Does self-management lead to sustainable health benefits in people with arthritis? A 2-year transition study of 452 Australians.

Objective: To evaluate the Arthritis Self-Management Course (ASMC) when applied in a nationwide context.

Methods: Four hundred fifty-two people who participated in the ASMC across Australian states took part in a longitudinal followup study. ASMC is a 6 week, 2 h group educational program designed to assist people with chronic illness to better manage their condition. Measures of program effectiveness included health status and service utilization. Data were collected on 3 occasions: before intervention (baseline) and 6 months and 2 years after the program.

Results: Several indicators of health status showed improvement at 6 months following the ASMC. These included reduction in pain (4%; p < 0.001), fatigue (3%; p < 0.01), and health distress (12%; p < 0.001) as well as increase in self-efficacy (6%; p < 0.001). Increased self-efficacy was a significant predictor of positive change in health status. Health-related behaviors such as aerobic exercise also increased, with the proportion of people who did little or no exercise decreasing by up to 8%. These changes were sustained at 2 years. There was an increase in use of analgesics at 6 months and an increase in use of nonsteroidal antiinflammatory drugs at 2 years. No changes in healthcare utilization (physician visits, allied health visits, and hospitalizations) were observed.

Conclusion: The ASMC is a widely applied program in which participants benefit through a reduction in pain, fatigue, and health distress. Although the absolute changes in health status are small, the low cost and wide application of the intervention suggests the program may have a substantial public health effect.

The sustainable farm families project: changing farmer attitudes to health

Farm health and safety has focussed on strategies such as injury prevention, audits and fulfilling legislative responsibilities. We know farmer injuries mask deeper health issues such as higher rates of cancer, suicides, cardiovascular disease and stress. The relationship between occupational health and safety and farming family health has not been investigated by other researchers either nationally or internationally. The Sustainable Farm Families (SFF) project attempts to make this connection in order to address the unacceptable rates of premature death, higher morbidity and injury on Australian farms.

The SFF focuses on the human resource in the triple bottom line and is working with farmers, families, industry, and university to collaboratively address and improve the health and well being of farming families. Based on a model of extension that engages farming families as active learners where they commit to healthy living and safe working practices the SFF is proving to be an effective model for engaging communities in learning and change. Health education and information is delivered to farming families using a workshop format with participants reporting positive impacts on their farming business. The SFF project sits across generations and sexes and has a high level of support with the overwhelming majority of participants saying they would recommend the program to others.

This paper discusses the progress of the research outlining the design of the project, the delivery and extension processes used to engage 321 farming families to date. The paper presents key learning’s on intersectoral collaboration, engaging farmers and families in health and the future for this project extending into agricultural industries across the nation.

Three key learnings: (1) The increased health risks faced by farmers and their families need social and political attention. (2) Joint ownership and collaborative partnerships where all partners have a key role within the development and delivery of the project to their relevant representative groups enables resources to be shared and encourages greater in-kind support to augment funding received. (3) Farming families are keen to understand more about their health and farmers who participate in health education programs based around industry collaboration with high levels of individual participation will engage with health professionals and obtain an improved health status if programs are presented to them in personally engaging and relevant ways

Factors influencing attitudes to violence against women

Attitudes toward men's violence against women shape both the perpetration of violence against women and responses to this violence by the victim and others around her. For these reasons, attitudes are the target of violence-prevention campaigns. To improve understanding of the determinants of violence against women and to aid the development of violence-prevention efforts, this article reviews the factors that shape attitudes toward violence against women. It offers a framework with which to comprehend the complex array of influences on attitudes toward violent behavior perpetrated by men against women. Two clusters of factors, associated with gender and culture, have an influence at multiple levels of the social order on attitudes regarding violence. Further factors operate at individual, organizational, communal, or societal levels in particular, although their influence may overlap across multiple levels. This article concludes with recommendations regarding efforts to improve attitudes toward violence against women.

Tissue donation and the attitudes of health care professionals

Since the first corneal transplant in 1905, improved surgical techniques and the development of immunosuppressive drugs have led to excellent success rates for organ and tissue transplantation procedures. This Chapter ,"'ill focus on the cadaveric donation of tissue and the attitudes towards it of health professionals, because they are key players in the donation- transplantation process.

The chapter begins with an overview of cadaveric tissue donation, including what can currently be transplanted. It will then present what is known about health professionals' attitudes to and knowledge of tissue donation and the impact that these have on donation rates. Attitudes, their components and their effect upon behaviour are explored using theories arising from social psychology to explain how these influence actual or intended behaviours associated with the discussion of donation wishes with relatives of the potential donor. Since some tissues, such as blood and bone marrow, can only normally be donated during life, these will be excluded since the behaviours associated with blood donation differ significantly from those associated with cadaveric tissue donation.

Consumer knowledge and attitudes to salt intake and labelled salt information

The objective of this study was to investigate consumers’ knowledge of health risks of high salt intake and frequency of use and understanding of labelled salt information. We conducted a cross-sectional survey in shopping centres within Metropolitan Melbourne. A sample of 493 subjects was recruited. The questionnaire assessed salt related shopping behaviours, attitudes to salt intake and health and their ability to interpret labelled sodium information. Four hundred and seventy four valid surveys were collected (65% female, 64% being the main shopper). Most participants knew of the relationship between salt intake and high blood pressure (88%). Sixty five percent of participants were unable to correctly identify the relationship between salt and sodium. Sixty nine percent reported reading the salt content of food products when shopping. Salt label usage was significantly related to shoppers concern about the amount of salt in their diet and the belief that their health could improve by lowering salt intake. Approximately half of the sample was unable to accurately use labelled sodium information to pick low salt options. Raising consumer awareness of the health risks associated with high salt consumption may increase salt label usage and purchases of low salt foods. However, for food labels to be effective in helping consumers select low salt foods a more ‘user friendly’ labelling format is needed.

Improving the uptake of pulmonary rehabilitation in patients with COPD : qualitative study of experiences and attitudes

Background
Pulmonary rehabilitation can improve the quality of life and ability to function of patients with chronic obstructive pulmonary disease (COPD). It may also reduce hospital admission and inpatient stay with exacerbations of COPD. Some patients who are eligible for pulmonary rehabilitation may not accept an offer of it, thereby missing an opportunity to improve their health status.

Aim
To identify a strategy for improving the uptake of pulmonary rehabilitation.

Design of study
Qualitative interviews with patients.

Setting
Patients with COPD were recruited from a suburban general practice in north-east Derbyshire, UK.

Method
In-depth interviews were conducted on a purposive sample of 16 patients with COPD to assess their concerns about accepting an offer of pulmonary rehabilitation. Interviews were analysed using grounded theory.

Results
Fear of breathlessness and exercise, and the effect of pulmonary rehabilitation on coexisting medical problems were the most common concerns patients had about taking part in the rehabilitation. The possibility of reducing the sensation of breathlessness and regaining the ability to do things, such as play with their grandchildren, were motivators to participating.

Conclusion
A model is proposed where patients who feel a loss of control as their disease advances may find that pulmonary rehabilitation offers them the opportunity to regain control. Acknowledging patients' fears and framing pulmonary rehabilitation as a way of ‘regaining control’ may improve patient uptake.

A preliminary analysis of barriers, intentions, and attitudes towards moderate physical activity in women who are overweight

Physical activity is important for the health of all individuals, however, the determinants of physical activity behaviour for women who are overweight remain largely unexplored. The purpose of this investigation was to explore a range of factors that influence participation in physical activity for a group of women who are overweight. Participants were 30 women, aged 25–71 years, with a mean age of 46.8 years (+12.95) and an average BMI of 31.2 kg/m2 (+5.6). Self-reported level of physical activity, perceived barriers and facilitators of physical activity, attitudes, intentions and perceived behavioural control to physical activity were measured. Seventeen participants were generally active, with self-reported moderate physical activity of 218.53 min (±113.82) in the last 7 days; whereas 13 participants were reportedly less active 43.46 (±42.98) min. Active participants were more likely to identify social reasons for participating in physical activity, while inactive participants perceived that their laziness prevented them from being physically active. There were no significant differences between active and inactive overweight women for attitude, intention or subjective norm for moderate-intensity physical activity. There was a significant difference between these women in perceived behavioural control (p = .014) for moderate-intensity physical activity, as women who felt more in control of their physical activity behaviour were more likely to engage in physical activity than inactive women. Future research should investigate interventions to increase behavioural control of moderate-intensity physical activity in women who are overweight.

Malaysian and Australian male and female middle managers : a cross-cultural comparison of workplace attitudes, aspirations for promotion, and self-rated leadership styles

This paper outlines the rise of women in management worldwide, and considers why so few women achieve senior or executive management positions. This slow advance of women into senior roles is unexpected given that the changes in organisations today are believed to require more ‘feminine leadership’. A decrease in the emphasis on masculine characteristics for managers is reported, and a requirement that more ‘feminine leadership’ needs to be adopted by organisations in order to ensure their survival in the future (Powell, Butterfield & Parent, 2002, p.189). Recent empirical research reports that there are differences in leadership style between male and female managers, and the findings suggest that women exhibit more transformational leadership than their male counterparts, with this style being strongly equated with effective leadership (Eagly, Johannesen-Schmidt, van Engen, 2003). However, these findings are based on western research, and it may be that cross cultural research will yield a different picture (House, Hanges, Javidan, Dorfman, & Gupta, 2004). Leadership and leadership styles may be conceptualised differently in a more paternalistic society. To explore this possibility, a cross cultural study was conducted in Malaysia and Australia. It is hypothesised that countries that are paternalistic in cultural values will exhibit a stronger constraint on women in management roles, which may impact on workplace attitudes, aspirations for promotion and style of leadership exhibited. Therefore, it is possible that the career advancement of women may be more problematic for Malaysian managerial women than their Australian counterparts. Results from an initial pilot study in Malaysia and Australia are outlined, and highlight some interesting similarities and differences to what are reported in the western literature.

Differences within and between travel preference, planned travel and choice behavior of Australians traveling to Asian and oversea destinations

This study seeks to examine differences in travel preference, travel intention and destination choice behavior of an aggregated set of Australian travelers. Additionally the study seeks to relate income, age, gender, life cycle and life style of Australians to the preference, planning and choice of Asian and overseas destinations. A large representative sample of 49,000 Australian respondents is utilized. Binomial regression is used to profile travelers to Asia and overseas in general. Specific significant variables and differences are highlighted. There are consistent relationships between travel preference, planning and choice and the set of independent variables of income, life cycle and life style. Age nor gender are not consistently related to travel planning or travel choice. It is apparent that a combination of demographics, e.g. age, income and life cycle, combined with life style will provide a more valuable basis for segmentation of Asian and overseas travel markets. The study aims to profile potential Australian tourists thereby making a contribution to tourism knowledge and market segmentation practice.

Bottersnikes and other lost things : a celebration of Australian illustrated children's books

This is a history of illustrated Australian children's books published between 1845 and 2008 that emphasises the lesser known elements of the Australian child's literary history. Beyond the icons, such as May Gibbs' Snugglepot and Cuddlepie and Dorothy Wall's Blinky Bill, lie a wealth of illustrated books that broaden the potential for further research. Bottersnikes and Other Lost Things with over 400 full colour illustrations, is a tangible resource giving researchers the potential to expand our understanding of Australian children's literature: Advertising and ephemeral children's books provide insight into the varied nature children's reading from the turn of the 20th century; The educational reading reveals the expectations of the adults who wrote the School Papers and Readers and the aspirations they had for their readership; Attitudes to cultural difference across this period is remarkable for the overt nature of the racist portrayal of Indigenous Australians during the 19th and first half of the 20th centuries. These are some of the aspects of the Australian child's literary heritage explored for the first time in this history of Australian children's literature.

Program sustainability of a community-based intervention to prevent falls among older Australians

Multi-strategy interventions have been demonstrated to prevent falls among older people, but studies have not explored their sustainability. This paper investigates program sustainability of Stay on Your Feet (SOYF), an Australian multi-strategy falls prevention program (1992–1996) that achieved a significant reduction in falls-related hospital admissions. A series of surveys assessed recall, involvement and current falls prevention activities, 5 years post-SOYF, in multiple original SOYF stakeholder groups within the study area [general practitioners (GPs), pharmacists, community health (CH) staff, shire councils (SCs) and access committees (ACs)]. Focus groups explored possible behavioural changes in the target group. Surveys were mailed, except to CH staff and ACs, who participated in guided group sessions and were contacted via the telephone, respectively. Response rates were: GPs, 67% (139/209); pharmacists, 79% (53/67); CH staff, 63% (129/204); SCs, 90% (9/10); ACs, 80% (8/10). There were 73 older people in eight focus groups. Of 117 GPs who were practising during SOYF, 80% recalled SOYF and 74% of these reported an influence on their practice. Of 46 pharmacists operating a business during SOYF, 45% had heard of SOYF and 79% of these reported being ‘somewhat’ influenced. Of 76 community health staff (59%) in the area at that time, 99% had heard of SOYF and 82% reported involvement. Four SCs retained a SOYF resource, but none thought current activities were related. Seven ACs reported involvement, but no activities were sustained. Thirty-five focus group participants (48%) remembered SOYF and reported a variety of SOYF-initiated behaviour changes. Program sustainability was clearly demonstrated among health practitioners. Further research is required to assess long-term effect sustainability.