Increased food energy supply is more than sufficient to explain the US epidemic of obesity

Background: The major drivers of the obesity epidemic are much debated and have considerable policy importance for the population-wide prevention of obesity.

Objective: The objective was to determine the relative contributions of increased energy intake and reduced physical activity to the US obesity epidemic.

Design: We predicted the changes in weight from the changes in estimated energy intakes in US children and adults between the 1970s and 2000s. The increased US food energy supply (adjusted for wastage and assumed to be proportional to energy intake) was apportioned to children and adults and inserted into equations that relate energy intake to body weight derived from doubly labeled water studies. The weight increases predicted from the equations were compared with weight increases measured in representative US surveys over the same period.

Results: For children, the measured weight gain was 4.0 kg, and the predicted weight gain for the increased energy intake was identical at 4.0 kg. For adults, the measured weight gain was 8.6 kg, whereas the predicted weight gain was somewhat higher (10.8 kg).

Conclusions: Increased energy intake appears to be more than sufficient to explain weight gain in the US population. A reversal of the increase in energy intake of 2000 kJ/d (500 kcal/d) for adults and of 1500 kJ/d (350 kcal/d) for children would be needed for a reversal to the mean body weights of the 1970s. Alternatively, large compensatory increases in physical activity (eg, 110–150 min of walking/d), or a combination of both, would achieve the same outcome. Population approaches to reducing obesity should emphasize a reduction in the drivers of increased energy intake.

An online environment for value added learning : more than you bargained for

Online web-based technologies are increasingly being used in educational and professional contexts to create an effective environment for teaching or professional learning. A number of studies have explored the intersections between on and off line teaching and learning, participants’ perceptions, and claims of connectedness and community fostered by online sites (Jones, 1998; Rheingold, 1995; Soderstrom, 2006). This paper will outline the development, functionality and usefulness of the online environment (Drupal) installed and used to support the Australian Government Summer School for Teachers of English. It includes an analysis of the virtual environment (social software) established for the Summer School. The research project aimed to determine what aspects of an online environment supported the success of this national professional development activity that incorporated physically present, and online communication, connection, and collaboration between 200 teachers over a period of seven months. In this paper the site manager explains their role and perspective of the potential of social software for learning.

The assessment and management of common male sexual difficulties in family practice

Sexual problems are distressing for patients, and their doctors need to feel comfortable giving advice about and treating the more common conditions. Treatment of sexual problems can prevent much anxiety and the development of depression. This article outlines approaches useful in managing the more common male sexual difficulties encountered in family practice.

Can the impact on health of a government policy designed to create more liveable neighbourhoods be evaluated? an overview of the RESIDential Environment Project

There is growing interest in the impact of community design on the health of residents. In 1998, the Western Australian Government began a trial of new subdivision design codes (i.e. Liveable Neighbourhoods Community Design Code) aimed at creating pedestrian-friendly neighbourhoods to increase walking, cycling and public transport use. The trial provided a unique opportunity for a natural experiment to evaluate the impact of a government planning policy on residents. Nevertheless, evaluations of this kind present a number of methodological challenges in obtaining the highest quality evidence possible. This paper describes the RESIDential Environment Project’s study design and discusses how various methodological challenges were overcome.

The citizen's charter : how such initiatives might be more effective

In Public Policy and Administration Taylor (1999) concluded that the charter system was inadequate to safeguard consumers’ and citizens’ interests and that they would have to have a greater input to ensure success. Following its introduction in 1991, the Charter initiative certainly made an impact and by 1997 there were 40 main charters and perhaps 10,000 local ones. However since then the original Citizen’. Charter has, in the words of one commentator, ‘perished, or at least atrophied’ Drewry (2002, p.12). There is little doubt that it could have been more effective. For example, tax charters seem to have had more success - indeed the UK Taxpayers’ Charter pre-dates the Citizen’. Charter, having been introduced in 1986. This paper therefore reviews the Charter initiative in the light of the development of tax charters and describes a particularly successful one - the Australian Taxpayers’ Charter - that continues to provide a clear focus on twelve basic principles of tax administration. An important factor in the Australian success appears to be the more strategic approach taken with respect to the implementation, monitoring and development of its Taxpayers’ Charter. The paper also presents relevant results of two surveys (N = 2,040 and 2,374) on the extent to which Australian voters consider the Australian Tax Office adheres to the principles outlined in the Charter. The evidence is consistent with Taylor’. (1999) views and concludes that initiatives such as the Citizen’. Charter would benefit from more strategic or systematic preparation that incorporates the views and expertise of a wide range of stakeholders before being introduced and for the initiative to become an integral part of the approach to standards of service thereafter.

Regulating more effectively : the relationship between procedural justice, legitimacy and tax non-compliance

In recent years, a significant number of middle-income taxpayers have been making use of aggressive tax planning strategies to reduce tax. In many cases, it is unclear whether these are designed and used by tax- payers to minimize tax legally or to avoid tax illegally. Those that are designed to exploit loopholes in tax law need to be dealt with in a way that restores faith and equity to the system. But how can tax authorities best manage taxpayers who may have inadvertently become involved in such illegal tax planning practices? Using longitudinal survey data, it will be shown that attempts to coerce and threaten taxpayers into compliance can undermine the legitimacy of the Tax Office's authority, which in turn can affect taxpayers' subsequent compliance behaviour. Responsive regulation, which is based on principles of procedural justice, will be discussed as an alternative enforcement strategy.

The influence of medical enduring power of attorney and advance directives on decision making by Australian intensive care doctors

OBJECTIVE: Despite government encouragement for patients to make advance plans for medical treatment, and the increasing numbers of patients who have done this, there is little research that examines how doctors regard these plans.
DESIGN: We surveyed Australian intensive care doctors, using a hypothetical clinical scenario, to evaluate how potential end-of-life treatment decisions might be influenced by advance planning - the appointment of a medical enduring power of attorney (MEPA) or an advance care plan (ACP). Using open-ended questions we sought to explore the reasoning behind the doctors' decisions.
RESULTS: 275 surveys were returned (18.3% response rate). We found that opinions expressed by an MEPA and ACP have some influence on treatment decisions, but that intensive care doctors had major reservations. Most did not follow the request for palliation made by the MEPA in the hypothetical scenario.
CONCLUSIONS: Many intensive care doctors believe end-of-life decisions remain medical decisions, and MEPAs and ACPs need only be respected when they accord with the doctor's treatment decision. This study suggests a need for further education of doctors, particularly those working in intensive care, who are responsible for initiating and maintaining life support treatment.

Community onset staphylococcus aureus infections in Melbourne

Objective: To investigate the relative importance of methicillin resistant Staphylococcus aureus (MRSA) in the community in Melbourne by describing circulating S. aureus strains and infection characteristics.

Methods: Patients with any community-onset S. aureus infection were identified via clinical specimens submitted to a community-based pathology service in 2006. The referring doctors confirmed community onset and defined site and severity of each infection. Patient isolates were characterised by antibiotic resistance subtype and presence of the Panton-Valentine leukocidin gene (pvl).

Results: Between April and September 2006, 2,094 S. aureus isolates were processed. Of these, 133 (6.4%) were multiresistant MRSA (mMRSA) and 110 (5.3%) were resistant to less than 3 non-betalactam antibiotics (non-multiresistant MRSA or nmMRSA). We followed-up all nmMRSA (34) and mMRSA (15) confirmed community-onset infections, and a random subset of eligible patients with MSSA infections (57), for whom clinical data were available from referring doctors (82% response).

The majority of isolates were from skin infections (99/106), but drainage was performed in less than one third of cases (29/99). Antibiotics were prescribed for 89% (95%CI: 82, 94) of infections. The isolates were resistant to the prescribed antibiotic 100% of the time for mMRSA infections and 80% for nmMRSA. Those with infections caused by MRSA had on average one additional visit to their doctor compared with MSSA infections.

Ten nmMRSA clones were identified, including one new pvl positive nmMRSA. Of the 29 nmMRSA isolates, 14 were pvl positive (48%; 95%CIs: 30%, 66%) compared with 16% of MSSA and 0% mMRSA.

Patients with an infection caused by pvl positive strains (23) were younger ((mean age 23 years (95%CI: 16, 30) compared with the 55 years (95%CI: 50, 61)). Infection site also varied with presence of pvl; more pvl positive infections were found in the axilla (17.9% compared with 0%) and head and neck (35.7% compared with 8.2%), and less for the leg or foot (21.4% compared with 55.7%).

Conclusions: We estimate that 3.5% of community-onset S. aureus infections in Melbourne in 2006 were caused by MRSA, and 70 to 90% of patients with MRSA infections were treated initially with antibiotics to which their isolate was resistant. pvl positive isolates of S. aureus were associated with younger age and axillary or head and neck infections.

Women's views and outcomes of an educational intervention designed to enhance psychosocial support for women during pregnancy

Background: Identification of psychosocial issues in pregnant women by screening is difficult because of the lack of accuracy of screening tools, women's reluctance to disclose sensitive issues, and health care practitioner's reluctance to ask. This paper evaluates if a health professional education program, a new (ANEW) approach, improves pregnant women's ratings of care and practitioner's listening skills and comfort to disclose psychosocial issues.

Methods: Midwives and doctors from Mercy Hospital for Women, Melbourne, Australia, were trained from August to December 2002. English-speaking women (< 20 wks' gestation) were recruited at their first visit and mailed a survey at 30 weeks (early 2002) before and after (2003) the ANEW educational intervention. Follow-up was by postal reminder at 2 weeks and telephone reminder 2 weeks later.

Results: Twenty-one midwives and 5 doctors were trained. Of the eligible women, 78.2 percent (584/747) participated in a pre-ANEW survey and 73.3 percent (481/657) in a post-ANEW survey. After ANEW, women were more likely to report that midwives asked questions that helped them to talk about psychosocial problems (OR 1.45, CI 1.09–1.98) and that they would feel comfortable to discuss a range of psychosocial issues if they were experiencing them (coping after birth for midwives [OR 1.51, CI 1.10–2.08] and feeling depressed [OR 1.49, 1.16–1.93]; and concerns relating to sex [OR 1.35, CI 1.03–1.77] or their relationships [OR 1.36, CI 1.00–1.85] for doctors).

Conclusions: The ANEW program evaluation suggests trends of better communication by health professionals for pregnant women and should be evaluated using rigorous methods in other settings.

Putting woman-centered care into practice : a new (ANEW) approach to psychosocial risk assessment during pregnancy

Background: When antenatal care is provided, identification and management of challenging problems, such as depression, domestic violence, child abuse, and substance abuse, are absent from traditional midwifery and medical training. The main objective of this project was to provide an alternative to psychosocial risk screening in pregnancy by offering a training program (ANEW) in advanced communication skills and common psychosocial issues to midwives and doctors, with the aim of improving identification and support of women with psychosocial issues in pregnancy.

Methods: ANEW used a before‐and‐after survey design to evaluate the effects of a 6‐month educational intervention for health professionals. The setting for the project was the Mercy Hospital for Women in Melbourne, Australia. Surveys covered issues, such as perceived competency and comfort in dealing with specific psychosocial issues, self‐rated communication skills, and open‐ended questions about participants' experience of the educational program.

Results: Educational program participants (n = 22/27) completed both surveys. After the educational intervention, participants were more likely to ask directly about domestic violence (p = 0.05), past sexual abuse (p = 0.05), and concerns about caring for the baby (p = 0.03). They were less likely to report that psychosocial issues made them feel overwhelmed (p = 0.01), and they reported significant gains in knowledge of psychosocial issues, and competence in dealing with them. Participants were highly positive about the experience of participating in the program.

Conclusions:The program increased the self‐reported comfort and competency of health professionals to identify and care for women with psychosocial issues.

It takes more than breadcrumbs to learn generic skills : collaborating to improve information literacy

The effective teaching and learning of generic skills is becoming an important component of undergraduate education with the introduction of graduate attribute programmes in some Australian universities. Research shows that contextualised learning of these skills is important, but is a discipline-specific context sufficient to ensure student success in acquiring these skills? This paper studies the effectiveness of information skills
learning by a group of undergraduates using Brookfield’s concept of critical reflection and Critical Incident Questionnaire (CIQ). Most students reported positive experiences where the learning environment encouraged a deep approach to learning and negative experiences where that environment encouraged a surface approach. To ensure that students’ approach to
learning is appropriate for achieving the level of information literacy required of graduates, the study recommends the integration of information skills learning into course curricula through the close collaboration of academic and library staff.