What aspects of rehabilitation provision contribute to self-reported met needs for rehabilitation one year after stroke - amount, place, operator or timing?

BACKGROUND AND OBJECTIVE: To a large extent, people who have suffered a stroke report unmet needs for rehabilitation. The purpose of this study was to explore aspects of rehabilitation provision that potentially contribute to self-reported met needs for rehabilitation 12 months after stroke with consideration also to severity of stroke. METHODS: The participants (n = 173) received care at the stroke units at the Karolinska University Hospital, Sweden. Using a questionnaire, the dependent variable, self-reported met needs for rehabilitation, was collected at 12 months after stroke. The independent variables were four aspects of rehabilitation provision based on data retrieved from registers and structured according to four aspects: amount of rehabilitation, service level (day care rehabilitation, primary care rehabilitation and home-based rehabilitation), operator level (physiotherapist, occupational therapist, speech therapist) and time after stroke onset. Multivariate logistic regression analyses regarding the aspects of rehabilitation were performed for the participants who were divided into three groups based on stroke severity at onset. RESULTS: Participants with moderate/severe stroke who had seen a physiotherapist at least once during each of the 1st, 2nd and 3rd-4th quarters of the first year (OR 8.36, CI 1.40-49.88 P = 0.020) were more likely to report met rehabilitation needs. CONCLUSION: For people with moderate/severe stroke, continuity in rehabilitation (preferably physiotherapy) during the first year after stroke seems to be associated with self-reported met needs for rehabilitation.

The Nurse Professional Competence (NPC) scale : self-reported competence among nursing students on the point of graduation

BACKGROUND: International organisations, e.g. WHO, stress the importance of competent registered nurses (RN) for the safety and quality of healthcare systems. Low competence among RNs has been shown to increase the morbidity and mortality of inpatients. OBJECTIVES: To investigate self-reported competence among nursing students on the point of graduation (NSPGs), using the Nurse Professional Competence (NPC) Scale, and to relate the findings to background factors. METHODS AND PARTICIPANTS: The NPC Scale consists of 88 items within eight competence areas (CAs) and two overarching themes. Questions about socio-economic background and perceived overall quality of the degree programme were added. In total, 1086 NSPGs (mean age, 28.1 [20-56]years, 87.3% women) from 11 universities/university colleges participated. RESULTS: NSPGs reported significantly higher scores for Theme I "Patient-Related Nursing" than for Theme II "Organisation and Development of Nursing Care". Younger NSPGs (20-27years) reported significantly higher scores for the CAs "Medical and Technical Care" and "Documentation and Information Technology". Female NSPGs scored significantly higher for "Value-Based Nursing". Those who had taken the nursing care programme at upper secondary school before the Bachelor of Science in Nursing (BSN) programme scored significantly higher on "Nursing Care", "Medical and Technical Care", "Teaching/Learning and Support", "Legislation in Nursing and Safety Planning" and on Theme I. Working extra paid hours in healthcare alongside the BSN programme contributed to significantly higher self-reported scores for four CAs and both themes. Clinical courses within the BSN programme contributed to perceived competence to a significantly higher degree than theoretical courses (93.2% vs 87.5% of NSPGs). SUMMARY AND CONCLUSION: Mean scores reported by NSPGs were highest for the four CAs connected with patient-related nursing and lowest for CAs relating to organisation and development of nursing care. We conclude that the NPC Scale can be used to identify and measure aspects of self-reported competence among NSPGs.

Knowledge about folate and the contribution of nutrient supplements to the intake of folic acid and vitamin B12 in Australian adults in 1995 and 1996

The present paper reports knowledge about folate and the contribution of supplements to the intake of folic acid and vitamin B12 in Australian adults during 1995 and 1996. Data were obtained from two population survey monitor surveys conducted in a sample of 5422 adults in 1995-96. The surveys were designed to complement food intake data from the 1995 National Nutrition Survey and to provide an estimate of total folate intake prior to the implementation of voluntary fortification of foods with folic acid. The proportion with knowledge about folate increased with education level and socioeconomic status and was greater in women than men. It was also greater in those who were married, and in those residing in Western Australia and the Australian Capital Territory than in other states and territories. Five per cent of men and 10% of women had taken a supplement containing folio acid on the previous day. The equivalent figures for vitamin B12 were 7.5% for men and 12.5% for women. On average, intake of folic acid from supplements was 11 micro g per day for men and 28 micro g per day for women and intake of vitamin B12 was 2.6 micro g per day for men and 4.5 micro g per day for women. For individuals who consumed a supplement containing folic acid on the day before the survey the median folic acid contribution was 200 micro g. In 1995 and 1996 only one in two adult Australians had heard of folate and only one in ten women of child-bearing age had taken a supplement containing folic acid.

From local to national: aspects of mapping the welfare third sector in Australia

The paper charts the authors' research experiences in various types of sociological mapping ofc ommunity or third sector organisations. Specifically this was a search for a way of understanding how third sector organisations dealing with welfare issues were operating in Australia in the mid I990s.

The paper tells the story of how the researchers worked through the implications of being faced initially with a dearth of information about their subject and of how lessons were learnt about the disjunctions between what is formally given as textbook knowledge about research practice and what actually can and does happen: that is, the relationship between the theory and the practice of research.

In discussing the creation of a database of organisations, conducting focus groups and a national sample survey, the paper comments on some of the practical problems facing third sector researchers as well as looking at concept generation and typology building as analytical tools.

Being explicit about aspects of mathematics pedagogy

It is conventional wisdom that contextualising mathematics tasks can make them more meaningful for students, and that open-ended questions create opportunities for student engagement. Yet concerns are emerging that strategies such as these may exacerbate the disadvantage of some. We report data from a project that seeks to address such concerns by encouraging teachers to be explicit about aspects of their pedagogy. Men teachers were explicit about aspects of the pedagogy, the students responded in the direction intended.

The influence of various aspects of enjoyment on participation in leisure time physical activity

This study examines the direct and indirect influence of various aspects of enjoyment, including activity enjoyment, enjoyment conceptualised as physical/environmental, and enjoyment conceptualised as social interaction, on regular participation in leisure-time physical activity (LTPA). The study was cross-sectional and used self-report questionnaires to collect data from a random sample of 250 people aged 19-87 years living in an Australian city. Questionnaires included demographic items and scales to measure enjoyment of LTPA, prioritisation of LTPA and regularity of participation in LTPA. The findings suggest that the influence of enjoyment on participation in LTPA is complex. Aspects of enjoyment have varying levels of influence on participation in LTPA and this influence is indirect through preference for LTPA, life priority of LTPA and making time for LTPA. Policies, programs and strategies by government and practitioners that aim to increase participation in LTPA should primarily aim to enhance activity enjoyment, rather than focusing on other aspects of participation. Theoretically, this study suggests that enjoyment is a multidimensional concept and that enjoyment is a part of a larger decision-making process influencing participation in LTPA.

New teachers, professional knowledge and educational reform in New Zealand

This thesis examines the professional knowledge of new secondary school teachers in New Zealand, their negotiation of multiple discourses encountered in policy and practice, and their processes of professional identity formation. It is also a study of policy reform. In New Zealand, as elsewhere, recent educational and social reforms have brought about major changes to the way education is managed and implemented. These reforms emphasise market ideologies promoting consumer choice and responsibility, while measuring and monitoring quality and effectiveness. At the same time, the reforms attempt to alleviate social inequality. Teachers' negotiation of an accountability culture and the dominant equity policies is a major focus of this study. The study draws upon group interviews held with nine new teachers during the first two years of their teaching careers. The group interviews were designed to elicit extended narratives from individual teachers, as well as promote more interactive dialogue and reflections within the groups. Because the interviews were conducted at different points in their early careers, the study also has a longitudinal element, allowing insight into how teachers' views are formed or changed during an intense period of professional learning. Analysis of the teachers' narratives is informed by poststructural and feminist understandings of identity and knowledge and by a methodological orientation to writing as a method of enquiry. The thesis develops three main types of discussion and sets of arguments. The first examines new teachers' negotiation of the 'macro' context of teacher knowledge formation that is, their negotiation of an educational policy environment that juxtaposes an equity agenda with accountability controls. In order to historically situate these dilemmas, the particular political, social and educational context of New Zealand is examined. It is argued that teachers negotiate competing political and conceptual debates about social justice, equity and difference, and that this negotiation is central to the formation of professional knowledge. The analysis illustrates ways in which teachers make sense of equity discourses in educational policy and practice, and the apparent contradictions that arise from placing tight accountability standards on schools and teachers to achieve associated equity goals. The second type of discussion focuses on teachers' negotiation of the 'micro' dimension of professional knowledge, looking closely at the processes and practices that form professional identity. Against stage or developmental models of teacher identity, it is argued that professional identity is formed in an ongoing, uneven and fluid manner and is socially and discursively situated/embedded. It is further argued that professional knowledge and identity are entwined and that this relationship is most usefully understood through analysis of the discursive practices that frame teachers' working lives and through which teachers work out who they are or should become and what and how they (should) think. This analysis contributes new perspectives to debates in teacher education about teacher preparation and the knowledge required of teachers in current 'new times'. The final cluster of arguments brings together these macro and micro aspects of professional knowledge and identity with a case study of how new teachers negotiated a recent educational reform of senior secondary school qualifications in New Zealand. This reform has had a significant impact on secondary schools and on the way teachers, and New Zealanders in general, think about education, achievement and success. It was found that this reform significantly challenged new teachers to question their beliefs about assessment and justice in education, and what counts as success. This case study draws attention to the tensions between equity, academic excellence and standards-based assessment, and contributes to understanding how teacher professional knowledge forms both in the context of a specific educational policy reform and in relation to educational reform in general. This study contributes new knowledge to the formation of teacher professional knowledge and identity in an educational climate of change in New Zealand. The findings offer new insights for teacher educators, policymakers and schools into how teachers build, shape and sustain professional knowledge; how they juggle contradictions between a desire for justice, policy imperatives and teacher education rhetoric; the self-constructed, but contingent nature of professional knowledge and identity; and the urgency to address identity formation as part of teacher education and to take account of the dynamic ways in which identities form. These matters need to be articulated in teacher education both pre-service and in-service in order to address teacher retention and satisfaction, and teachers' commitment to equity reform in education.

Making a finding : guardianship and construction of substituted decisions about women's health and fertility

Substituted decisions about health and fertility of women deemed incompetent, because of a disability, expose the constitutive power of knowledge about the female, disabled body and its stereotypical place in social relations. This study addresses issues about the self of modern citizenship and feminist politics in a changing policy climate.

The energetics of self-paced motor skills

In activities such as walking individuals can select an optimum speed that minimises energy expenditure. When learning to row, individuals initially selected fast inefficient stroke rates but learned to become more efficient by taking longer, slower strokes. The research showed, therefore, that optimum pacing depends on extensive practice and sensitivity to energy cost helps us to change movements in order to become more efficient.

Practice nurses' role and knowledge about diabetes management within rural and remote Australian general practices

Background: The increasing prevalence of diabetes and obesity represents a significant disease burden in Australia. Practice nurses (PNs) play an important role in diabetes education and management.

Aim: To explore PNs' roles, knowledge and beliefs about diabetes education and management in rural and remote general practice in Australia.

Method: Exploratory study undertaken in three phases: 1) Pilot study to test the performance of the questionnaire; 2) One-shot cross-sectional survey using self-complete questionnaires; 3) Individual interviews.

Results: Ten PNs completed the pilot test; the draft questionnaire was deemed appropriate to the study purpose. Then, 65 questionnaires were distributed to PNs and 21 responded. Fourteen respondents had worked in the role <5 years, and most PNs attended diabetes education programmes in their workplace. A minority (40%) used diabetes management guidelines regularly. Most knew obesity to be the most common risk factor for diabetes but only 50% knew that glycosylated haemoglobin indicates blood glucose levels over the preceding three months. Self-reported competency to assess patients' self-care practices and medication management practices varied.

Conclusion: PNs' diabetes management was self-reported; their knowledge varied and their perceived benefits of diabetes education differed from those of patients.

Diabetes MILES – The Netherlands: rationale, design and sample characteristics of a national survey examining the psychosocial aspects of living with diabetes in Dutch adults

Background : As the number of people with diabetes is increasing rapidly worldwide, a more thorough understanding of the psychosocial aspects of living with this condition has become an important health care priority. While our knowledge has grown substantially over the past two decades with respect to the physical, emotional and social difficulties that people with diabetes may encounter, many important issues remain to be elucidated. Under the umbrella of the Diabetes MILES (Management and Impact for Long-term Empowerment and Success) Study International Collaborative, Diabetes MILES – The Netherlands aims to examine how Dutch adults with diabetes manage their condition and how it affects their lives. Topics of special interest in Diabetes MILES - The Netherlands include subtypes of depression, Type D personality, mindfulness, sleep and sexual functioning.

Methods/design : Diabetes MILES – The Netherlands was designed as a national online observational study among adults with diabetes. In addition to a main set of self-report measures, the survey consisted of five complementary modules to which participants were allocated randomly. From September to October 2011, a total of 3,960 individuals with diabetes (40% type 1, 53% type 2) completed the battery of questionnaires covering a broad range of topics, including general health, self-management, emotional well-being and contact with health care providers. People with self-reported type 1 diabetes (specifically those on insulin pump therapy) were over-represented, as were those using insulin among respondents with self-reported type 2 diabetes. People from ethnic minorities were under-represented. The sex distribution was fairly equal in the total sample, participants spanned a broad age range (19–90 years), and diabetes duration ranged from recent diagnosis to living with the condition for over fifty years.

Discussion : The Diabetes MILES Study enables detailed investigation of the psychosocial aspects of living with diabetes and an opportunity to put these findings in an international context. With several papers planned resulting from a pooled Australian-Dutch dataset and data collections planned in other countries, the Diabetes MILES Study International Collaborative will contribute substantially to identifying potentially unmet needs of those living with diabetes and to inform clinical research and care across the globe.

The natural history of self-harm from adolescence to young adulthood : a population-based cohort study

Background Knowledge about the natural history of self-harm is scarce, especially during the transition from adolescence to young adulthood, a period characterised by a sharp rise in self-inflicted deaths. From a repeated measures cohort of a representative sample, we describe the course of self-harm from middle adolescence to young adulthood.

Methods A stratified, random sample of 1943 adolescents was recruited from 44 schools across the state of Victoria, Australia, between August, 1992, and January, 2008. We obtained data pertaining to self-harm from questionnaires and telephone interviews at seven waves of follow-up, commencing at mean age 15·9 years (SD 0·49) and ending at mean age 29·0 years (SD 0·59). Summary adolescent measures (waves three to six) were obtained for cannabis use, cigarette smoking, high-risk alcohol use, depression and anxiety, antisocial behaviour and parental separation or divorce.

Findings 1802 participants responded in the adolescent phase, with 149 (8%) reporting self-harm, More girls (95/947 [10%]) than boys (54/855 [6%]) reported self-harm (risk ratio 1·6, 95% CI 1·2–2·2). We recorded a substantial reduction in the frequency of self-harm during late adolescence. 122 of 1652 (7%) participants who reported self-harm during adolescence reported no further self-harm in young adulthood, with a stronger continuity in girls (13/888) than boys (1/764). During adolescence, incident self-harm was independently associated with symptoms of depression and anxiety (HR 3·7, 95% CI 2·4–5·9), antisocial behaviour (1·9, 1·1–3·4), high-risk alcohol use (2·1, 1·2–3·7), cannabis use (2·4, 1·4–4·4), and cigarette smoking (1·8, 1·0–3·1). Adolescent symptoms of depression and anxiety were clearly associated with incident self-harm in young adulthood (5·9, 2·2–16).

Interpretation Most self-harming behaviour in adolescents resolves spontaneously. The early detection and treatment of common mental disorders during adolescence might constitute an important and hitherto unrecognised component of suicide prevention in young adults.

Funding National Health and Medical Research Council, Australia, and operational infrastructure support programme, Government of Victoria, Australia.

Knowing Indonesia : intersections of self, discipline and nation

 This is the first book in almost two decades to bring together scholars of Indonesia from the Australian academy in a single volume to reflect on and engage in a deep critique of their field. This is a timely contribution. The importance of Indonesia to Australia has never been more acute and it is essential that we have the tools for interpreting and understanding our nearest neighbour. Investigation of debates within the field of Indonesian studies will help us interpret better the perceptions and politics informing our study. As is befitting the multi-disciplinary nature of Indonesian studies, the book brings together leading political scientists, historians and anthropologists to give their unique perspectives and analysis of this field in the Australian academy and elsewhere in the West. This approach results in some divergent views on the fundamental questions of how Indonesia should be studied and the uses of Indonesia knowledge for activism, and presents new ideas about how we might pursue our work in the future.