Factors that affect health outcomes in adults with type 2 diabetes : a cross-sectional study

Background: Factors that individually influence blood sugar control, health-related quality of life, and diabetes self-care behaviors have been widely investigated; however, most previous diabetes studies have not tested an integrated association between a series of factors and multiple health outcomes. ---------- Objectives: The purposes of this study are to identify risk factors and protective factors and to examine the impact of risk factors and protective factors on adaptive outcomes in people with type 2 diabetes.---------- Design: A descriptive correlational design was used to examine a theoretical model of risk factors, protective factors, and adaptive outcomes.---------- Settings: This study was conducted at the endocrine outpatient departments of three hospitals in Taiwan. Participants A convenience sample of 334 adults with type 2 diabetes aged 40 and over.---------- Methods: Data were collected by a self-reported questionnaire and physiological examination. Using the structural equation modeling technique, measurement and structural regression models were tested.---------- Results: Age and life events reflected the construct of risk factors. The construct of protective factors was explained by diabetes symptoms, coping strategy, and social support. The construct of adaptive outcomes comprised HbA1c, health-related quality of life, and self-care behaviors. Protective factors had a significant direct effect on adaptive outcomes (β = 0.68, p < 0.001); however, risk factors did not predict adaptive outcomes (β = − 0.48, p = 0.118).---------- Conclusions: Identifying and managing risk factors and protective factors are an integral part of diabetes care. This theoretical model provides a better understanding of how risk factors and protective factors work together to influence multiple adaptive outcomes in people living with type 2 diabetes.

The multiliteracies classroom

Mary Kalantzis and Bill Cope write in the foreword: “The Multiliteracies Classroom demonstrates in convincing detail how powerful learning can be achieved. Along the way, the book seamlessly weaves cutting-edge theoretical ideas into the fabric of its narrative. In one moment, we hear the lilt of the accents of the children’s discussions. In another, this is connected to the theoretical intricacies of ‘discourse’, ‘heteroglossia’, ‘multimodality’, or ‘dialogic spaces’. We witness the triumphs of a teacher who, in Mills’ words, ‘did not regard literacy as an independent variable. Rather, she regarded it as inseparable from social practices, contextualized in certain political, economic, historic and ecological contexts. Kathy Mills has produced a masterpiece of qualitative research.”

From domestic violence to sustainable employment

International research has found that domestic violence is a significant barrier to accessing and sustaining work (Lloyd and Taluc 1999, 385; Browne et al. 1999, 398). In the Australian context, the Bureau of Crime Statistics and Research reports that between 6 and 9 per cent of Australian women aged 18 and over are physically assaulted each year and that more than half of all women in Australia experience sexual or physical violence across their adult lifetime. Such behaviour has been estimated to cost $8.1 billion, of which $4.4 billion is estimated to be borne by the victims themselves, $1.2 billion by the general community and smaller amounts by friends and family and various levels of government (Access Economics 2004). This assessment underestimates the costs of domestic violence in terms of the inability of those who have experienced domestic violence to move into and secure sustainable employment options. Despite these statistics there is a dearth of Australian research focussing on the link between domestic violence and its impact on long-term sustainable employment for those who have been subjected to such violence. This paper explores the issue of domestic violence and access to work opportunities. In so doing, it links the work of Gianakos (1999) and her Career Development theory with that of Bandura‘s (1989) Social Cognitive Career Theory to develop a framework which would provide a pathway to enable those who have suffered domestic violence to achieve sustainable employment and economic independence.

Gender equality in national politics : the views of Australian male politicians

Studies of gender and politics have typically been studies of women and politics. In contrast, this paper places men at the centre of its inquiry by drawing on interviews with 15 current federal male politicians. Of concern is exploring the ways in which men conceptualise the question of gender equity in the Australian parliament. Three frameworks are identified in the men's narratives. These are that the parliament is a masculinised space but that this is unavoidable; that the parliament is now feminised and women are advantaged; and that the parliament is gender neutral and gender is irrelevant. It is argued that collectively these framing devices operate to mask the many constraints which exist to marginalise women from political participation and undermine attempts to address women's political disadvantage as political participants. The paper concludes by highlighting the significance of the paper beyond the Australian context and calling for further research which names and critiques political men and their discourses on gender and parliamentary practices and processes.

Franchisor failure : an assessment of the adequacy of regulatory response

Franchisor failure is one of the most problematic areas of the franchise relationship. It impacts negatively on landlords and other suppliers, but the contracting parties that are currently without legal rights to respond when a franchisor fails, and thus without consumer protection, are its franchisees. In this thesis I explore the current contractual, regulatory and commercial environment that franchisees inhabit, within the context of franchisor failure. I conclude that ex ante there are opportunities to level the playing field through consumer protection legislation. I also conclude that the task is not one solely for the consumer protection legislation; the problem should also be addressed ex post through the Corporations Act.

A prospective pilot study evaluating the ‘cardiac decompensation score’ in the setting of intraaortic balloon counterpulsation

The study objective was to determine whether the ‘cardiac decompensation score’ could identify cardiac decompensation in a patient with existing cardiac compromise managed with intraaortic balloon counterpulsation (IABP). A one-group, posttest-only design was utilised to collect observations in 2003 from IABP recipients treated in the intensive care unit of a 450 bed Australian, government funded, public, cardiothoracic, tertiary referral hospital. Twenty-three consecutive IABP recipients were enrolled, four of whom died in ICU (17.4%). All non-survivors exhibited primarily rising scores over the observation period (p < 0.001) and had final scores of 25 or higher. In contrast, the maximum score obtained by a survivor at any time was 15. Regardless of survival, scores for the 23 participants were generally decreasing immediately following therapy escalation (p = 0.016). Further reflecting these changes in patient support, there was also a trend for scores to move from rising to falling at such treatment escalations (p = 0.024). This pilot study indicates the ‘cardiac decompensation score’ to accurately represent changes in heart function specific to an individual patient. Use of the score in conjunction with IABP may lead to earlier identification of changes occurring in a patient's cardiac function and thus facilitate improved IABP outcomes.

Diarrhoea risk factors in enterally tube fed critically ill patients : a retrospective audit

Objective: Diarrhoea in the enterally tube fed (ETF) intensive care unit (ICU) patient is a multifactorial problem. Diarrhoeal aetiologies in this patient cohort remain debatable; however, the consequences of diarrhoea have been well established and include electrolyte imbalance, dehydration, bacterial translocation, peri anal wound contamination and sleep deprivation. This study examined the incidence of diarrhoea and explored factors contributing to the development of diarrhoea in the ETF, critically ill, adult patient. ---------- Method: After institutional ethical review and approval, a single centre medical chart audit was undertaken to examine the incidence of diarrhoea in ETF, critically ill patients. Retrospective, non-probability sequential sampling was used of all emergency admission adult ICU patients who met the inclusion/exclusion criteria. ---------- Results: Fifty patients were audited. Faecal frequency, consistency and quantity were considered important criteria in defining ETF diarrhoea. The incidence of diarrhoea was 78%. Total patient diarrhoea days (r = 0.422; p = 0.02) and total diarrhoea frequency (r = 0.313; p = 0.027) increased when the patient was ETF for longer periods of time. Increased severity of illness, peripheral oxygen saturation (Sp02), glucose control, albumin and white cell count were found to be statistically significant factors for the development of diarrhoea. ---------- Conclusion: Diarrhoea in ETF critically ill patients is multi-factorial. The early identification of diarrhoea risk factors and the development of a diarrhoea risk management algorithm is recommended.

Probiotics and diarrhoea management in enterally tube fed critically ill patients : what is the evidence?

Objective: The aim of this literature review is to identify the role of probiotics in the management of enteral tube feeding (ETF) diarrhoea in critically ill patients.---------- Background: Diarrhoea is a common gastrointestinal problem seen in ETF patients. The incidence of diarrhoea in tube fed patients varies from 2% to 68% across all patients. Despite extensive investigation, the pathogenesis surrounding ETF diarrhoea remains unclear. Evidence to support probiotics to manage ETF diarrhoea in critically ill patients remains sparse.---------- Method: Literature on ETF diarrhoea and probiotics in critically ill, adult patients was reviewed from 1980 to 2010. The Cochrane Library, Pubmed, Science Direct, Medline and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) electronic databases were searched using specific inclusion/exclusion criteria. Key search terms used were: enteral nutrition, diarrhoea, critical illness, probiotics, probiotic species and randomised clinical control trial (RCT).---------- Results: Four RCT papers were identified with two reporting full studies, one reporting a pilot RCT and one conference abstract reporting an RCT pilot study. A trend towards a reduction in diarrhoea incidence was observed in the probiotic groups. However, mortality associated with probiotic use in some severely and critically ill patients must caution the clinician against its use.---------- Conclusion: Evidence to support probiotic use in the management of ETF diarrhoea in critically ill patients remains unclear. This paper argues that probiotics should not be administered to critically ill patients until further research has been conducted to examine the causal relationship between probiotics and mortality, irrespective of the patient's disease state or projected prophylactic benefit of probiotic administration.

The Australian Parliament: a gendered organisation

This study, drawing on interviews with 13 male and 15 female members of the Australian parliament, has two aims. The first is to contribute to knowledge about the nature of the Australian parliament, an institution which has seldom been subjected to gender analysis. This is particularly pertinent given the significant increase in women's representative status over the past decade. The second of the paper's aims is to demonstrate the efficacy of contemporary gender and organisational theory, particularly work on men and masculinities, for investigating questions related to women's involvement in politics. The paper draws on Joan Acker's (‘Hierarchies, Jobs, Bodies: A Theory of Gendered Organizations’, Gender and Society, 4, 1990, 139–58; ‘From Sex Roles to Gendered Institutions’, Contemporary Sociology, 21, 1992, 565–9.) notion of ‘gendered organisations’ to interrogate the data.

A longitudinal study of the relationship between lifestyle and mental health among midlife and older women in Australia : findings from the Healthy Aging of Women Study

We investigated the temporal relationship between lifestyle and mental health among 564 midlife women. The mental health measured included anxiety, depression, and mental well-being; the lifestyle measures included body mass index (BMI), exercise, smoking, alcohol use, and caffeine consumption. We found that BMI was positively related with mental well-being (r = .316, p = .009); smokers had lower mental well-being than nonsmokers (β = 6.725, p = .006), and noncaffeine drinkers had higher mental well-being (β = 5, p = .023). Past alcohol-drinkers had less anxiety than nondrinkers (β = 1.135, p = .04). Therefore, lifestyle is predictive of mental health among midlife and older women.

A three year outcome evaluation of a theory based drink driving education program

This study reports on the impact of a "drink driving education program" taught to grade ten high school students. The program which involves twelve lessons uses strategies based on the Ajzen and Madden theory of planned behavior. Students were trained to use alternatives to drink driving and passenger behaviors. One thousand seven hundred and seventy-four students who had been taught the program in randomly assigned control and intervention schools were followed up three years later. There had been a major reduction in drink driving behaviors in both intervention and control students. In addition to this cohort change there was a trend toward reduced drink driving in the intervention group and a significant reduction in passenger behavior in this group. Readiness to use alternatives suggested that the major impact of the program was on students who were experimenting with the behavior at the time the program was taught. The program seems to have optimized concurrent social attitude and behavior change.

Development of a 3-dimensional human skin equivalent wound model for investigating novel wound healing therapies

Numerous difficulties are associated with the conduct of preclinical studies related to skin and wound repair. Use of small animal models such as rodents is not optimal because of their physiological differences to human skin and mode of wound healing. Although pigs have previously been used because of their human-like mode of healing, the expense and logistics related to their use also renders them suboptimal. In view of this, alternatives are urgently required to advance the field. The experiments reported herein were aimed at developing and validating a simple, reproducible, three-dimensional ex vivo de-epidermised dermis human skin equivalent wound model for the preclinical evaluation of novel wound therapies. Having established that the human skin equivalent wound model does in fact “heal," we tested the effect of two novel wound healing therapies. We also examined the utility of the model for studies exploring the mechanisms underpinning these therapies. Taken together the data demonstrate that these new models will have wide-spread application for the generation of fundamental new information on wound healing processes and also hold potential in facilitating preclinical optimization of dosage, duration of therapies, and treatment strategies prior to clinical trials.

A chimeric vitronectin : IGF-I protein supports feeder-cell-free and serum-free culture of human embryonic stem cells

This paper was retracted by the Journal of Stem Cells and Development on February 15, 2013.

Clinical outcomes in residential care : setting benchmarks for quality

Aim Australian residential aged care does not have a system of quality assessment related to clinical outcomes, or comprehensive quality benchmarking. The Residential Care Quality Assessment was developed to fill this gap; and this paper discusses the process by which preliminary benchmarks representing high and low quality were developed for it. Methods Data were collected from all residents (n = 498) of nine facilities. Numerator–denominator analysis of clinical outcomes occurred at a facility-level, with rank-ordered results circulated to an expert panel. The panel identified threshold scores to indicate excellent and questionable care quality, and refined these through Delphi process. Results Clinical outcomes varied both within and between facilities; agreed thresholds for excellent and poor outcomes were finalised after three Delphi rounds. Conclusion Use of the Residential Care Quality Assessment provides a concrete means of monitoring care quality and allows benchmarking across facilities; its regular use could contribute to improved care outcomes within residential aged care in Australia.

Contribution of transmembrane domain V amino acids to β1l-adrenoceptor activity and affinity

There are two binding sites on the β1-adrenoceptor (AR), β1H and β1L corresponding to high and low affinity binding sites respectively, which can be activated to cause cardiostimulation (reviewed Kaumann and Molenaar, 2008). Some β-blockers that block β1AR and β2ARs can activate β1LARs at higher concentrations than those required to cause blockade. The β2AR does not form a corresponding low affinity binding site (Baker et al 2002) and therefore we postulated that heterologous amino acids are responsible for the formation of β1LAR. Our aim was to investigate whether heterologous amino acids of transmembrane domain V (TMDV) of β1AR and β2ARs contribute to β1LAR. β1ARs, β2ARs and mutant β1ARs containing all (β1(β2TMDV)AR) or single amino acids of TMDV of the β2AR were prepared and stably expressed in Chinese Hamster Ovary cells. Concentration-effect curves for cyclicAMP accumulation were carried out for (-)-CGP12177 or (-)-isoprenaline in the absence or presence of (-)-bupranolol. _______________________________________________________________________ (-)-CGP 12177 (-)-Bupranolol affinity (pKB) pEC50 vs (-)-CGP 12177 vs (-)-isoprenaline _______________________________________________________________________ β1AR 8.00 ± 0.11 (11) 7.23 ± 0.23 (5) 9.52 ± 0.28 (5) β2AR (high density) 9.24 ± 0.14 (5) 9.82 ± 0.52 (8) xPaulxxxxxxx β2AR (low density) no effect β1(β2TMV)AR 8.86 ± 0.10 (15) 8.06 ± 0.17 (8) 9.08 ± 0.22 (6) β1(V230I)AR 9.07 ± 0.07 (10) 7.64 ± 0.12 (8) 9.36 ± 0.28 (9) β1(R222Q)AR 8.09 ± 0.29 (6) 7.33 ± 0.23 (5) 9.36 ± 0.08 (6) β1(V230A)AR 7.59 ± 0.09 (6) 7.32 ± 0.24 (4) 8.62 ± 0.18 (5) _______________________________________________________________________ The potency of (-)-CGP12177 was higher at β2AR than at β1AR consistent with activation through a low affinity site at the β1AR (β1LAR) but not β2AR. The presence of V230 in β1AR accounted for the lower potency of (-)-CGP 12177. The affinity of (-)-bupranolol at β1AR and mutants was higher when determined with (-)-isoprenaline than with (-)-CGP 12177. The affinity of (-)-bupranolol determined against (-)-CGP 12177 was lower at β1AR compared to β2AR. The presence of V230 in β1AR accounted in part for the lower affinity. In conclusion V230 of the β1AR contributes in part to the low affinity binding site of β1AR. Baker JG, Hall IP, Hill SJ (2002). Pharmacological characterization of CGP12177 at the human β2-adrenoceptor. Br J Pharmacol 137, 400−408 Kaumann AJ, Molenaar P (2008) The low-affinity site of the β1-adrenoceptor and its relevance to cardiovascular pharmacology. Pharmacol Ther 118, 303-336