The economic burden of ill health due to diet, physical inactivity, smoking, alcohol and obesity in the UK : an update to 2006-07 NHS costs

Background: Estimates of the economic cost of risk factors for chronic disease to the NHS provide evidence for prioritization of resources for prevention and public health. Previous comparable estimates of the economic costs of poor diet, physical inactivity, smoking, alcohol and overweight/obesity were based on economic data from 1992–93.

Methods: Diseases associated with poor diet, physical inactivity, smoking, alcohol and overweight/obesity were identified. Risk factor-specific population attributable fractions for these diseases were applied to disease-specific estimates of the economic cost to the NHS in the UK in 2006–07.

Results: In 2006–07, poor diet-related ill health cost the NHS in the UK £5.8 billion. The cost of physical inactivity was £0.9 billion. Smoking cost was £3.3 billion, alcohol cost £3.3 billion, overweight and obesity cost £5.1 billion.

Conclusion: The estimates of the economic cost of risk factors for chronic disease presented here are based on recent financial data and are directly comparable. They suggest that poor diet is a behavioural risk factor that has the highest impact on the budget of the NHS, followed by alcohol consumption, smoking and physical inactivity.

Implementation and evaluation of brief depression and anxiety screening in clients contacting a drug and alcohol service

Introduction and Aims. High prevalence mental health (HPMH) comorbidity is common in clients seeking alcohol and other drug (AOD) treatment yet can remain undetected. Although research has reported on the introduction of screening into AOD services, little research has reported on the processes surrounding the introduction or evaluated its effectiveness.This study reports on the implementation and evaluation of brief anxiety and depression screening within a specialised, publicly funded AOD service in South-East Victoria.
Design and Methods. Study one examined the implementation of standardised HPMH screening with 114 adult clients (Mean age = 35.49, SD = 9.53; 64% male) telephoning an AOD service over a 5 week period. Measures included severity of HPMH problems,AOD use, care plans and referrals. Study two used semistructured interviews with nine staff/managers to evaluate the effectiveness of screening and its impact on service delivery.
Results. Ninety-four per cent of clients were identified at risk of anxiety or depression. Most care plans incorporated counselling, and concurrent referrals commonly involved a general practitioner. Staff and management found systematic screening increased identification and understanding of comorbid issues and enhanced client interaction but impacted on resource requirements.
Discussion and Conclusions. Most AOD treatment seekers were identified HPMH comorbid and care plans generally included counselling.Adjunctive referrals were more common for severely depressed clients. Screening was effective and enhanced client rapport.Evaluations revealed low confidence in treating HPMH issues in-house.Training may increase worker confidence in managing mental health interventions with subclinical cases, enhancing services’ ability to move towards dual diagnosis capability.

Outsourcing the risks : alcohol licensing, risk and the making of the night time economy

Mariana Valverde argues that in the late twentieth century, the British state contracted out the prevention of disorder and monitoring of risks produced by widespread alcohol use to the private sector through the process of liquor licensing. This paper will argue that this scenario was duplicated in Victoria at the same time. It will do so by an analysis of four government-instigated inquiries into liquor licensing regimes from 1965 to 1998. The inquiries were distinguished by the subtly different emphases in their terms of reference. In 1965, the Phillips Royal Commission was directed to inquire into the best ways of dealing with the problems alcohol produced and how best to regulate it for the benefit of the population as a whole. By the time the Nieuwenhuysen Report was commissioned in 1985, the emphasis had changed, and he was directed to inquire how best to serve the interests of alcohol consumers and to produce the licensing regulatory regime which would enable the construction of a 24-hour city. Any anomalies that still existed in the revised Act were eliminated in the 1998 review which was instigated as a direct response to the National Competition Policy. A consequence of these changes over 30 years was the development of particular risk groups, such as ‘binge-drinking young people’, whose violence and nuisance must be controlled to enable all other ‘reasonable’ and ‘moderate’ drinkers be allowed to keep drinking. Thus the notion of risk had been redefined and the responsibility for dealing with these risks had been directed from the state to individual licensees and individual drinkers.

The epidemiology of ecstasy use and harms in New South Wales, Australia

Aims:This paper examines the epidemiology of ecstasy use and harm in Australia using multiple data sources.

Design: The data included (1) Australian Customs Service 3,4-methylenedioxymethamphetamine (MDMA) detections; (2) the National Drug Strategy Household and Australian Secondary Student Alcohol and Drug Surveys; (3) data from Australia's ecstasy and Related Drugs Reporting System; (4) the number of recorded police incidents for ecstasy possession and distribution collated by the N.S.W. Bureau of Crime Statistics and Research; (5) the number of calls to the Alcohol and Drug Information Service and Family Drug Support relating to ecstasy; (6) the Alcohol and Other Drug Treatment Services National Minimum Dataset on number of treatment episodes for ecstasy, and (7) N.S.W. Division of Analytical Laboratories toxicology data on number of deaths where MDMA was detected.

Findings: Recent ecstasy use among adults in the general population has increased, whereas among secondary students it has remained low and stable. The patterns of ecstasy consumption among regular ecstasy users have changed over time. Polydrug use and use for extended periods of time (>48 h) remain common among this group. Frequent ecstasy use is associated with a range of risk behaviours and other problems, which tend to be attributed to a number of drugs along with ecstasy. Few ecstasy users present for treatment for problems related to their ecstasy consumption.

Conclusions: Messages and interventions to reduce the risks associated with polydrug use and patterns of extended periods of use are clearly warranted. These messages should be delivered outside of traditional health care settings, as few of these users are engaged with such services.

Targeting and measuring housing problems in developing countries through urban texture analysis

Latin-american countries passed from predominantely rural to predominantely urban within few decades. The level of urbanisation in Brazil progressed from 36% in 1950, 50% in 1970, and scalating to 85% in 2005. This rapid transformation resulted in many social problems, as cities were not able to provide appropriate housing and infrastructure for the growing population. As a response, the Brazilian Ministry for Cities, in 2005, created the National System for Social Housing, with the goal to establish guidelines in the Federal level, and build capacity and fund social housing projects in the State and Local levels. This paper presents a research developed in Gramado city, Brazil, as part of the Local Social Housing Plan process, with the goal to produce innovative tools to help social housing planning and management. It proposes and test a methodology to locate and characterise/rank housing defficiencies across the city combining GIS and fractal geometry analysis. Fractal measurements, such as fractal dimension and lacunarity, are able to differentiate urban morphology, and integrated to infrastructure and socio-economical spatial indicators, they can be used to estimate housing problems and help to target, classify and schedule actions to improve housing in cities and regions. Gramado city was divided in a grid with 1,000 cells. For each cell, the following indicators were measured: average income of households, % of roads length which are paved (as a proxy for availability of infrastructures as water and sewage), fractal dimension and lacunarity of the dwellings spatial distribution. A statistical model combining those measurements was produced using a sample of 10% of the cells divided in five housing standards (from high income/low density dwellings to slum's dwellings). The estimation of the location and level of social housing deficiencies in the whole region using the model, compared to the real situation, achived high correlations. Simple and based on easily accessible and inexpensive data, the method also helped to overcome limitations of lack of information and fragmented knowledge of the area related to housing conditions by local professionals.

Demographic and psychological factors related to sexual desire among heterosexual women in a relationship

This study examined demographic, psychological, and relationship factors that are associated with the experience of sexual desire in women. The contribution of other aspects of sexual function on sexual desire was also investigated. The participants were 741 partnered heterosexual women (mean age¼45.7 years), who completed the Female Sexual Desire Questionnaire online, which evaluated their levels of sexual desire, as well as a range of individual and dyadic variables. For each of the six aspects of sexual desire assessed, the number and frequency of problems in other aspects of women’s sexual functioning were the most common predictors. The results demonstrated that sexual desire was lower among older, postmenopausal women and those who had been in their current relationship for a longer period of time. Women who reported that their partner experienced a sexual dysfunction also obtained lower sexual desire scores. These findings demonstrate the strong interrelationship between the different phases of the sexual response cycle for women. Further, they suggest that sexual dysfunction in one partner is likely to be associated with sexual dysfunction in the other partner. The clinical implications of these findings in terms of the treatment for sexual dysfunction among women (and their partners) are discussed.

Multiple identification and risks : examination of peer factors across multiracial and single-race youth

Multiracial youth are thought to be more vulnerable to peer-related risk factors than are single-race youth. However, there have been surprisingly few well-designed studies on this topic. This study empirically investigated the extent to which multiracial youth are at higher risk for peer influenced problem behavior. Data are from a representative and longitudinal sample of youth from Washington State (N = 1,760, mean age = 14.13, 50.9% girls). Of those in the sample, 225 youth self-identified as multiracial (12.8%), 1,259 as White (71.5%), 152 as Latino (8.6%), and 124 as Asian American (7.1%). Results show that multiracial youth have higher rates of violence and alcohol use than Whites and more marijuana use than Asian Americans. Higher levels of socioeconomic disadvantage and single-parent family status partly explained the higher rates of problem behaviors among multiracial youth. Peer risk factors of substance-using or antisocial friends were higher for multiracial youth than Whites, even after socioeconomic variables were accounted for, demonstrating a higher rate of peer risks among multiracial youth. The number of substance-using friends was the most consistently significant correlate and predictor of problems and was highest among multiracial youth. However, interaction tests did not provide consistent evidence of a stronger influence of peer risks among multiracial youth. Findings underscore the importance of a differentiated understanding of vulnerability in order to better target prevention and intervention efforts as well as the need for further research that can help identify and explain the unique experiences and vulnerabilities of multiracial youth.

Moving beyond the restrictions : the evaluation of the Alice Springs alcohol management plan

There have been a number of evaluations of alcohol management in the Alice Springs region. Interestingly, an evaluation in 1975 emphasised the need for government and other agencies to view the issues holistically and to address them accordingly. The outcomes of this evaluation point to a similar situation with comparable recommendations.

The situation in Alice Springs is unique in some respects but has parallel characteristics to other towns and communities in Australia. Alice Springs is an important regional supply, service-orientated, and tourism town. Its people have diverse backgrounds and appear as durable as the environment they live in. Associated with this is a hard drinking culture that permeates the community with a range of issues regardless of one’s cultural background.

The research group found a community that in many ways is ruptured and fragmented when it comes to the ways and means of how such challenges can be confronted. This situation is exemplified by the perception that alcohol problems are confined to a minority of drinkers that seemingly pervades the dialogue surrounding drinking and its effects in the town.

Nevertheless, a positive outcome of such discourse is the fact that people do care about their community and are very keen to live in a town where there are more responsible attitudes toward drinking. There is some way to go; the first thing that everyone needs to accept is that it is a community problem. Non-Indigenous and Indigenous individuals, groups and organisations all have a responsibility therefore in addressing the challenges and working toward better solutions. Government have an important role of course, however the acceptance by the community that it is a community problem is paramount.

Some of the community and government initiatives are having a positive effect on drinking in the town. However, some of the initiatives, such as certain restrictions, can and should not be considered, on their own, as long-term solutions. Other processes need to be implemented, oversighted and managed in an effective manner. An important component of such processes is data that is well managed, available, and appropriate for those agencies involved.

A clustered randomised trial examining the effect of social marketing and community mobilisation on the age of uptake and levels of alcohol consumption by Australian adolescents

Introduction
Throughout the world, alcohol consumption is common among adolescents. Adolescent alcohol use and misuse have prognostic significance for several adverse long-term outcomes, including alcohol problems, alcohol dependence, school disengagement and illicit drug use. The aim of this study was to evaluate whether randomisation to a community mobilisation and social marketing intervention reduces the proportion of adolescents who initiate alcohol use before the Australian legal age of 18, and the frequency and amount of underage adolescent alcohol consumption.
Method and analysis
The study comprises 14 communities matched with 14 non-contiguous communities on socioeconomic status (SES), location and size. One of each pair was randomly allocated to the intervention. Baseline levels of adolescent alcohol use were estimated through school surveys initiated in 2006 (N=8500). Community mobilisation and social marketing interventions were initiated in 2011 to reduce underage alcohol supply and demand. The setting is communities in three Australian states (Victoria, Queensland and Western Australia). Students (N=2576) will complete school surveys in year 8 in 2013 (average age 12). Primary outcomes: (1) lifetime initiation and (2) monthly frequency of alcohol use. Reports of social marketing and family and community alcohol supply sources will also be assessed. Point estimates with 95% CIs will be compared for student alcohol use in intervention and control communities. Changes from 2006 to 2013 will be examined; multilevel modelling will assess whether random assignment of communities to the intervention reduced 2013 alcohol use, after accounting for community level differences. Analyses will also assess whether exposure to social marketing activities increased the intervention target of reducing alcohol supply by parents and community members.

Conceptualizing teamwork and group-work in architecture and related design disciplines

This paper reports on the early findings of an Australian Learning Teaching Council (ALTC/OLT) funded project – “Enhancing and Assessing Group and Team Learning in Architecture and Related Design Contexts.” This is a two-year project investigating good practice in Australian higher education for the teaching of teamwork in the design disciplines, with a focus on architecture. Drawing upon a review of the literature and discussions with teachers and practitioners, the paper considers how teamwork is conceived in the context of the design disciplines. The paper explores notions of team and group design activities in the literature, identifying the key elements and characteristics of effective teams and groups. While a great deal of research exists on effective teamwork in organizational, management and general education literature, this research found a clear gap in knowledge relating to teaching teamwork in architecture and related design contexts. Suggestions are made about the ways in which theories on effective teamwork in organisations might elucidate teaching and assessment of effectively functioning student design teams. The literature review prompted five key questions, outlined here, around the conceptualisation of teamwork in design education that were subsequently discussed with educators and practitioners, thus allowing the identification of issues, problems and solutions common to all fields of design.

Introducing mental health and substance use screening into a community-based health service in Australia : usefulness and implications for service change

Mental health issues such as depression or anxiety and alcohol or other drug (AOD) problems often remain undiagnosed and untreated despite their prevalence in the community. This paper reports on the implementation and evaluation of an AOD and depression/anxiety screening programme within two Community Health Services (CHS) in Australia. Study 1 examined results from 5 weeks of screening (March–April 2008) using the Patient Health Questionnaire (two- and nine-item, Kroenke et al. 2001, 2003), the Conjoint Screen for Alcohol and other Drug Problems (Brown et al. 2001) and the Alcohol, Smoking and Substance Involvement Screening Test (Humeniuk & Ali 2006). Of the 55 clients screened, 33% were at risk of depression or anxiety, 22% reporting moderate-severe depression. Thirteen per cent were at risk of substance use disorders. A substantial proportion of at-risk clients were not currently accessing help for these issues from the CHS and therefore screening can facilitate identification and treatment referral. However, the majority of eligible clients were not screened, limiting screening reach. A second study evaluated the screening implementation from a process perspective via thematic analysis of focus group data from six managers and 14 intake/assessment workers (April 2008). This showed that when screening occurred, it facilitated opportunities for education and intervention with at-risk clients, although cultural mores, privacy concerns and shame/stigma could affect accuracy of screen scores at times. Importantly, the evaluation revealed that most decisions not to screen were made by workers, not by clients. Reasons for non-screening related to worker discomfort in asking sensitive questions and/or managing client distress, and a reluctance to spend long periods of time screening in time-pressured environments. The evaluation suggested that these problems could be resolved by splitting screening responsibilities, enhancing worker training and expanding follow-up screening. Findings will inform any community-based health system considering introducing screening.

Health-related quality of life and strain in caregivers of Australians with Parkinson’s disease : An observational study

Background: The relationship between health-related quality of life (HRQoL) in people with Parkinson’s disease and their caregivers is little understood and any effects on caregiver strain remain unclear. This paper examines these relationships in an Australian sample.
Methods: Using the generic EuroQol (EQ-5D) and disease-specific Parkinson’s Disease Questionnaire-39 Item (PDQ- 39), HRQoL was evaluated in a sample of 97 people with PD and their caregivers. Caregiver strain was assessed using the Modified Caregiver Strain Index. Associations were evaluated between: (i) caregiver and care-recipient HRQoL; (ii) caregiver HRQoL and caregiver strain, and; (iii) between caregiver strain and care-recipient HRQoL.
Results: No statistically significant relationships were found between caregiver and care-recipient HRQoL, or between caregiver HRQoL and caregiver strain. Although this Australian sample of caregivers experienced relatively good HRQoL and moderately low strain, a significant correlation was found between HRQoL of people with PD and caregiver strain (rho 0.43, p<.001).
Conclusion: Poor HRQoL in people with PD is associated with higher strain in caregivers. Therapy interventions may target problems reported as most troublesome by people with PD, with potential to reduce strain on the caregiver

Steps in the design, development and formative evaluation of obesity prevention-related behavior change trials

Obesity prevention interventions through dietary and physical activity change have generally not been effective. Limitations on possible program effectiveness are herein identified at every step in the mediating variable model, a generic conceptual framework for understanding how interventions may promote behavior change. To minimize these problems, and thereby enhance likely intervention effectiveness, four sequential types of formative studies are proposed: targeted behavior validation, targeted mediator validation, intervention procedure validation, and pilot feasibility intervention. Implementing these studies would establish the relationships at each step in the mediating variable model, thereby maximizing the likelihood that an intervention would work and its effects would be detected. Building consensus among researchers, funding agencies, and journal editors on distinct intervention development studies should avoid identified limitations and move the field forward.

Development and delivery of the appropriate assessments items for power systems related PBL subjects

Problem Based Learning (PBL) as a teaching method has been around for many years. It is one of the most effective ways of learning and teaching. It uses real world problems as a learning method and encourages learners to learn independently while a mentoring support is provided by the academic. However, various academic institutions develop the assessments items in many ways; the implementation and delivery become a challenge in ensuring the right assessment and implementation. This paper discusses some of the practical experiences of the development and delivery of the appropriate assessment items for power systems related PBL subjects.