Does self-efficacy mediate the cross-sectional relationship between perceived quality of health care and self-management of diabetes? Results from Diabetes MILES - Australia

OBJECTIVE: Quality of health care (QoC) and self-efficacy may affect self-management of diabetes, but such effects are not well understood. We examined the indirect role of diabetes-specific self-efficacy (DSE) and generalised self-efficacy (GSE) in mediating the cross-sectional relationship between self-reported QoC and diabetes self-management.

DESIGN: Diabetes MILES-Australia was a national survey of 3,338 adults with diabetes. We analysed data from 1,624 respondents (Age: M=52.1, SD=13.9) with type 1 (T1D; n=680) or type 2 diabetes (T2D; n=944), who responded to a version of the survey containing key measures.

MAIN OUTCOME MEASURES: Self-reported healthy eating, physical activity, self-monitoring of blood glucose frequency, HbA1c, medication/insulin adherence. RESULTS: We used Preacher and Hayes' bootstrapping method, controlling for age, gender and diabetes duration, to test mediation of DSE and GSE on the relationship of QoC with each self-management variable. We found statistically significant but trivial mediation effects of DSE and of GSE on most, but not all, variables (all effect sizes <0.06).

CONCLUSION: Support for mediation was weak, suggesting that relationships amongst these variables are small and that future research might explore other aspects of self-management in diabetes.

Relationships between civil engineering students’ learning approaches and their perception of curriculum and teaching quality

BACKGROUND: Deakin University graduated its first cohort from four-year undergraduate civil engineering course/program in 2012. The internal annual Course Experience Survey, which has been running annually since 2012, targets to identify the graduating students’ learning approaches and students’ perceptions of the curriculum and teaching quality. Literature suggests that students’ learning outcomes can be achieved more efficiently when the students’ perceptions of curriculum and teaching quality are closely aligned with their learning approaches. Where the students’ approaches to learning and their perception of curriculum and teaching quality are mismatched, a series of frustrations can result for the students that may not only negatively impact their learning achievement but also their learning experience.
PURPOSE OR GOAL: This study explores the relationships between students’ learning approaches and their perception of curriculum and teaching quality in an undergraduate civil engineering program/course. This will help understand whether the curriculum and teaching quality provided by the university have actually accommodated ‘all’ enrolled students in the similar way.
APPROACH: To uncover these relationships, this study adopts questionnaire survey approach to collect response data over a two year period by asking students about their perception through a series of statements. 5-point Likert-scale questionnaire survey (strongly disagree, disagree, neutral, agree, strongly agree) is developed and responses are collected. The responses are then statistically analysed in order to uncover the relationships between students’ learning approaches and their perception of curriculum and teaching quality provided by the university.
DISCUSSION: Deep learners and surface learners had a statistically different perception of curriculum and teaching quality. These results contradict the assumption that learners will have uniform preferences on the curriculum, teaching quality and the way they deal with the demands of specific learning situations. Anecdotal belief that ‘good course/program curriculum and good teaching approaches are good for all students and vice-versa’ may not be strictly true for contemporary heterogeneous student cohorts.
RECOMMENDATIONS/IMPLICATIONS/CONCLUSION: This finding highlights the challenge for curriculum designer to design appropriate course curriculum and teaching staff to implement efficient teaching strategies that benefit both surface and deep learners, who are usually enrolled together. It may be beneficial to provide diversity and flexibility in the curriculum and teaching approaches (rather than a uniform approach). However, this may demand additional resources and may also be questioned for equity and consistency of education. It is also important to note that due to relatively a small dataset, these results may not be generalised.

Patterns of time use among regional and rural adolescent girls: associations with correlates of physical activity and health-related quality of life

OBJECTIVES: To describe patterns of time use among regional and rural adolescent girls and compare identified clusters with respect to correlates of physical activity (PA) and health-related quality of life (HRQoL).

DESIGN: Cross-sectional PA and lifestyle survey.

METHODS: Data were from Year 7-9 adolescent girls (aged 12-15 years) from 16 schools involved in a cluster-randomised trial in regional and rural Victoria, Australia (n=494). Time use data were collected using 24-h Previous Day Physical Activity Recall (PDPAR-24) questionnaire, collapsed into 17 categories of time use. Differences between time use clusters with regard to demographics, correlates of PA and HRQoL measured using PedsQL 4.0 Generic Core Scales, were investigated.

RESULTS: Two time use clusters were identified and were associated with correlates of PA and HRQoL. Girls who spent significantly more time in teams sports, non-team sports, school classes, watching TV and sleeping had higher levels of positively aligned PA correlates (e.g. self-efficacy, perceived sports competence) and HRQoL than girls characterised with high levels of computer use and video gaming. CONCLUSIONS: These findings highlight how different activity patterns of regional and rural girls affect HRQoL and can inform future intervention strategies to improve PA levels and HRQoL. Clusters characterised by low levels of PA and high computer use and video gaming require targeted interventions to address barriers to their participation.

The predictors of diet quality among Australian children aged 3.5 years

BACKGROUND: It is critical to promote healthy eating early in life. OBJECTIVE: The aim of this study was to examine diet quality and its predictors among Australian preschool-aged children. DESIGN: Diet was assessed at age 3.5 years using multiple 24-hour recalls. Diet quality was assessed using an adapted version of the Revised Children's Diet Quality Index (RC-DQI). Potential predictors of diet quality were from questionnaires at age 3, 9, and 18 months and informed by the ecologic model of childhood overweight. Potential predictors included child's sex, age of introduction to solid foods, breastfeeding status, food acceptance, maternal nutrition knowledge, modeling of healthy eating, self-efficacy, education, and home food availability. PARTICIPANTS: Data from 244 children participating in the Melbourne Infant Feeding, Activity, and Nutrition Trial in 2008-2010 and follow-up data collection in 2011-2013 were examined. MAIN OUTCOME MEASURES: Diet quality at age 3.5 years. STATISTICAL ANALYSES PERFORMED: Bivariate logistic regression was performed to assess the relationship between diet quality and each predictor. A multivariable logistic regression model accounting for influences of covariates, treatment arm, and clustering by group tested associations between diet quality and significant predictors from bivariate analyses. RESULTS: RC-DQI scores had a mean±standard deviation score of 62.8±8.3 points out of a maximum of 85 points. Breastfeeding status (odds ratio [OR] 2.34, 95% CI 1.33 to 4.10) and maternal modeling of healthy eating (OR 1.75, 95% CI 1.01 to 3.03) were positively associated with RC-DQI scores. Both breastfeeding status (OR 3.09, 95% CI 1.63 to 5.85) and modeling (OR 2.01, 95% CI 1.04 to 3.88) remained positively associated with diet quality after adjustment for child age, body mass index z score, energy intake, treatment arm, and clustering. CONCLUSIONS: Breastfeeding status and modeling of healthy eating were independently associated with children's diet quality. Early intervention could assist mothers to practice these behaviors to provide support for improving child diet quality.

Associations between parent-child relationship quality and obesogenic risk in adolescence: a systematic review of recent literature.

Adolescence is a period of significant cognitive, social and physiological change, presenting unique risk factors for weight gain. Childhood obesity research has traditionally focused on the influence of parent-level factors on children's eating and weight status. Increasingly, emphasis is turning towards the reciprocal nature of the parent-child relationship and its influence on health behaviour. A systematic literature review was conducted to investigate the relationship between parent-child relationship quality (defined as the felt emotional bond between parent and child) and obesogenic risk (weight status, eating attitudes and behaviours, level of physical activity and sedentary behaviour) in adolescence; 26 papers were included in the review. The results neither support nor challenge an association between parent-child relationship quality and weight, with study design flaws and limited measurement of the parent-child relationship precluding robust conclusions. The review does however suggests that several aspects of the parent-child relationship are important in understanding eating attitudes and behaviours, including the felt emotional bond between the parent and child, the child's perception of how much the parent cares for them and the mother's sensitivity towards the child. The need for further longitudinal research into the association between parent-child relationship quality and obesity risk across this developmental period is discussed.

Relationship between health-related quality of life, comorbidities and acute health care utilisation, in adults with chronic conditions

Background: There is increased interest in developing multidisciplinary ambulatory care models of service delivery to manage patients with complex chronic diseases. These programs are expensive and given limited resources it is important that care is targeted effectively. One potential screening strategy is to identify individuals who report the greatest decrement in health related quality of life (HRQoL) and thus greater need. The aim of this study was to explore the relationship between HRQoL, comorbid conditions and acute health care utilisation. Methods: A prospective, longitudinal cohort design was used to evaluate the impact of HRQoL on acute care utilisation rates over three-years of follow-up. Participants were enrolled in chronic disease management programs run by a metropolitan health service in Australia. Baseline data was collected from 2007-2009 and follow-up data until 2012. Administrative data was used to classify patients' primary reasons for enrolment, number of comorbidities (Charlson Score) and presentations to acute care. At enrolment, HRQoL was measured using the Assessment of Quality of Life (AQoL) instrument, for analysis AQoL scores were dichotomised at two standard deviations below the population norm. Results: There were 1999 participants (54% male) with a mean age of 63years (range 18-101), enrolled in the study. Participants' primary health conditions at enrolment were: diabetes 915 (46%), chronic respiratory disease 463 (23%), cardiac disease 260 (13%), peripheral vascular disease, and 181 (9%) and aged care 180 (9%). At 1-year multivariate logistic regression models demonstrated that AQOL utility score was not predictive of acute care presentations after adjusting for comorbidities. Over 3-years an AQoL utility score in the lowest quartile was predictive of both ED presentation (OR 1.58, 95% CI, 1.16-2.13, p=0.003) and admissions (OR 1.67, 95% CI.1.21 to 2.30, p=0.002) after adjusting for differences in age and comorbidities. Conclusion: This study found that both HRQoL and comorbidities were predictive of subsequent acute care attendance over 3-years of follow-up. At 1-year, comorbidities was a better predictor of acute care representation than HRQoL. To maximise benefits, programs should initially focus on medical disease management, but subsequently switch to strategies that enhance health independence and raise HRQoL.

Inter-professional clinical handover in post-anaesthetic care units: tools to improve quality and safety

OBJECTIVES: To examine quality and safety in inter-professional clinical handovers in Post Anaesthetic Care Units (PACUs) and make recommendations for tools to standardize handover processes.
DESIGN: Mixed methods combining data from observations and focus groups.
SETTING: Three PACUs, one public tertiary hospital and two private hospitals.
PARTICIPANTS: Observations were made of 185 patient handovers from anaesthetists to nurses. Eight focus groups were conducted with 62 staff (15 anaesthetists and 47 nurses) across the study sites.
INTERVENTION: Inter-professional clinical handovers in PACU's.
MAIN OUTCOME MEASURES: Characteristics of the structure and processes that support safe inter-professional PACU handover practice.
RESULTS: Characteristics of the process, content, activities and risks during anaesthetist to nurse patient handover into the PACU were integrated into four steps in the PACU handover process summarized by the acronym COLD (Connect, Observe, Listen and Delegate), a verbal communication tool (ISoBAR), a checklist of critical information for safe patient transfer into PACU and a matrix of factors perceived to increase handover risk.
CONCLUSIONS: The standard structure and checklists for optimal content of patient handovers were derived from existing practices and consensus, hence, expected to provide ecologically valid and practical resources to improve quality and safety during clinical handovers in the PACU.

Investigating the issue of pollution in the micro-scale design of mega-cities : a case study of Enghelab Street, Tehran

Today there is a growing concern about urbanization and its impact on environmental pollution, which threatens human health and quality of life especially in mega cities. The mega city of Tehran, the capital of Iran, deals with various types of pollution. Although a large body of research has highlighted the significance of study on urban pollution in mega cities, only a few studies have addressed the issue at the micro scale. However, most of the research is restricted to air and noise pollution, whereas visual pollution as an important type of pollution that can be interpreted more deeply on a micro-scale, has been neglected. This study aims to evaluate some of the major issues of environmental pollution in Tehran by focusing on the micro-scale of the street. Therefore, as the central part of Tehran is one of the most affected divisions in the city, Enghelab Street has been selected as the case study for this research. This paper argues that identification and implementation of pollution mitigating strategies in Tehran’s master plan is not responsive enough to the whole city. This study of Enghelab Street reveals that policy making strategies for decreasing pollution should be initiated from micro-scale with further emphasis on psychological health. In the future, the lessons learned from the case study of Enghelab will help other major cities in developing countries to combat pollution through initiating from most affected districts in small scale.

Perceptions of journal quality and research paradigm: results of a web-based survey of British accounting academics

This paper reports the results of a web-based perception study of the ranking of peer reviewed accounting journals by UK academics. The design of the survey instrument allows an interactive selection of journals to be scored. The web-based format is unique in that it also includes a step in which respondents classify the journals according to methodological perspective (paradigm). This is depicted graphically in the paper in a bubble diagram that shows the “positioning” of journals according to perceptions of both paradigm and quality.

Quality of life in outpatients with depression in China

BACKGROUND: Quality of life (QOL) is an important outcome measure for patients with depression, but QOL research involving large samples of patients has been uncommon. The purpose of this study was to evaluate the QOL of Chinese outpatients with depression and its determinants. METHODS: Using a cross-sectional survey design, data were collected continuously from 19,984 outpatients; 19,950 usable questionnaires were obtained. Along with the QOL index (WHOQOL-BREF), the questionnaire also included participants' sociodemographic characteristics, outpatient visits, and medication use information. RESULTS: Less than 5% of depressed patients reported "good" or "very good" QOL, while less than 3% were satisfied with their general health. The overall score was low (54.12); four QOL domain (physical health, psychological, social relationships, and environment) scores (range, 35.03-40.10) were significantly lower than in other community population surveys. QOL scores were significantly lower among first-visit than non-first-visit patients. Medication users reported significantly higher QOL scores than non-users, with NaSSA more effective than SSRIs, followed by other types, SNRIs, and no medication, in that order. LIMITATIONS: Since this was an observational, cross-sectional survey with continuous outpatient data collection method instead of random sampling, generalization of the results is limited, and causality cannot be determined. However, the "natural" observational design, large sample size, and similarity in findings with other studies reveal the "real world" QOL of depressed outpatients in mainland China. CONCLUSIONS: Depressed patients had a low QOL, and the scores of first-visit patients with severe symptoms were significantly lower than non-first-visit patients. Though medication can improve patients' QOL, different types of medications have different impacts.

Engineering education quality assurance within the school of engineering: a holistic approach

BACKGROUND Quality assurance is a key element of engineering education at Deakin University and is monitored through various mechanisms which also include the process of collecting students’ feedback within the Schools and faculties. The information received are then looked at holistically and action plan is developed to implement. This has proven to be very effective to ensure feedback received from the students has been properly addressed.
PURPOSE The School of Engineering at Deakin University, has initiated the formation of Engineering Educational Quality Working Group (QWG). The aim of QWG is to provide a focal point for learning and teaching quality and its assurance in undergraduate and postgraduate Engineering courses. The school approach complements Deakin University processes of collecting and analysing student feedback on unit curricula design, delivery and facilitator delivery performance; feedback regarding individual facilitator, unit evaluations and graduate course experiences.
DESIGN/METHOD The data are collected through face to face feedback from both on and off campus students. Feedback received from the end of trimester student evaluation process was also analysed.
RESULTS The motivation behind the practise is to close the loop for the feedback received from the students and take appropriate action against the feedback. This is to enhance overall delivery of engineering education at Deakin University.
CONCLUSIONS This paper outlines the activities planned by the QWG and elaborates on quality assurance approaches and key strategies to be implemented by the working group to achieve the desired quality as well as efficacy of those recommendations/actions undertaken at the school level.

Neighbourhood environment, physical activity, quality of life and depressive symptoms in Hong Kong older adults: a protocol for an observational study

INTRODUCTION: The neighbourhood environment can assist the adoption and maintenance of an active lifestyle and affect the physical and mental well-being of older adults. The psychosocial and behavioural mechanisms through which the environment may affect physical and mental well-being are currently poorly understood. AIM: This observational study aims to examine associations between the physical and social neighbourhood environments, physical activity, quality of life and depressive symptoms in Chinese Hong Kong older adults.

METHODS AND ANALYSES: An observational study of the associations of measures of the physical and social neighbourhood environment, and psychosocial factors, with physical activity, quality of life and depressive symptoms in 900 Hong Kong older adults aged 65+ years is being conducted in 2012-2016. The study involves two assessments taken 6 months apart. Neighbourhood walkability and access to destinations are objectively measured using Geographic Information Systems and environmental audits. Demographics, socioeconomic status, walking for different purposes, perceived neighbourhood and home environments, psychosocial factors, health status, social networks, depressive symptoms and quality of life are being assessed using validated interviewer-administered self-report measures and medical records. Physical functionality is being assessed using the Short Physical Performance Battery. Physical activity and sedentary behaviours are also being objectively measured in approximately 45% of participants using accelerometers over a week. Physical activity, sedentary behaviours, quality of life and depressive symptoms are being assessed twice (6 months apart) to examine seasonality effects on behaviours and their associations with quality of life and depressive symptoms.

ETHICS AND DISSEMINATION: The study received ethical approval from the University of Hong Kong Human Research Ethics Committee for Non-Clinical Faculties (EA270211) and the Department of Health (Hong Kong SAR). Data are stored in a password-protected secure database for 10 years, accessible only to the named researchers. Findings will be submitted for publication in peer-reviewed journals.

Computer Aided Design Algorithmic Technique for Very Large Scale Integrated Circuit Design and Smart Home Embedded System Design

To tackle the challenges at circuit level and system level VLSI and embedded system design, this dissertation proposes various novel algorithms to explore the efficient solutions. At the circuit level, a new reliability-driven minimum cost Steiner routing and layer assignment scheme is proposed, and the first transceiver insertion algorithmic framework for the optical interconnect is proposed. At the system level, a reliability-driven task scheduling scheme for multiprocessor real-time embedded systems, which optimizes system energy consumption under stochastic fault occurrences, is proposed. The embedded system design is also widely used in the smart home area for improving health, wellbeing and quality of life. The proposed scheduling scheme for multiprocessor embedded systems is hence extended to handle the energy consumption scheduling issues for smart homes. The extended scheme can arrange the household appliances for operation to minimize monetary expense of a customer based on the time-varying pricing model.

Continuous quality improvement in a Maltese hospital using logical framework analysis

Purpose: The purpose of this paper is to present the application of logical framework analysis (LFA) for implementing continuous quality improvement (CQI) across multiple settings in a tertiary care hospital. Design/methodology/approach: This study adopts a multiple case study approach. LFA is implemented within three diverse settings, namely, intensive care unit, surgical ward, and acute in-patient psychiatric ward. First, problem trees are developed in order to determine the root causes of quality issues, specific to the three settings. Second, objective trees are formed suggesting solutions to the quality issues. Third, project plan template using logical framework (LOGFRAME) is created for each setting. Findings: This study shows substantial improvement in quality across the three settings. LFA proved to be effective to analyse quality issues and suggest improvement measures objectively. Research limitations/implications: This paper applies LFA in specific, albeit, diverse settings in one hospital. For validation purposes, it would be ideal to analyse in other settings within the same hospital, as well as in several hospitals. It also adopts a bottom-up approach when this can be triangulated with other sources of data. Practical implications: LFA enables top management to obtain an integrated view of performance. It also provides a basis for further quantitative research on quality management through the identification of key performance indicators and facilitates the development of a business case for improvement. Originality/value: LFA is a novel approach for the implementation of CQI programs. Although LFA has been used extensively for project development to source funds from development banks, its application in quality improvement within healthcare projects is scant.