The treatment of recurrent abdominal pain in children : a controlled comparison of cognitive-behavioral family intervention and standard pediatric care

This study describes the results of a controlled clinical trial involving 44 7- to 14-year-old children with recurrent abdominal pain who were randomly allocated to either cognitive-behavioral family intervention (CBFI) or standard pediatric care (SPC). Both treatment conditions resulted in significant improvements on measures of pain intensity and pain behavior. However, the children receiving CBFI had a higher rate of complete elimination of pain, lower levels of relapse at 6- and 12-month follow-up, and lower levels of interference with their activities as a result of pain and parents reported a higher level of satisfaction with the treatment than children receiving SPC. After controlling for pretreatment levels of pain, children's active self-coping and mothers' caregiving strategies were significant independent predictors of pain behavior at posttreatment.

Courtyard housing as a subtropical urban design model

Through both theory and practice, this practice-based research develops and tests the idea that courtyard housing can deliver sustainable, compact housing in rapidly growing subtropical cities. It proposes a contemporary urban design model that incorporates urban design courtyard housing prototypes. These prototypes can be further developed by architects and urban designers for similar climatic conditions across the world.

Characterisation, toxicity and source apportionment of atmospheric organic pollutants in urban schools

Airborne organic pollutants have significant impacts on health; however their sources, atmospheric characteristics and resulting human exposures are poorly understood. This research characterized chemical composition of atmospheric volatile organic compounds, polycyclic aromatic hydrocarbons and carbonyls in representative number of primary schools in Brisbane Metropolitan Area, quantified their concentrations, assessed their toxicity and apportioned them to their sources. The findings expand scientific knowledge of these pollutants, and will contribute towards science based management of risks associated with pollution emissions and air quality in schools and other urban and indoor environments.

An innovative online intervention: The Steering Clear First Offender Drink Driving Program

Drink driving remains a substantial public health issue warranting investigation. First offender drink drivers are seen to be less risky than repeat offenders, though the majority of first offenders report drink driving prior to detection, and many continue to drink drive following conviction. Few first offenders are offered treatment programs, and as such there is a need to address drink driving behaviour at this stage. A comprehensive approach including first offender treatment is needed to address the problem. Online interventions have demonstrated effectiveness in reducing risky behaviours such as harmful substance use. Such interventions allow for personalised tailored content to be delivered to individuals targeting specific mechanisms of behavioural change. This method also allows for targeting screening to ensure relevance of content on an individual level. However, there have been no research based online programs to date aimed at reducing repeat drink driving by first offenders. The Steering Clear First Offender Drink Driving Program is a self-guided, research based online program aimed at reducing recidivism by first time drink driving offenders. It includes a specialised web app to track drinks and build plans to prevent future drink driving. This allows for elongation of learning and encouragement of sustained behavioural change using self-monitoring after initial program completion. An outline of the program is discussed and the qualitative experience of the program on a sample of first offenders recruited at the time of court appearance is described.

Improving SEA procedures within Italian regions: Towards a more effective evaluation of urban sustainability

Sustainable urban development, a major issue at global scale, will become more relevant according to population growth predictions in developed and developing countries. Societal and international recognition of sustainability concerns led to the development of specific tools and procedures, known as sustainability assessments/appraisals (SA). Their effectiveness however, considering that global quality life indicators have worsened since their introduction, has promoted a re-thinking of SA instruments. More precisely, Strategic Environmental Assessment (SEA), – a tool introduced in the European context to evaluate policies, plans, and programmes (PPPs), – is being reconsidered because of several features that seem to limit its effectiveness. Over time, SEA has evolved in response to external and internal factors dealing with technical, procedural, planning and governance systems thus involving a shift of paradigm from EIA-based SEAs (first generation protocols) towards more integrated approaches (second generation ones). Changes affecting SEA are formalised through legislation in each Member State, to guide institutions at regional and local level. Defining SEA effectiveness is quite difficult. Its’ capacity-building process appears quite far from its conclusion, even if any definitive version can be conceptualized. In this paper, we consider some European nations with different planning systems and SA traditions. After the identification of some analytical criteria, a multi-dimensional cluster analysis is developed on some case studies, to outline current weaknesses.

Improving SEA prodedures within Italian regions: Towards a more effective evaluation of urban sustainability

Sustainable urban development, a major issue at global scale, will become more relevant according to population growth predictions in developed and developing countries. Societal and international recognition of sustainability concerns led to the development of specific tools and procedures, known as sustainability assessments/appraisals (SA). Their effectiveness however, considering that global quality life indicators have worsened since their introduction, has promoted a re-thinking of SA instruments. More precisely, Strategic Environmental Assessment (SEA), – a tool introduced in the European context to evaluate policies, plans, and programmes (PPPs), – is being reconsidered because of several features that seem to limit its effectiveness. Over time, SEA has evolved in response to external and internal factors dealing with technical, procedural, planning and governance systems thus involving a shift of paradigm from EIA-based SEAs (first generation protocols) towards more integrated approaches (second generation ones). Changes affecting SEA are formalised through legislation in each Member State, to guide institutions at regional and local level. Defining SEA effectiveness is quite difficult. Its’ capacity-building process appears quite far from its conclusion, even if any definitive version can be conceptualized. In this paper, we consider some European nations with different planning systems and SA traditions. After the identification of some analytical criteria, a multi-dimensional cluster analysis is developed on some case studies, to outline current weaknesses.

PW376 A pilot study of a post-discharge nurse-led, educational intervention on cardiac self-efficacy and anxiety in post-PCI patients

Introduction Hospitalisation for percutaneous coronary intervention (PCI) is often short, with limited nurse-teaching time and poor information absorption. Currently, patients are discharged home only to wait up to 4-8 weeks to commence a secondary prevention program and visit their cardiologist. This wait is an anxious time for patients and confidence or self-efficacy (SE) to self-manage may be low. Objectives To determine the effects of a nurse-led, educational intervention on participant SE and anxiety in the early post-discharge period. Methods A pilot study was undertaken as a randomised controlled clinical trial. Thirty-three participants were recruited, with n=13 randomised to the intervention group. A face-to-face, nurse-led, educational intervention was undertaken within the first 5-7 days post-discharge. Intervention group participants received standard post-discharge education, physical assessment, with a strong focus on the emotional impact of cardiovascular events and PCI. Early reiteration of post-discharge education was offered, along with health professional support with the aim to increase patients’ SE and to effectively manage their post-discharge health and well being, as well as anxieties. Self-efficacy to return to normal activities was measured to gauge participants’ abilities to manage post-PCI after attending the intervention using the cardiac self-efficacy (CSE) scale. State and trait anxiety was also measured using the State-Trait Anxiety Inventory (STAI) to determine if an increase in SE would influence participant anxiety. Results There were some increases in mean CSE scores in the intervention group participants over time. Areas of increase included return to normal social activities and confidence to change diet. Although reductions were observed in mean state and trait anxiety scores in both groups, an overall larger reduction in intervention group participants was observed over time. Conclusion It is essential that patients are given the education, support, and skills to self-manage in the early post-discharge period so that they have greater SE and are less anxious. This study provides some initial evidence that nurse-led support and education during this period, particularly the first week following PCI, is beneficial and could be trialled using alternate modes of communication to support remote and rural PCI patients and extend to other cardiovascular patients.

Use of physicochemical signatures to assess the sources of metals in urban road dust

Road deposited dust is a complex mixture of pollutants derived from a wide range of sources. Accurate identification of these sources is seminal for effective source-oriented control measures. A range of techniques such as enrichment factor analysis (EF), principal component analysis (PCA) and hierarchical cluster analysis (HCA) are available for identifying sources of complex mixtures. However, they have multiple deficiencies when applied individually. This study presents an approach for the effective utilisation of EF, PCA and HCA for source identification, so that their specific deficiencies on an individual basis are eliminated. EF analysis confirmed the non-soil origin of metals such as Na, Cu, Cd, Zn, Sn, K, Ca, Sb, Ba, Ti, Ni and Mo providing guidance in the identification of anthropogenic sources. PCA and HCA identified four sources, with soil and asphalt wear in combination being the most prominent sources. Other sources were tyre wear, brake wear and sea salt.

Urban growth and development of contemporary neighbourhood public space in Kathmandu Valley, Nepal

Rapid and unplanned growth of Kathmandu Valley towns over the past decades has resulted in the haphazard development of new neighbourhoods with significant consequences on their public space. This paper examines the development of public space in the valley’s new neighbourhoods in the context of the current urban growth. A case study approach of three new neighbourhoods was developed to examine the provision of public space with data collected from site observations, interviews with neighbourhood residents and other secondary sources. The cases studies consist of both planned and unplanned new neighbourhoods. Findings reveal a severe loss of public space in the unplanned new neighbourhoods. In planned new neighbourhoods, the provision of public space remains poor in terms of physical features, and thus, does not support community activities and needs. Several factors, which are an outcome of the lack of proper urban growth initiatives and control measures, such as an overall drawback in the formation of new neighbourhoods, the poor capacity of local community-based organisations and the encroachment of public land are responsible for the present development of neighbourhood public space. The problems with ongoing management of public spaces are a significant issue in both unplanned and planned new neighbourhoods.

Assessing environmental inequalities in ambient air pollution across urban Australia

Identifying inequalities in air pollution levels across population groups can help address environmental justice concerns. We were interested in assessing these inequalities across major urban areas in Australia. We used a land-use regression model to predict ambient nitrogen dioxide (NO2) levels and sought the best socio-economic and population predictor variables. We used a generalised least squares model that accounted for spatial correlation in NO2 levels to examine the associations between the variables. We found that the best model included the index of economic resources (IER) score as a non-linear variable and the percentage of non-Indigenous persons as a linear variable. NO2 levels decreased with increasing IER scores (higher scores indicate less disadvantage) in almost all major urban areas, and NO2 also decreased slightly as the percentage of non-Indigenous persons increased. However, the magnitude of differences in NO2 levels was small and may not translate into substantive differences in health.

Cough and ARI outcomes in urban Indigenous Children

Aim To identify cough epidemiology and outcomes in urban Indigenous children Methods An ongoing prospective cohort study of Indigenous children aged <5 years registered with at an urban Indigenous primary health care centre, Brisbane. Detailed baseline data are collected and, children are followed monthly for 12 months to capture ARI events. Children who develop cough as a symptom at any time over the 12 months have weekly follow-up for four weeks to ascertain cough outcomes. Results To date, 118 children have been enrolled (535 child-months of observation); Respiratory illnesses accounted for 23 (19 %) of overall reported reasons for presentation, however respiratory symptoms were present in 41 (35%) of all visits; a dry cough in 22 (18%), wet cough in 31 (26%). To date, 99 ARI’s have been recorded with an incidence of 18.4 episodes/100 child months. Seventeen children (14.4%) had persistent cough at day 28. Conclusion This is the first study to comprehensively describe the incidence and outcomes of cough in urban Indigenous children. Early data suggest respiratory illnesses are the most common illnesses for which these children seek medical advice and there is a high prevalence of wet cough.

General practitioner utilisation amongst urban Aboriginal and Torres Strait Islander children aged less than 5 years

Aim There are limited studies documenting the frequency and reason for attendance to primary health care services in Australian children, particularly for urban Aboriginal and Torres Strait Islander children. This study describes health service utilisation in this population in an urban setting. Methods An ongoing prospective cohort study of Aboriginal and Torres Strait Islander children aged <5 years registered with an urban Aboriginal and Torres Strait Islander primary health care centre in Brisbane, Australia. Detailed demographic, clinical, health service utilisation and risk factor data are collected by Aboriginal researchers at enrolment and monthly for a period of 12 months on each child. The incidence of health service utilisation was calculated according to the Poisson distribution. Results Between 14 February 2013 and 31 October 2014, 118 children were recruited, providing data for 535 child-months of observation. Ninety-one percent of children were Aboriginal, 4% Torres Strait Islander and 5% were both Aboriginal and Torres Strait Islander. The incidence of presentations to see a doctor for any reason was 43.9 episodes/100 child months (95%CI 38.4 – 49.9) The most common reasons for presentation were for immunisations (23%), respiratory illnesses (19%) and for Australian Government funded Indigenous child health check (16%). The primary health services used, for majority of these visits were Aboriginal and Torres Strait Islander specific medical services (61%). Conclusions Within a cultural-specific service for an urban Aboriginal and Torres Strait Islander people, there is a high frequency of childhood attendance at for primary health care services. Well-health checks and respiratory illnesses were the most common reasons. The high proportion of visits for well child services suggests a potential for opportunistic health promotion, education and early interventions across a range of child health issues.

Comparison of Radiation Doses for Catheter Ablation Procedures for Atrial Fibrillation with Percutaneous Coronary Intervention Cases

Background: Catheter ablation procedures for atrial fibrillation (AF) may frequently require long fluoroscopic times. We sought to undertake a review of radiation safety practice in our Cardiac Electrophysiology Laboratory and implement changes to minimize fluoroscopic doses. We also sought to compare the results with radiation doses for percutaneous coronary intervention (PCI) cases performed in our hospital. Methods: Fluoroscopic times and doses for AF ablation procedures performed by a single operator on a Philips Integris H3000 image-intensifier were analysed for 11-month period. Results were compared with all PCI procedures performed over a similar period by multiple operators on a Philips Integris Allura FD system. Comprehensive review of radiation practice in the Electrophysiology laboratory identified the potential to reduce pulse frame rates and doses, and to narrow the field of interest without impacting the performance of the procedure. These changes were implemented and results analysed after a further 11 months. Results: In the pre-intervention period 50 AF catheter ablations had a mean fluoroscopic time of 86.4 min and mean fluoroscopic dose 68.4 Gy/cm2. Post-intervention 75 procedures had a mean fluorosocopic time of 68.9 min (p < 0.0001) and mean dose of 14.3 Gy/cm2 (p < 0.0001) 128 PCI procedures had a mean combined fluoroscopic and image acquisition time of 10.0 min and mean total dose 38.8 Gy/cm2. Conclusions: Catheter ablation procedures for AF may require lengthy use of fluoroscopy but simple modifications to radiation practice can result in marked reductions in radiation dose that compare favourably with PCI case doses

'Work it out': Evaluation of a chronic condition self-management program for urban Aboriginal and Torres Strait Islander people with or at risk of cardiovascular disease

This thesis evaluates a chronic condition self-management program for Aboriginal and Torres Strait Islander people in urban south-east Queensland who have or are at risk of cardiovascular disease. Outcomes showed short-term improvements for some anthropometry measures which could be a trend for improvement in other anthropometry indicators over the longer term. The program was of particular benefit for participants who had several social and emotional wellbeing conditions. The use of an Aboriginal and Torres Strait Islander conceptual framework was critical in undertaking culturally competent quantitative research in this project.

Urban Revitalization: Remaking Cities in a Changing World

Following decades of neglect and decline, many US cities have undergone a dramatic renaissance. From New York to Nashville and Pittsburgh to Portland governments have implemented innovative redevelopment strategies to adapt to a globally integrated, post-industrial economy and cope with declining industries, tax bases, and populations - but the urban comeback has been highly uneven. Urban Revitalization integrates academic and policy research with professional knowledge and techniques. Written in an accessible style and with a thoughtful structure, it will provide graduate and upper-level undergraduate students with a comprehensive resource while also serving as a reference for professionals.