Government food service policies and guidelines do not create healthy school canteens

Objective
In 2006, the Victorian Government adopted the School Canteens and other school Food Services (SCFS) Policy that bans the sale of sweet drinks and confectionary and recommends the proportions of menu items based on a traffic light system of food classification. This study aims to determine whether compliance with the policy improves the nutritional profile of the menus.
Methods
Items from food service menus were assessed for compliance with the SCFS policy and categorised as ‘everyday’ (‘green’), ‘select carefully’ (‘amber’) or ‘occasionally’ (‘red’) (n=106). Profile analysis assessed differences in the nutritional profile of the menus between sub-groups.
Results
Overall, 37% of menus contained items banned under the policy. The largest proportion of items on the assessed menus were from the ‘amber’ category (mean: 51.0%), followed by ‘red’ (29.3%) and ‘green’ (20.3%). No menus met the traffic light-based recommendations and there was no relationship between policy compliance and the proportion of items in each of the three categories.
Conclusions and implications
To increase the healthiness of the school food service we recommend a greater investment in resources and infrastructure to implement existing policies, and establishing stronger monitoring and support systems.

The international construction student: a missed opportunity?

Australian universities now have a more diverse undergraduate student population in construction degrees than at any other time in their history. The linguistic, ethnic and indigenous diversity of the Australian university student population has never been richer and this is reflected in construction classrooms. Wider participation rates of domestic students combined with the internationalisation and globalisation of higher education has resulted in a student population of identifiable sub-groups that were significantly under-represented or not represented at all in previous decades. This changing student cohort and the inherent pressures and challenges arising from this changing population is the subject of considerable discussion within the Australian tertiary sector. The extent to which Australian universities and the construction degree educators have responded to these pressures is under scrutiny. This paper argues that the climate, culture and curriculum of higher education within construction schools in Australia has not reflected this diversity and that rather than accommodate and embrace the effects of internationalisation Australian university construction schools may have missed a vital opportunity to be part of a global learning network.

Estimating the impact of mandatory folic acid fortification on the folic acid intake of Australian women of childbearing age

Objective: The primary aim of this study was to estimate the impact of mandatory folic acid (FA) fortification of bread-making flour on the FA intake of Australian women of childbearing age (16-44 years). The secondary objective was to investigate the relationship between estimated FA intake and socio-economic status (SES) and age.

Method: Dietary modelling was used to estimate FA intake under four mandatory fortification scenarios – no supplement use, supplement use unrelated to FA intake, supplement use only among the highest consumers of bread, and increased supplement use. Data were obtained from the 1995 National Nutrition Survey for food intake patterns, the 2007 Victorian Population Health Survey for FA supplement use, and a marketplace survey.

Results: It is estimated that the National Health and Medical Research Council (NHMRC) recommendation for an additional 400 mg/day FA will be achieved by a minimum of 3.9, 25.4, 21.7 and 30% of the target population under scenarios 1-4, respectively. The FA upper level of intake is exceeded by a maximum of 0.1, 1.7, 6.1 and 4.1% of the target population for scenarios 1-4, respectively.

Conclusions: Mandatory FA fortification is not sufficient for the NHMRC recommendations for minimum and maximum intakes to be met by all of the target population under a number of plausible behaviour scenarios.

Implications: Targeted nutrition education campaigns are needed for SES and age sub-groups and research of this nature should be extended to other population groups. Monitoring and evaluation of this policy will be important to ensure appropriate FA intake.

Short-term food deprivation before a fish oil finishing strategy improves the deposition of n-3 LC-PUFA, but not the washing-out of C18 PUFA in rainbow trout

This study aimed to test the hypothesis that the efficiency of a finishing period can be improved by reducing the initial fat content of fish fillets, by means of a period of food deprivation. Two groups of rainbow trout (Oncorhynchus mykiss) were fed for an 18-week grow-out period on a vegetable oil-based diet (VO) or a fish oil-based diet (FO). VO fed fish were then split into two sub groups: one (VO/FO) was shifted to the FO diet for 8 weeks, whilst the other (UF/FO) was deprived of food (unfed) for 2 weeks and then fed the FO diet for the remaining 6 weeks. The control treatment (FO/FO) was represented by fish continuously fed FO. The subsequent reduction of total fat in the UF/FO treatment was then responsible for a much faster recovery towards a FO-like fatty acid profile, validating the proposed hypothesis. However, the modification of the fatty acid composition of fish fillets during the feed withholding period, coupled with the postponement of the finishing diet, resulted in only minor beneficial effects of this strategy, and the loss of potential weight gain. However, the n-3 LC-PUFA content in UF/VO fish fillets was significantly higher than fish subjected to the VO/FO treatment.

Acceptability of a theory of planned behaviour email-based nutrition intervention

This study investigated feasibility and acceptability of a new email-delivered intervention promoting fruit and vegetable consumption in a university-based population of Australian young adults. The study explored whether there are differences in the reported feasibility and acceptability between demographic groups within the population of interest and at three levels of intervention intensity. The email-delivered intervention program consists of an implementation intention ‘planning task’ and between 3 and 15 short email messages over a 15-day study period. The intervention program was developed using the Theory of Planned Behaviour and was designed to modify perceived behavioural control. One hundred and ten participants (mean age = 19.21 years, 25.6% male) completed the feasibility and acceptability questionnaire at Day 15. This questionnaire contained items about all intervention components. High acceptability and feasibility scores were found for all intervention parts and at all levels of intervention intensity. There were few significant differences in the reported acceptability of items between key demographic sub-groups, and no differences in reported acceptability at different levels of intervention intensity. These results suggest that this email-delivered intervention is an acceptable and feasible tool for promoting fruit and vegetable consumption for participants in the target population.

A new framework for interpreting the outcomes of imperfectly blinded controlled clinical trials

It is well known that the outcome of an intervention is affected both by the inherent effects of the intervention and the patient's expectations. For this reason in comparative clinical trials an effort is made to conceal the nature of the administered intervention from the participants in the trial i.e. to blind the trial. Yet, in practice perfect blinding is impossible to ensure or even verify post hoc. The current clinical standard is to follow up the trial with an auxiliary questionnaire, which allows trial participants to express in closed form their belief concerning the intervention, i.e. trial group assignment (treatment or control). Auxiliary questionnaire responses are then used to compute the extent of blinding in the trial in the form of a blinding index. If the estimated extent of blinding exceeds a particular threshold the trial is deemed sufficiently blinded; otherwise, the strength of evidence of the trial is brought into question. This may necessitate that the trial is repeated. In this paper we make several contributions. Firstly, we identify a series of problems of the aforesaid clinical practice and discuss them in context of the most commonly used blinding indexes. Secondly, we formulate a novel approach for handling imperfectly blinded trials. We adopt a feedback questionnaire of the same form as that which is currently in use, but interpret the collected data using a novel statistical method, significantly different from that proposed in the previous work. Unlike the previously proposed approaches, our method is void of any ad hoc free parameters and robust to small changes in the participants' feedback responses. Our method also does not discard any data and is not predicated on any strong assumptions used to interpret participants' feedback. The key idea behind the present method is that it is meaningful to compare only the corresponding treatment and control participant sub-groups, that is, sub-groups matched by their auxiliary responses. A series of experiments on simulated trials is used to demonstrate the effectiveness of the proposed approach and its superiority over those currently in use.

Acceptability of a theory of planned behaviour email-based nutrition intervention

This study investigated feasibility and acceptability of a new email-delivered intervention promoting fruit and vegetable consumption in a university-based population of Australian young adults. The study explored whether there are differences in the reported feasibility and acceptability between demographic groups within the population of interest and at three levels of intervention intensity. The email-delivered intervention program consists of an implementation intention ‘planning task’ and between 3 and 15 short email messages over a 15-day study period. The intervention program was developed using the Theory of Planned Behaviour and was designed to modify perceived behavioural control. One hundred and ten participants (mean age = 19.21 years, 25.6% male) completed the feasibility and acceptability questionnaire at Day 15. This questionnaire contained items about all intervention components. High acceptability and feasibility scores were found for all intervention parts and at all levels of intervention intensity. There were few significant differences in the reported acceptability of items between key demographic sub-groups, and no differences in reported acceptability at different levels of intervention intensity. These results suggest that this email-delivered intervention is an acceptable and feasible tool for promoting fruit and vegetable consumption for participants in the target population.

Community languages, linguistic isolation and social exclusion in the Australian context

The detrimental impacts of social exclusion to health and well-being are well-known and are of increasing concern around the world. For many of the population sub-groups who are most at risk of social exclusion, linguistic isolation—the inability to use and understand the majority language—is a major barrier to full participation in the life of the community as well as to full integration into the society in which its members live. This paper, using data obtained from community-based research in Melbourne, Australia, will discuss the problem of linguistic isolation in the context of Australian multicultural policy and use of languages other than English among members of culturally and linguistically diverse (CALD) communities. The experience of members of two specific CALD communities, speakers of Arabic and speakers of Indonesian, will be discussed to illustrate the impacts of linguistic isolation on health and well-being and to elucidate the relationship between CALD status and social exclusion in these communities.

A realist review of interventions and strategies to promote evidence-informed healthcare: a focus on change agency

Background
Change agency in its various forms is one intervention aimed at improving the effectiveness of the uptake of evidence. Facilitators, knowledge brokers and opinion leaders are examples of change agency strategies used to promote knowledge utilization. This review adopts a realist approach and addresses the following question: What change agency characteristics work, for whom do they work, in what circumstances and why?

Methods
The literature reviewed spanned the period 1997-2007. Change agency was operationalized as roles that are aimed at effecting successful change in individuals and organizations. A theoretical framework, developed through stakeholder consultation formed the basis for a search for relevant literature. Team members, working in sub groups, independently themed the data and developed chains of inference to form a series of hypotheses regarding change agency and the role of change agency in knowledge use.

Results
24, 478 electronic references were initially returned from search strategies. Preliminary screening of the article titles reduced the list of potentially relevant papers to 196. A review of full document versions of potentially relevant papers resulted in a final list of 52 papers. The findings add to the knowledge of change agency as they raise issues pertaining to how change agents’ function, how individual change agent characteristics effect evidence-informed health care, the influence of interaction between the change agent and the setting and the overall effect of change agency on knowledge utilization. Particular issues are raised such as how accessibility of the change agent, their cultural compatibility and their attitude mediate overall effectiveness. Findings also indicate the importance of promoting reflection on practice and role modeling. The findings of this study are limited by the complexity and diversity of the change agency literature, poor indexing of literature and a lack of theory-driven approaches.

Conclusion
This is the first realist review of change agency. Though effectiveness evidence is weak, change agent roles are evolving, as is the literature, which requires more detailed description of interventions, outcomes measures, the context, intensity, and levels at which interventions are implemented in order to understand how change agent interventions effect evidence-informed health care.

The impact of knowledge and attitudes on access to eye-care services in Cambodia

Purpose: To investigate how knowledge and attitudes influence the access to eye-care services in Takeo Province, Cambodia.

Design: A cross-sectional survey (n=600).

Methods: 30 villages were randomly selected. Groups included: >50 years, 30–49 years, and parents with children <5 years. A newly developed Knowledge, Attitude and Practice in Eye Health (KAP-EH) questionnaire about knowledge and treatment of eye diseases, practices and attitudes to accessing services was used to interview respondents. Descriptive analysis, including Chi square and logistic regression tested for associations with sub-groups of gender, age group, education and self-reported type of disability.

Results: The proportion of respondents who reported having knowledge of specific eye conditions ranged from 97% for eye injury, to 8% for diabetic eye disease. While 509 (85%) people reported knowledge of cataract, 47% did not know how cataract was treated and only 19% listed surgery. The older group (66.5%) were least informed about cataract (p= 0.001) compared to other groups, and were least likely to believe that some blindness could be prevented (p < 0.001). Women (55%) were more likely than men (46%) (p=0 .003) to report that a child with blindness could attend school, as did people without a disability compared to those with a disability (58% vs 34%) (p < 0.001).

Conclusions: The knowledge about cataract and refractive error and what to do to resolve the problems was low among this population and this study suggests that poor knowledge of eye diseases might contribute to the occurrence of un-operated cataract and uncorrected refractive error.

Intervention efficacy among 'At Risk' adolescents: a test of subjective wellbeing homeostasis theory

 This study tests a number of theoretical predictions based on subjective wellbeing (SWB) Homeostasis Theory. This theory proposes that SWB is actively maintained and defended within a narrow, positive range of values around a 'set-point' for each person. Due to homeostatic control, it is predicted to be very difficult to substantially increase SWB in samples operating normally within their set-point-range. However, under conditions of homeostatic defeat, where SWB is lower than normal, successful interventions should be accompanied by a substantial increase as each person's SWB returns to lie within its normal range of values. This study tests these propositions using a sample of 4,243 participants in an Australian Federal Government Program for 'at-risk' adolescents. SWB was measured using the Personal Wellbeing Index and results are converted to a metric ranging from 0 to 100 points. The sample was divided into three sub-groups as 0-50, 51-69, and 70+ points. The theoretical prediction was confirmed. The largest post-intervention increase in SWB was in the 0-50 group and lowest in the 70+ group. However, a small increase in SWB was observed in the normal group, which was significant due to the large sample size. The implications of these findings for governments, schools and policy makers are discussed.

Gambling motives: application of the reasons for gambling questionnaire in an Australian population survey

The Reasons for Gambling Questionnaire (RGQ) consist of 15 items forming five factors: enhancement, social, money, recreation and coping. The RGQ was developed for use in the 2010 British Gambling Prevalence Survey (BGPS) and has now been employed in the second Social and Economic Impact Study (SEIS) of Gambling in Tasmania study conducted in 2011 in Australia. Given differences between Britain and Australia in terms of socio-demographic profiles, gambling cultures and attitudes, gambling access and availability, gambling regulation, and rates and patterns of gambling participation, the aims of this study were to analyse the RGQ data from the SEIS to: (1) determine the most commonly endorsed gambling motives in an Australian jurisdiction, (2) explore the factor structure of the RGQ in an Australian sample, and (3) explore how motives for gambling vary among different Australian population sub-groups. A representative sample of the Tasmanian population who had gambled in the previous 12 months (n = 2,796) were administered the RGQ via computer-assisted telephone interviewing. The five most commonly endorsed reasons for gambling were for fun (62 %), followed by the chance of winning big money (52 %), it being something to do with friends and family (48 %), to be sociable (40 %), and excitement (38 %). A principal component analysis revealed a five-factor structure that is slightly different from that derived in the BGPS: money, regulate internal state, positive feelings, social, and challenge reasons. Finally, gambling motives varied according to socio-demographic factors, number of gambling activities, problem gambling severity, and participation on different gambling activities. Although some of these findings are consistent with those from the BGPS, there are also some slight differences, suggesting that there may be regional-specific variations in gambling motives.

Depression, anxiety and self-care behaviours of young adults with Type 2 diabetes: results from the International Diabetes Management and Impact for Long-term Empowerment and Success (MILES) Study.

Young adults with Type 2 diabetes have higher physical morbidity and mortality than other diabetes sub-groups, but differences in psychosocial outcomes have not yet been investigated. We sought to compare depression and anxiety symptoms and self-care behaviours of young adults with Type 2 diabetes with two matched control groups.

The effect of surgical timing on the outcome of patients with neck of femur fracture

Aims: To investigate the effect of surgical timing (in hours versus after hours and weekdays versus weekends) on the outcome of patients with neck of femur fracture. Methods: Patients who were admitted to a single tertiary referral hospital for surgical management of femoral neck fractures over a continuous period from 1/11/2002 to 12/7/2012 were identified from medical records and the operating theatre database. Results: A consecutive series of 2334 patients were included in the study. Of the patients who underwent surgery during the weekday and during usual hours, 18 % (207/1135) experienced an adverse event, compared to 16 % (193/1199) outside of these times. The difference between the two groups was not significant (p = 0.17). The same conclusion was made for the comparison between those who had surgery during the week with those who had surgery on the weekend (17 %, 267/1546 and 17 %, 133/788, respectively, p > 0.05). The proportion of patients who underwent surgery during hours that experienced an adverse event was significantly higher than those undergoing surgery out of hours (18 %, 327/1789 and 13 %, 73/545, respectively, p = 0.0081). When adjusted for age, ASA score and pre-operative stay, there was no statistical difference between those different sub-groups. Conclusions: There was no difference in the rates of adverse events between patients who had surgery during hours and weekdays with those who had surgery after hours or weekends. The careful selection of patients with appropriate hospital staff, resources and adequate theatre access, surgery during after hours and weekends may be safely considered to prevent a delay in surgical treatment for patient with neck of femur fracture.

Sports betting marketing during sporting events: a stadium and broadcast census of Australian Football League matches

OBJECTIVE: Using Australian Football League (AFL) matches as a case study, we investigated the frequency, length and content of marketing strategies for sports betting during two specific settings: 1) at stadiums during four live matches; and 2) during eight televised broadcasts of matches. METHODS: Census of sports betting marketing during Round 12 of the 2011 AFL premiership season. RESULTS: Per match, there was an average of 58.5 episodes (median 49.5, s.d 27.8) and 341.1 minutes (median 324.1 minutes and s.d 44.5) of sports betting marketing at stadiums, and 50.5 episodes (median 53.5, s.d 45.2) and 4.8 minutes (median 5.0 minutes, s.d 4.0) during televised broadcasts. A diverse range of marketing techniques were used to: a) embed sports betting within the game; b) align sports betting with fans' overall experience of the game; and c) encourage individuals to bet live during the game. There were very few visible or audible messages (such as responsible gambling or Gambler's Help messages) to counter-frame the overwhelmingly positive messages that individuals received about sports betting during the match. CONCLUSIONS AND IMPLICATIONS: This study raises important questions about the impacts of saturation, integrated and impulse gambling marketing strategies in sporting matches. Future research should explore: 1) how wagering industry marketing strategies may affect the attitudes and behaviours of community sub-groups (e.g. young male sports fans, and children); and 2) which public health and policy strategies, including regulation and harm minimisation messaging, will be effective in responding to wagering industry marketing strategies during sporting matches.