortcomings including the use of outcome measures which do not accurately reflect program goals. Additionally, limited cost-effectiveness analyses have been undertaken and the cost-utility of the program has not been explored.

Methods/design: This study is a randomised controlled trial to determine the efficacy (in terms of Health-Related Quality of Life and self-management skills) and cost-utility of a 6-week group-based Stanford ASMP for people with hip or knee OA.

Six hundred participants referred to an orthopaedic surgeon or rheumatologist for hip or knee OA will be recruited from outpatient clinics at 2 public hospitals and community-based private practices within 2 private hospital settings in Victoria, Australia. Participants must be 18 years or over, fluent in English and able to attend ASMP sessions. Exclusion criteria include cognitive dysfunction, previous participation in self-management programs and placement on a waiting list for joint replacement surgery or scheduled joint replacement.

Eligible, consenting participants will be randomised to an intervention group (who receive the ASMP and an arthritis self-management book) or a control group (who receive the book only). Follow-up will be at 6 weeks, 3 months and 12 months using standardised self-report measures. The primary outcome is Health-Related Quality of Life at 12 months, measured using the Assessment of Quality of Life instrument. Secondary outcome measures include the Health Education Impact Questionnaire, Western Ontario and McMaster Universities Osteoarthritis Index (pain subscale and total scores), Kessler Psychological Distress Scale and the Hip and Knee Multi-Attribute Priority Tool. Cost-utility analyses will be undertaken using administrative records and self-report data. A subgroup of 100 participants will undergo qualitative interviews to explore the broader potential impacts of the ASMP.

Discussion: Using an innovative design combining both quantitative and qualitative components, this project will provide high quality data to facilitate evidence-based recommendations regarding the ASMP.

People, places and policies – trying to account for health inequalities in impoverished neighbourhoods

Objective : We consider associations between individual, household and area-level characteristics and self-reported health.
Method : Data is taken from baseline surveys undertaken in 13 socio-economically disadvantaged neighbourhoods in Victoria (n=3,944). The neighbourhoods are sites undergoing Neighbourhood Renewal (NR), a State government initiative redressing place-based disadvantage.
Analysis :This focused on the relationship between area and compositional factors and self-reported health. Area was coded into three categories; LGA, NR residents living in public housing (NRPU) and NR residents who lived in private housing (NRPR). Compositional factors included age, gender, marital status, identifying as a person with a disability, level of education, unemployment and receipt of pensions/benefits.
Results : There was a gradient in socio-economic disadvantage on all measures. People living in NR public housing were more disadvantaged than people living in NR private housing who, in turn, were more disadvantaged than people in the same LGA. NR public housing residents reported the worst health status and LGA residents reported the best.
Conclusions : Associations between compositional characteristics of disability, educational achievement and unemployment income and poorer self-reported health were shown. They suggested that area characteristics, with housing policies, may be contributing to differences in self-reported health at the neighbourhood level.
Implications : The clustering of socio-economic disadvantage and health outcomes requires the integration of health and social support interventions that address the circumstances of people and places.

Sources of stress in impoverished neighbourhoods : insights into links between neighbourhood environments and health

Objective : We consider associations between individual, household and area-level characteristics and self-reported health.
Method : Data is taken from baseline surveys undertaken in 13 socio-economically disadvantaged neighbourhoods in Victoria (n=3,944). The neighbourhoods are sites undergoing Neighbourhood Renewal (NR), a State government initiative redressing place-based disadvantage.
Analysis :This focused on the relationship between area and compositional factors and self-reported health. Area was coded into three categories; LGA, NR residents living in public housing (NRPU) and NR residents who lived in private housing (NRPR). Compositional factors included age, gender, marital status, identifying as a person with a disability, level of education, unemployment and receipt of pensions/benefits.
Results : There was a gradient in socio-economic disadvantage on all measures. People living in NR public housing were more disadvantaged than people living in NR private housing who, in turn, were more disadvantaged than people in the same LGA. NR public housing residents reported the worst health status and LGA residents reported the best.
Conclusions : Associations between compositional characteristics of disability, educational achievement and unemployment income and poorer self-reported health were shown. They suggested that area characteristics, with housing policies, may be contributing to differences in self-reported health at the neighbourhood level.
Implications : The clustering of socio-economic disadvantage and health outcomes requires the integration of health and social support interventions that address the circumstances of people and places.

Barriers to learners' successful completion of VET flexible delivery programs

In the early 1990s, Australian policymakers began explicitly promoting increased use of flexible delivery in vocational education and training (VET). Some researchers argued that many students lack the learning skills required to deal with the unique demands of flexible delivery. Concerns were also raised about the VET sector's capacity to help students develop needed cognitive and metacognitive skills. A review of the literature revealed wide agreement that students' success in flexible delivery and open and distance education in Australia and elsewhere is generally determined by a complex interplay of factors, including the following: readiness for self-directed learning; ability to balance the time demands of study with other commitments such as family and work; level of literacy; ability to understand and deal with assessment requirements; level of motivation; and previous educational experiences. Two case studies based on the actual experiences of two of six students interviewed about their experiences in flexible VET delivery were reviewed. Both students decided to withdraw from their VET course because of several interconnected factors that built up over time. Both cases illustrated that some problems that can be addressed quickly in face-to-face learning environments are much more difficult to resolve when students are off campus.

Prison officer's beliefs regarding self-harm in prisoners : an empirical investigation

The prevention of self-harm and suicide in prisoners depends on good interaction between the individual prisoner and prison staff. Staff perceptions of prisoner self-harm are likely to be a crucial factor influencing this interaction. The aim of the present study was to determine correctional officers' perception of the causes and functions of self-harm, and the effects of incident severity and repetitiveness on perceptions. A sample of 76 correctional officers was presented with a vignette depicting a self-harm in which the severity and repetitiveness of the incident was systematically altered. Officers' rated both the causes and functions of the behaviour. Four attributional dimensions were identified by factor analysis. These factors related primarily to personal factors about the individual prisoner. Staff perceived the functions of self-harm to be communicative rather than to commit suicide. Perceptions were not affected by severity or repetitiveness information, except for high severity leading to a greater perception of suicidal intent. Initiatives to help staff work more effectively and therapeutically with distressed prisoners are therefore likely to impact positively upon rates of self-harm.