What's wrong with me? Concerns about online medical self-diagnosis

Self-service technologies (SSTs) are becoming increasingly commonplace in healthcare. However, research on the customer (patient) experience in this context is rare. This paper focuses on online medical self-diagnosis, a type of e-health service. This SST can provide customers with benefits such as greater convenience and control, yet we argue that this form of do-it-yourself doctoring also raises concerns for customers. This paper contributes to the service domain by presenting research propositions on the potential negative implications for customers, and their antecedents, of online medical self-diagnosis. We propose that this form of self-diagnosis is related to harms, such as customer anxiety, customer willingness to bypass healthcare professionals, and self-medication. Future research opportunities are discussed, along with implications for policy and practice.

Patients and nurses' perspective on oxygen therapy : a qualitative study

Aim. This paper is a report of a study to describe patients' and nurses' perspectives on oxygen therapy.
Background. Failure to correct significant hypoxaemia may result in cardiac arrest, need for mechanical ventilation or death. Nurses frequently make clinical decisions about the selection and management of low-flow oxygen therapy devices. Better understanding of patients' and nurses' experiences of oxygen therapy could inform clinical decisions about oxygen administration using low-flow devices.
Methods. Face-to-face interviews with a convenience sample of 37 adult patients (17 cardio-thoracic: 20 medical surgical) and 25 intensive care unit nurses were conducted from February 2007 to September 2007. Interviews were audio-taped, transcribed verbatim and then analysed using a thematic analysis approach.
Findings. The patients identified three key factors that underpinned their compliance with oxygen therapy: (i) device comfort; (ii) ability to maintain activities of daily living; and (iii) therapeutic effect. The nurses identified factors, such as: (i) therapeutic effect, (ii) issues associated with compliance, (iii) strategies to optimize compliance, (iv) familiarity with device, (v) triggers for changing oxygen therapy devices, as being key to the effective management of oxygen therapy.
Conclusion. Differences between the patients' and nurses' perspective of oxygen therapy illustrate the variety of factors that impact on effective oxygen administration. Further research should seek to provide a further in-depth understanding of the current oxygen administration practices of nurses and the patient factors that enhance or hinder effectiveness of oxygen therapy. Detailed information about nurse and patient factors that influence oxygen therapy will inform a sound evidence base for nurses' oxygen administration decisions.

Support needs of parents of sick and/or preterm infants admitted to a neonatal unit

The sudden unexpected delivery of a preterm infant elicits many emotional responses from parents, with studies confirming the importance of providing parents with nursing support. The purpose of this study was to measure parents' perception of the type and level of support that nurses provided in an Australian neonatal unit, and to determine the extent to which parents were satisfied with the support currently provided. A convenience sample of 112 parents in an Australian tertiary neonatal unit were invited to complete the nurse parent support tool (NPST), which is a 21-item questionnaire used to measure the level of nursing support. The NPST consists of four domains -emotional, informational, appraisal and instrumental support. A second tool was used to assess parent satisfaction with nurse-to-parent support. A total of 62 parents completed the NPST and satisfaction tool.

Results showed that instrumental support had the highest mean score for both nurse-to-parent support 4.51 (out of 5) and 4.36 for satisfaction. The mean score for nursing support was 4.21 followed by satisfaction with nurse-to-parent support at 4.16. In contrast, emotional support had the lowest mean score for both nurse-to-parent support at 3.94 and 3.97 for satisfaction. Parents indicated that they needed further support with lactation, breastfeeding and assistance with parenting skills. Overall, results indicated that parent perception of nursing support was positive and that parents were highly satisfied with the nursing support provided in the neonatal unit. However, some attention needs to be given to providing more support and information on breastfeeding and parenting skills.

The influence of Sport Education on student motivation in physical education

Background: Physical educators are faced with trying to provide motivating and enjoyable experiences in physical education. Sport Education is an instructional model that aims to provide positive motivational sport experiences by simulating the features of authentic sport. Research support for Sport Education is positive, however, the effects on student motivation and the motivational climate are not well understood.

Purpose: To investigate the influence of the Sport Education model on student motivation (intrinsic/extrinsic motivation, goal orientations, and perceived motivational climate) in secondary physical education.

Setting: Six classes were selected according to teacher and class availability in the sports of soccer, hockey, and football codes in a co-educational government school.

Participants: Participants were 115 (male = 97, female = 18) Year-8 students (aged 13-14 years), in a Sport Education condition (n = 41) and a Traditional condition (n = 74).

Measures: At pre- and post-test, all participants completed three questionnaires: the Intrinsic Motivation Inventory, the Task and Ego Orientation in Sport Questionnaire, and the Perceived Motivational Climate in Sport Questionnaire.

Intervention: Participants completed either a Sport Education condition or a Traditional condition for one double period (100 minutes) one day per week for 10 weeks (Sport Education condition) or for five weeks (Traditional condition). The Sport Education condition incorporated six distinctive features: seasons, affiliation, formal competition, record keeping, festivity, and a culminating event. The Traditional condition used whole-group instruction led by the teacher.

Research design: The study used a non-equivalent control group design with pre- and post-test procedures. The independent variable was teaching condition and the dependent variable was student motivation (assessed by intrinsic motivation, goal orientations, and motivational climate). The groups were already established and selected for convenience purposes.

Data collection and analysis: Participants completed pre-test measures and then participated in their pre-established classes. Post-test measures were completed in the last class in each condition. A reliability analysis on measures was conducted using Cronach's alphas. A pre-test manipulation check was performed to check for any initial differences in motivation. To compare the difference in changes between conditions on motivation, a series of 2 times 2 repeated measures analyses of variance were conducted. A comparison of the relationship between motivation measures was conducted using Pearson's product moment correlation coefficients.

Findings: There was a significant difference between the conditions on changes in perceived competence, task orientation, and mastery climate, with the Traditional condition decreasing significantly from pre- to post-test compared with the Sport Education condition. There were no significant differences on interest/enjoyment, effort/importance, pressure/tension, ego orientation, or performance climate. A mastery climate was positively related to task orientation and intrinsic motivation and a performance climate was related to ego orientation.

Conclusions: The Sport Education condition was more successful in maintaining high levels of intrinsic motivation, task orientation, and mastery climate than the Traditional condition. That is, the Traditional condition was associated with a decrease in adaptive aspects of motivation for students, whereas the Sport Education condition maintained existing levels of motivation.

What can prevalence studies tell us about female sexual difficulty and dysfunction?

Introduction. Many recent studies have investigated the prevalence of female sexual difficulty/dysfunction.
Aim. Investigate female sexual difficulty/dysfunction using data from prevalence studies.
Methods. We reviewed published prevalence studies excluding those that had not included each category of sexual difficulty (desire, arousal, orgasm, and pain), were based on convenience sampling, or had a response rate <50% or a sample size <100.
Main Outcome Measures. For each study we used the prevalence of any sexual difficulty as the denominator and calculated the proportion of women reporting each type of difficulty. For each category of sexual difficulty we used the prevalence of that difficulty lasting 1 month or more as the denominator and calculated the proportion of difficulties lasting several months or more and 6 months or more.
Results. Only 11 of 1,248 studies identified met our inclusion criteria. These studies used different measures of sexual dysfunction, so generating a simple summary prevalence was not possible. However, we observed consistent patterns in the published data. Among women with any sexual difficulty, on average, 64% (range 16–75%) experienced desire difficulty, 35% (range 16– 48%) experienced orgasm difficulty, 31% (range 12–64%) experienced arousal difficulty, and 26% (range 7–58%) experienced sexual pain. Of the sexual difficulties that occurred for 1 month or more in the previous year, 62–89% persisted for at least several months and 25–28% persisted for 6 months or more. Two studies investigated distress. Only a proportion of women with sexual difficulty were distressed by it (21–67%).
Conclusions. Desire difficulty is the most common sexual difficulty experienced by women. While the majority of difficulties last for less than 6 months, up to a third persist for 6 months or more. Sexual difficulties do not always cause distress. Consequently, prevalence estimates will vary depending on the time frame specified by researchers and whether distress is included in these estimates.

Folate fortification : a case study of public health policy-making

This thesis investigates the use of scientific evidence in the process of making public health policy. A case study located within a food regulation setting is used. The aim is to test theory against this case study. The outcome is a theoretical understanding of the use of scientific evidence in the policy-making process in a food regulation setting. Food regulation can influence food composition and food labelling and thereby affect the population's dietary intake. Frequently there are contested values, beliefs, ideologies and interests among stakeholders regarding the use of food regulation as a policy instrument to effect public health outcomes. The protection of public health and safety, taking into account evidence based practice, is generally employed by food regulators as the priority objective during the policy-making process to adjudicate among the competing expectations of stakeholders. However, this policy objective has not been clearly defined and is vulnerable to interpretation and application. The process by which folate fortification policy was made in Australia, in response to epidemiological evidence of a relationship between folate intake during the periconceptional period and reduced risk of neural tube defects, was analysed as a case study of the policy-making process. The folate fortification policy created a precedent for both food fortification and subsequently health claims policy in Australia. A social constructivist method was used to analyse the case study. The method involved deconstructing the food regulatory system into three levels; decision-making process; procedural; and political environment. Data aligned with each level of analysis was collected from 22 key informant interviews, documentary sources, field notes and surveys of both a random sample of the Australian population's knowledge of folate and use of folic acid-containing supplements (n = 5422), and the implementation of folate fortified food products into stores (n = 60). The insights that emerged from each of the three levels of analysis were assessed iteratively to identify a pattern of interrelationships associated with the policy-making process within the food regulatory system. The identified pattern was interpreted against existing theory to gain a theoretical understanding of the public health policy-making process in this political setting. The central argument of this thesis extends Sabatier and Jenkins-Smith's Advocacy Coalition Framework theory to a food regulation setting. The argument is that within the contemporary political climates of neoliberalism and globalisation, a coalition between corporate interests and the values of scientists with a positivist-reductionist approach to public health research is privileged so as to invoke certain scientific evidence to, in turn, legitimise food regulation policy decisions. The theory will help to inform policy-makers about how and why the public health policy objective in a food regulation setting is interpreted and applied. This will contribute to improving policy practice intended to effect public health outcomes. It is concluded that irrespective of the quantity and quality of the scientific evidence that is being made available, scientific evidence cannot be assumed to speak for itself Policy-making is an inherently political and value-laden process and the potential for politically motivated interpretation and application of otherwise value-neutral scientific evidence can undermine the investment in its generation. From this perspective, evidence based practice, far from liberating policy-making from political influence, can itself become part of the problem rather than the solution. Nevertheless, rational evidence based practice is an ideal to strive for and a series of recommendations is proposed to help make the use of evidence in current food regulation policy processes more transparent and democratic.

Effect of dietary arachidonic acid and n-3 polyunsaturated fatty acids on the production of eicosanoids

The major polyunsaturated fatty acid (PUFA) in the western diet is linoleic acid (LA), which is considered to be the major source of tissue arachidonic acid (AA), the principal precursor for the vaso-active eicosanoids via the cyclooxygenase enzymatic pathway. However, dietary AA may contribute significantly to tissue levels of AA in humans, leading to an increase in the production of eicosanoids, particularly the platelet aggregating, vasoconstricting, thromboxane (TXA2), hence increasing thrombosis risk. The aims of this study were to determine the extent to which dietary AA contributed to prostacyclin (PGI2) and TXA2 production in vivo and whether dietary long chain (LC) n-3 PUFA have a modulating influence on the metabolism of AA to these vaso-active eicosanoids. A gas chromatography -mass spectrometry (GCMS) method for urinary PGI2-M determination and a tandem GCMS/MS method for urinary TXA2-M determination were perfected for use within our laboratory (with the assistance of Dr Howard Knapp, University of Iowa and Professor Reinhard Lorenz, Ludwig Maximilian's University, Munich, respectively). An initial animal study compared the in vitro production of PGI2 by aorta segments with the whole body in vivo production of PGI2 in rats fed ethyl arachidonate or the ethyl ester of eicosapentaenoic acid (EPA), at levels many times higher than encountered in human diets. During AA feeding both measures of PGI2 increased, although in vitro TXA2 production was not affected. EPA feeding lowered in vitro TXA2 and in vivo PGI2. Prior to determining the effects of AA and LC n-3 PUFA in humans, a study was carried out to determine the AA and LC n-3 PUFA content of foods and from these, an estimate of the mean daily intake of AA and other LC PUFA. Eggs, organ meats and paté were found to be the richest sources of AA. Of the meat and fish analysed, white meat was found to be relatively rich in AA but poor in LC n-3 PUFA. Lean red meat, particularly kangaroo had similar LC n-3 PUFA and AA content. Fish, although rich in AA, had extremely high levels of LC n-3 PUFA. The calculated mean daily intakes of AA in Australian adults was 130mg (males) and 96mg (females). For total LC n-3 PUFA intake, the mean daily values were 247mg (males) and 197mg (females). Two human pilot studies involving dietary intervention trials examined the effects of dietary AA and AA plus long chain n-3 PUFA on thrombosis risk, gauged by the change in the ratio of PGI2 / TXA2 as well as alterations to other recognised risk factors, such as lipoprotein lipids and platelet aggregation. The desired dietary amounts of AA and LC n-3 PUFA were achieved in the first study by combining food items with known levels of each fatty acid. In the second study, where a diet with approximately equal quantities of AA and LC n-3 PUFA was being examined, kangaroo meat was consumed, following a low-fat vegetarian diet used as a baseline. Diets rich in AA alone (~500mg/day) increased plasma phospholipid (PL) AA levels, PGIi and TXA2 production. When foods containing equal quantities of AA and EPA (∼500mg/day of each) were fed to subjects PGI2 increased, with no change in TXAs production. Low fat vegetarian diets lowered PGI2 production, the level of which was reestablished by an AA rich diet (∼300mg AA/day + ∼260mg/day LC n-3 PUFA) of kangaroo meat. However, TXA2 production was not altered. A final, larger human dietary intervention trial then examined the effects of diets relatively rich in AA alone, AA plus LC n-3 PUFA and LC n-3 PUFA, on the ratio of PGI2/TXA2- The dietary sources of these fatty acids were white meat, red meat and fish, respectively. Each contained a mean level of AA of ∼140mg/day, with varying LC n-3 PUFA levels (59, 161 and 3380mg/day, respectively). Neither meat diet altered PGI2 or TXA2 production significantly, despite increasing serum PL AA levels. The fish diet resulted in a decrease in the serum and platelet PL AA/EPA ratio and TXA2 production, thus increasing the PGI2 / TXA2 ratio. These results would indicate that stores of AA in the body are sufficiently high to have effectively saturated the cyclooxygenase pathway for production of both PGI2 and TXA2, thus making any small change in the plasma level of AA due to 'normal' dietary levels, inconsequential. However, as seen in the rat study and the two pilot studies higher dietary levels of AA can increase both PGI2 and TXA2 production. Increases in platelet levels of EPA and DHA were associated with a decrease in TXA2 production, or the maintenance of a constant TXA2 level, while AA tissue levels and PGI2 production increased. This suggests a possible inhibitory effect of LC n-3 PUFA on the metabolism of AA to TXA2, particularly in platelets. From these short term studies, conducted over 2-3 week periods, it can be concluded that diets rich in lean meats can raise plasma AA levels but do not affect TXA2 or PGI2 production, hence are not pro-thrombotic. Diets rich in long chain n-3 PUFA from fish, raise plasma EPA and DHA levels, lower TXA2 production and are anti-thrombotic. Diets which combine equal quantities of AA and LC n-3 PUFA appear to increase PGI2 production while keeping TXA2 production constant. In order for these LC PUFA to have a significant effect on eicosanoid production the dietary intake of these fatty acids through foods such as red meat or white meat would have to be higher than average current Australian consumption levels.

Theoretical passages and boundaries : the indigenous subject, colonialism, and governmentality

Theoretical paternalism and the convenience of working within ‘accepted’ frameworks have appropriated the Indigenous subject within the boundaries of colonial relations. The establishment of post-colonial theory as one of the only ‘acceptable’ frameworks for exploring the Indigenous subject has limited the subject’s theoretical development within the binary of coloniser/colonised. Breaking from this tradition, the Foucauldian concepts of governmentality, ethics and care-ofthe-self will be used as a template for expansion. This paper will explore the passages of the Indigenous subject in theoretical development. It will examine the significance of post-colonial and settler colonial theories in the conceptualisation of the subject, and consider the transformations that occur when the borders established by these theories are crossed. The paper will therefore be comprised of four sections. The first will address the value and limitations of post-colonial and settler colonial theory. The second will posit reasons and implications for why theoretical neglect has occurred. The third will present and critique the Foucauldian concepts of governmentality, ethics and care-of-the-self. Applying Foucault’s concepts to examples of Indigenous offenders in the settler societies of Australia and New Zealand, the final section will examine the impact of the Indigenous subject in Western thought and institutional practice.

An evaluation of a community aged care nurse practitioner service

Evaluation aims: An evaluation is presented that aimed to augment current understandings of the nurse practitioner role by investigating potential outcomes of a community aged care nurse practitioner (ACNP) service on clients and the health care team.

Background: In Australia, the nurse practitioner role is being implemented in a variety of health care settings and is characterized by extended practice: prescribing of medications, requests for diagnostic investigations, referral to medical specialists and admitting clients to inpatient facilities.

Design: An exploratory qualitative evaluation method through data collection by interview and thematic analysis was undertaken.

Method: All clients referred to the ACNP service between June and August 2003, and a convenience sample of health professionals, were invited to participate in individual semi-structured interviews.

Results: Findings suggested that an ACNP could provide a high quality of holistic nursing care and positively affect clients' physical and psychological symptom management, enhance clients' quality of life, assist with supplies, provide health education and assist with advocacy. Health professionals commented on effective collaboration with the ACNP service during their partnerships in client care provision.

Conclusions: Overall, the positive effects of the ACNP service on clients and the health care team support the full implementation of the role within the community setting.

Relevance to clinical practice: Funding support for the nurse practitioner role is a vital addition to consideration in the development of international policy on advanced practice nursing. Without adequate funding, the full benefits of the nurse practitioner role in clinical practice, as suggested by the findings presented in this evaluation, will be compromised.

Collaborative care : the role of practice nurses

Background
Comorbid depression can occur with diabetes and heart disease. This article reports on a feasibility study focusing on additional roles for practice nurses in detecting and monitoring depression with other chronic diseases.
Method
A convenience sample of six practices in southeast Australia was identified. Practice nurses received training via a workshop, which included training in the use of the Patient Health Questionnaire, to detect depression.
Results
The 332 patients who participated in the project each received a comprehensive health summary to assist with self management. Depression was identified in 34% of patients in this convenience sample. After 18 months implementation, practice nurses were strongly in favour of continuing the model of care. General
practitioners gave highly favourable ratings for effectiveness and willingness to continue this model of care.
Discussion
Practice nurses can include depression monitoring alongside systematic care of diabetes and heart disease. A randomised trial is currently underway to compare the clinical outcomes of this model with usual care.

Assessing the intake of obesity-related foods and beverages in young children: comparison of a simple population survey with 24 hr-recall

Background: With an increasing focus on obesity prevention there is a need for simple, valid tools to assess dietary indicators that may be the targets of  intervention programs. The objective of this study was to determine the relative  validity of previous day dietary intake using a newly developed parent-proxy  questionnaire (EPAQ) for two to five year old children.

Methods: A convenience sample of participants (n = 90) recruited through preschools and the community in Geelong, Australia provided dietary data for their child via EPAQ and interviewer administered 24-hour dietary recall (24 hr-recall). Comparison of mean food and beverage group servings between the  EPAQ and 24 hr-recall was conducted and Spearman rank correlations were computed to examine the association between the two methods.

Results: Mean servings of food/beverage groups were comparable between methods for all groups except water, and significant correlations were found between the servings of food and beverages using the EPAQ and 24-hr recall methods (ranging from 0.57 to 0.88).

Conclusion: The EPAQ is a simple and useful population-level tool for  estimating the intake of obesity-related foods and beverages in children aged two to five years. When compared with 24-hour recall data, the EPAQ produced an acceptable level of relative validity and this short survey has application for population monitoring and the evaluation of population-based obesity prevention interventions for young children.

Acute signalling responses to intense endurance training commenced with low or normal muscle glycogen

We have previously demonstrated that well-trained subjects who completed a 3 week training programme in which selected high-intensity interval training (HIT) sessions were commenced with low muscle glycogen content increased the maximal activities of several oxidative enzymes that promote endurance adaptations to a greater extent than subjects who began all training sessions with normal glycogen levels. The aim of the present study was to investigate acute skeletal muscle signalling responses to a single bout of HIT commenced with low or normal muscle glycogen stores in an attempt to elucidate potential mechanism(s) that might underlie our previous observations. Six endurance-trained cyclists/triathletes performed a 100 min ride at ∼70% peak O₂ uptake (AT) on day 1 and HIT (8 × 5 min work bouts at maximal self-selected effort with 1 min rest) 24 h later (HIGH). Another six subjects, matched for fitness and training history, performed AT on day 1 then 1–2 h later, HIT (LOW). Muscle biopsies were taken before and after HIT. Muscle glycogen concentration was higher in HIGH versus LOW before the HIT (390 ± 28 versus 256 ± 67 μmol (g dry wt)⁻¹). After HIT, glycogen levels were reduced in both groups (P < 0.05) but HIGH was elevated compared with LOW (229 ± 29 versus 124 ± 41 μmol (g dry wt)−1; P < 0.05). Phosphorylation of 5'AMP-activated protein kinase (AMPK) increased after HIT, but the magnitude of increase was greater in LOW (P < 0.05). Despite the augmented AMPK response in LOW after HIT, selected downstream AMPK substrates were similar between groups. Phosphorylation of p38 mitogen-activated protein kinase (p38 MAPK) was unchanged for both groups before and after the HIT training sessions. We conclude that despite a greater activation AMPK phosphorylation when HIT was commenced with low compared with normal muscle glycogen availability, the localization and phosphorylation state of selected downstream targets of AMPK were similar in response to the two interventions.

Surrender to the market : thoughts on anthropology, the body shop, and intellectuals

The direction of anthropology over the last century is tied to the shifts from colonialism to postcolonialism and from modernism to postmodernism. These shifts have seen the thoroughgoing incorporation of the world population into the economic, political and juridical domain established through the last throes of colonialism and the transmutations of capitalism and the State. Anthropology, a discipline whose history shows close and regular links with colonial government, also transforms in association with the world it describes and partly creates. Two dominant trends in contemporary anthropology--applied consultancy and historicist self-reflexivity--are compared for the ways they represent the transmutation, which is characterised, following Fredric Jameson as 'the surrender to the market'. In this way it is asserted that just as the discipline had hitherto revealed its links to colonialism, it now reveals its links to globalisation through a form of commodified self-obsession. To illustrate this quality the paper considers the global chain of cosmetics stores, The Body Shop, as an example of 'late capitalism' and the moral juridical framework of globalisation. Finally, it treats these developments in anthropology as more generally affecting intellectuals and knowledge production through the promotion of intellectual 'silence'.

Media reports of heroin overdose spates: public health messages, moral panics or risk advertisements?

This article reports on an investigation of the public health utility of media messages concerning spates (temporal clusters) of heroin-related overdose (HOD) from the perspective of some injecting drug users (IDUs). In-depth qualitative interviews were carried out with a convenience sample of 60 IDUs, in the setting of two Needle and Syringe Programs in an Australian regional city (Geelong) between April and May 2000. Very few interviewees reported that they had personally experienced a spate of overdoses. None of the interviewees reported communicating the existence of a killer batch to other IDUs. No interviewees reported having changed either their injecting practices or the amount of heroin they used following such a media alert. Indeed, a substantial minority of the interviewees reported seeking out these stronger batches and participant narratives illustrate that, for a substantial group of interviewees, the media reporting of a hypothetical 'killer batch' of heroin may have implications for their drug-seeking and health-related behaviour. It was found that the accuracy of information available to IDUs is mixed and that the flow of information within this social network was slow. Findings demonstrate that media reporting of killer batches of heroin has little value as a public health strategy and provide an example of how some activities that are proposed as public health measures may in fact have the opposite effect.

Creatine transporter expression in skeletal muscle

Creatine is an important molecule involved in providing energy to the body. Its major stores are in skeletal muscle. The creatine transporter protein (CreaT) mRNA is believed to be responsible for the uptake of the majority of creatine in skeletal muscle. This thesis examined factors that might have affected the expression of the creatine transporter in skeletal muscle.