Is point of care testing for anaemia (HB) and microalbumin feasible in people with type 2 diabetes attending diabetes outpatient clinics?

Introduction: Diabetes is the major cause of chronic kidney disease (CKD) in Australia. Anaemia of CKD occurs earlier than in non-diabetics and is often insidious and undetected.

Aim: A large, prospective, single-centre study was undertaken to determine the feasibility of point of care testing (POCT) haemoglobin (Hb) and microalbumin in people with type 2 diabetes (T2DM) attending routine outpatient clinic appointments (OPC).

Method: Clinic nurses measured Hb and microalbumin using the HemoCue Haemoglobin Capillary Analyser and the HemoCue Urine Albumin Analyser (Medipac Scientific), respectively when they tested blood glucose, weight and blood pressure. The nurses were trained to use the analysers before the study commenced. Standard demographic data, duration of diabetes, treatment mode, and presence of complications, comorbidities, and HbA1c were ascertained from patients’ medical records.

Results: Five hundred and fifty-four (80%) patients were screened. The nurses were able to perform the tests competently but testing, especially microalbumin, was time-consuming. Patients’ mean age was 62 years (11 SD): 230 females, mean blood glucose (BG) 10 (3.9 SD) mmol/L, mean haemoglobin 127.2 (16.3 SD) g/L; mean microalbumin 47.8 (58.7 SD) mg/L: 324 were males, mean BG 10.2 (3.9 SD) mmol/L, mean Hb 138.6 (18.8 SD) gm/L, and mean microalbumin 67.9 (73.9 SD) mg/L. 27% of males and 22% of females were anaemic. Of those with anaemia, 27% of females and 29% of males had microalbuminuria.

Conclusions: POCT is feasible in routine outpatient clinics but is time-consuming. One in four T2DM attending OPC were anaemic. POCT Hb testing in OPC is feasible and could identify T2DM who need full haematological assessment.

Return to pre-injury health status and function 12 months after hospitalisation for sport and active recreation related orthopaedic injury

Background Hospitalised sport and active recreation injuries can have serious long-term consequences. Despite this, few studies have examined the long-term outcomes of these injuries. The purpose of this study was to establish whether patients hospitalised with orthopaedic sport and active recreation injuries, have returned to their pre-injury levels of health status and function, 12 months post injury and identify factors associated with poor outcomes. The present work was a cohort study with retrospective assessment of pre-injury status and prospective assessment of outcome at 12 months post injury.

Methods Adults with orthopaedic sport and active recreation injuries, captured by the Victorian Orthopaedic Trauma Outcomes Registry were recruited to the study. Pre-injury and 12-month outcomes were assessed using the 36-item Short Form Health Survey (SF-36) and the extended Glasgow Outcome Scale. Differences in pre-injury and post-injury SF-36 scores were examined and demographic, injury, hospital and physical activity variables were assessed for associations with outcome using multivariate linear regression.

Results Of the 324 participants 98% were followed-up at 12 months post injury. At 12 months, participants reported a mean 7.0-point reduction in physical health (95% CI 5.8 to 7.8) and a 2.5-point reduction in mental health (95% CI 1.2 to 3.0), with 58% (95% CI 52.6% to 63.4%) reporting reduced function. Sporting group (p=0.001), Injury Severity Score >15 (p=0.007) and high pre-injury vigorous activity levels (p=0.04), were related to poorer physical health outcomes.

Conclusions At 12 months post injury, most participants reported large reductions in physical health and reduced function. This information is important for furthering our understanding of the burden of sport and active recreation injury and setting priorities for treatment and rehabilitation.

The impact of sport and active recreation injuries on physical activity levels at 12 months post-injury

The aim of this study was to evaluate the impact of serious sport and active recreation injury on 12-month physical activity levels. Adults admitted to hospital with sport and active recreation-related injuries, and captured by the Victorian Orthopaedic Trauma Outcomes Registry were recruited to the study. Changes between preinjury and 12 month post-injury physical activity was assessed using the short International Physical Activity Questionnaire (IPAQ). Independent demographic, injury, and hospital variables were assessed for associations with changes in physical activity levels, using multivariate linear regression. A total of 324 patients were recruited, of which 98% were followed up at 12 months. Mean short IPAQ scores decreased from 7650 METS (95% CI: 7180, 8120) preinjury to 3880 METS; (95% CI: 3530, 4250) post-injury, independent of functional recovery. Education level and occupation group were the only variables independently associated with changes in physical activity levels post-injury. These results highlighted that sport and active recreation injuries lead to significant reductions in physical activity levels. Hence, the prevention of sport and active recreation injuries is important when considering promotion of activity at a population level.

Fourpoint

4pt is a publication by four designers and academics from Monash University, Faculty of Art & Design who have come together with a shared desire to critically analyse, question and debate issues facing the currency of graphic design through text, image and the medium of poster. This is the first issue of 4pt, a selection of 4 posters and essays united under the theme of Reverie by Gene Bawden, Brad Haylock, Sarah Jones and Russell Kennedy

Sports betting marketing during sporting events: a stadium and broadcast census of Australian Football League matches

OBJECTIVE: Using Australian Football League (AFL) matches as a case study, we investigated the frequency, length and content of marketing strategies for sports betting during two specific settings: 1) at stadiums during four live matches; and 2) during eight televised broadcasts of matches. METHODS: Census of sports betting marketing during Round 12 of the 2011 AFL premiership season. RESULTS: Per match, there was an average of 58.5 episodes (median 49.5, s.d 27.8) and 341.1 minutes (median 324.1 minutes and s.d 44.5) of sports betting marketing at stadiums, and 50.5 episodes (median 53.5, s.d 45.2) and 4.8 minutes (median 5.0 minutes, s.d 4.0) during televised broadcasts. A diverse range of marketing techniques were used to: a) embed sports betting within the game; b) align sports betting with fans' overall experience of the game; and c) encourage individuals to bet live during the game. There were very few visible or audible messages (such as responsible gambling or Gambler's Help messages) to counter-frame the overwhelmingly positive messages that individuals received about sports betting during the match. CONCLUSIONS AND IMPLICATIONS: This study raises important questions about the impacts of saturation, integrated and impulse gambling marketing strategies in sporting matches. Future research should explore: 1) how wagering industry marketing strategies may affect the attitudes and behaviours of community sub-groups (e.g. young male sports fans, and children); and 2) which public health and policy strategies, including regulation and harm minimisation messaging, will be effective in responding to wagering industry marketing strategies during sporting matches.

Psychological wellbeing among same-sex attracted and heterosexual parents: Role of connectedness to family and friendship networks

© 2015 Australian Association of Family Therapy. Increasing numbers of lesbian, gay and bisexual (LGB) adults are entering into parenthood. Previous studies indicate many of these parents receive little or no support from their families of origin due to family members' negative attitudes toward homosexuality. This study looks at the extent to which LGB parents report a lower sense of connectedness to family of origin and friendship networks than heterosexual parents and whether this has an impact on psychological wellbeing in either of these groups. Data were derived from two studies of parents: Work, Love, Play, a study of Australian and New Zealand LGB parents (n=324); and the Longitudinal Study of Australian Children, a population-based study of young children and parents (n=6460). Structural equation modelling was used to explore the relationships between: parent sexuality and family/friendship connectedness, family/friendship connectedness and psychological wellbeing, parent sexuality and psychological wellbeing. LGB parents reported feeling less connected to their families of origin but more connected to their friendship groups than heterosexual parents. Counter to previous studies, we found no difference in the psychological wellbeing of LGB parents compared to heterosexual parents when examining the direct effect of sexuality on psychological wellbeing. Clinical implications for counsellors and family therapists are discussed.

A way through the dark and thorny thickets? The adjudication of ‘serious injury’ under the narrative tests in the Transport Accident Act 1986 (Vic) and the Workplace Injury Rehabilitation and Compensation Act 2013 (Vic)

The so-called narrative test provides the means by which injured persons who satisfy the statutory and common law definition of serious injury may bring proceedings for common law damages under s 93 of the Transport Accident Act 1986 (Vic) and s 134AB of the Accident Compensation Act 1985 (Vic) (or, for injuries after 1 July 2014, under ss 324-347 of the Workplace Injury Rehabilitation and Compensation Act 2013 (Vic)). These are among the most litigated provisions in Australia. This article outlines the legislative and political background to these provisions, the provisions themselves, and an account of the statutory and common law requirements needed to satisfy the provisions.

A Gestão de Relacionamento entre os Supermercados de Pequeno e Médio Porte e seus Fornecedores no Município de São Caetano do Sul

SILVA FILHO, José Ribamar Tomaz da. A gestão de relacionamento entre os supermercados de pequeno e médio porte e seus fornecedores no município de São Paulo. 2013. 117f. Dissertação (Mestrado em Administração)- Universidade Municipal de São Caetano do Sul, São Caetano do Sul, 2013.

Modelos condicionais de apreçamento de ativos com prêmios de risco macroeconômicos variantes no tempo

Analisamos a previsibilidade dos retornos mensais de ativos no mercado brasileiro em um período de 10 anos desde o início do plano Real. Para analisarmos a variação cross-section dos retornos e explicarmos estes retornos em função de prêmios de risco variantes no tempo, condicionados a variáveis de estado macroeconômicas, utilizamos um novo modelo de apreçamento de ativos, combinando dois diferentes tipos de modelos econômicos, um modelo de finanças - condicional e multifatorial, e um modelo estritamente macroeconômico do tipo Vector Auto Regressive. Verificamos que o modelo com betas condicionais não explica adequadamente os retornos dos ativos, porém o modelo com os prêmios de risco (e não os betas) condicionais, produz resultados com interpretação econômica e estatisticamente satis fatórios

Isolated capital cities and misgovernance: theory and evidence

Motivated by a novel stylized fact { countries with isolated capital cities display worse quality of governance { we provide a framework of endogenous institutional choice based on the idea that elites are constrained by the threat of rebellion, and that this threat is rendered less e ective by distance from the seat of political power. In established democracies, the threat of insurgencies is not a binding constraint, and the model predicts no correlation between isolated capitals and misgovernance. In contrast, a correlation emerges in equilibrium in the case of autocracies. Causality runs both ways: broader power sharing (associated with better governance) means that any rents have to be shared more broadly, hence the elite has less of an incentive to protect its position by isolating the capital city; conversely, a more isolated capital city allows the elite to appropriate a larger share of output, so the costs of better governance for the elite, in terms of rents that would have to be shared, are larger. We show evidence that this pattern holds true robustly in the data. We also show that isolated capitals are associated with less power sharing, a larger income premium enjoyed by capital city inhabitants, and lower levels of military spending by ruling elites, as predicted by the theory.

The effect of options on coordination

This paper studies how constraints on the timing of actions affect equilibrium in intertemporal coordination problems. The model exhibits a unique symmetric equilibrium in cut-o¤ strategies. The risk-dominant action of the underlying one-shot game is selected when the option to delay effort is commensurate with the option to wait longer for others' actions. The possibility of waiting longer for the actions of others enhances coordination, but the option of delaying one s actions can induce severe coordination failures: if agents are very patient, they might get arbitrarily low expected payoffs even in cases where coordination would yield arbitrarily large returns.

O fenómeno das explicações: políticas educativas, sucesso escolar e seus determinantes: um estudo exploratório na Região Autónoma da Madeira

As explicações, enquanto fenómeno educativo, também denominado de “mercado das explicações”, “sistema educativo paralelo”, “mercado educativo”, “actividade na sombra” e “terceiro sistema educativo” é um fenómeno à escala global; existe praticamente em todos os países, desenvolvidos e em vias de desenvolvimento (PISA, 2003). As políticas educativas, em Portugal, já incidiram, tangencialmente, na regulação das suas práticas mas têm ignorado a sua importância e dimensão, sobretudo no que concerne às questões fundamentais que se levantam na área da igualdade de oportunidades e da equidade do acesso à educação. Estudos de investigação recentes indicam que o recurso às explicações tem como base subjacente a procura do sucesso educativo e a resposta à competitividade existente na sociedade pela educação enquanto valor social e económico. Na verdade, existem questões de igualdade de oportunidades que este fenómeno levanta, quer em função das possibilidades económicas das famílias, porque nem todos os pais têm poder económico para os filhos frequentarem as explicações, quer geográficas, já que no interior e nas zonas rurais a oferta das explicações não é a mesma. Neste trabalho, pretendemos analisar, duma forma exploratória, a incidência, as características e a importância deste fenómeno focando-nos essencialmente nos seguintes indicadores de análise: política educativa, sucesso escolar, impacto das explicações, disciplina mais procuradas, dispêndio financeiro por parte das famílias e tempo semanal dedicado às explicações. Nesse sentido, foram recolhidos dados empíricos de quarenta e cinco alunos do 12º ano dum Estabelecimento de Educação Secundária da Região Autónoma da Madeira no fim do ano lectivo de 2007-2008.

Entre a Madeira e as Antilhas: a emigração para a Ilha de Trindade: século XIX

As crises agrícolas, o sistema de colonia vigente na ilha, o excesso demográfico, a Guerra Civil entre 1820-1834, e um recrutamento militar obrigatório sem precedentes, afectaram o quotidiano dos madeirenses. Também a indústria do vinho, âncora da economia de exportação vinícola insular, entrou em declínio na segunda metade do século XIX, originando graves crises de subsistência. Todo este panorama contribuiu para uma onda emigratória dos insulares Madeirenses. Na ilha da Madeira existia uma colónia de mercadores ingleses e a ínsula era um importante interposto comercial britânico, nas rotas atlânticas das embarcações para as Índias Ocidentais. Na sequência da crise de mão-de-obra nas Antilhas Britânicas, com as proprietários a procurarem colonos para substituírem os antigos escravos, emancipados em 1834, os madeirenses eram vistos como bons candidatos, descritos como excelentes trabalhadores e artífices competentes. Surgiu, desde cedo, um sistema de aliciamento dos ilhéus para as plantações inglesas do Caribe. Em 1834-35 ocorreram as primeiras levas para a Ilha de Trindade, viagens garantidas pelo armador João de Freitas Martins e financiadas pelos proprietários da possessão inglesa. Entre 1834-47 saiu o maior número de madeirenses para a Ilha de Trindade, em toda a centúria oitocentista. O Anglicanismo praticado pelos britânicos na Ilha da Madeira era tolerado, mas não ensinado aos insulares, visto que havia uma religião de Estado em Portugal, o Catolicismo Apostólico Romano. Com a chegada do escocês Robert Kalley, em 1838, o pregador desencadeará um trabalho de propagação do protestantismo na Madeira e criará um número crescente de seguidores na ilha. Em 1846, criticado e acusado pelas autoridades civis e eclesiásticas, repudiado pela comunidade anglicana britânica, e perseguido pela população, sairá clandestinamente da Madeira. Muitos outros insulares também sairão da ilha, desembarcando a maior parte em Trindade, que estando próxima da costa da Venezuela, se tornará ilha de passagem para o vasto continente americano. Muitos ilhéus são os antepassados dos madeirenses presentes em Trindade, hoje elos de ligação com o passado, luso-descendentes activos da comunidade madeirense, a exemplo da Associação Portuguesa Primeiro de Dezembro, na história de Trindade e Tobago.