Enhancing capacity for 'systematic' thinking in public health

The concept of being evidence based or evidence informed is widely acknowledged as an important component of decision-making. It is perhaps most universally referred to in medicine, however has extended into many other disciplines over the past decade, including public health. Evidence-based public health has been defined as the ‘conscientious, explicit and judicious use of current best evidence in making decisions about the care of communities and populations in the domain of health protection, disease prevention, health maintenance and improvement (health promotion)’.1 More recent literature favours the use of the term evidence informed over evidence based to acknowledge the varying influences on decisions in this complex field.2,3 Evidence-informed activities in any discipline require a specific set of skills in critical thinking. These skills include identifying the questions to be resolved, collecting relevant evidence, and assessing, synthesizing and distilling evidence in a way that can inform the set of activities to be undertaken as a result.

Predictive modelling : parents’ decision making to use online child health information to increase their understanding and/or diagnose or treat their child’s health

Abstract Background The quantum increases in home Internet access and available online health information with limited control over information quality highlight the necessity of exploring decision making processes in accessing and using online information, specifically in relation to children who do not make their health decisions. Objectives To understand the processes explaining parents’ decisions to use online health information for child health care. Methods Parents (N = 391) completed an initial questionnaire assessing the theory of planned behaviour constructs of attitude, subjective norm, and perceived behavioural control, as well as perceived risk, group norm, and additional demographic factors. Two months later, 187 parents completed a follow-up questionnaire assessing their decisions to use online information for their child’s health care, specifically to 1) diagnose and/or treat their child’s suspected medical condition/illness and 2) increase understanding about a diagnosis or treatment recommended by a health professional. Results Hierarchical multiple regression showed that, for both behaviours, attitude, subjective norm, perceived behavioural control, (less) perceived risk, group norm, and (non) medical background were the significant predictors of intention. For parents’ use of online child health information, for both behaviours, intention was the sole significant predictor of behaviour. The findings explain 77% of the variance in parents’ intention to treat/diagnose a child health problem and 74% of the variance in their intentions to increase their understanding about child health concerns. Conclusions Understanding parents’ socio-cognitive processes that guide their use of online information for child health care is important given the increase in Internet usage and the sometimes-questionable quality of health information provided online. Findings highlight parents’ thirst for information; there is an urgent need for health professionals to provide parents with evidence-based child health websites in addition to general population education on how to evaluate the quality of online health information.

Extending the explanatory utility of the EPPM beyond fear-based persuasion

In the 20 years since its inception, the EPPM has attracted much empirical support. Currently, and unsurprisingly given that is a model of fear-based persuasion, the EPPM’s explanatory utility has been based only upon fear-based messages. However, an argument is put forth herein, which draws upon existing evidence, that the EPPM may be an efficacious framework for explaining the persuasive process and outcomes of emotion-based messages more broadly when such messages are addressing serious health topics. For the current study, four different types of emotional appeals were purposefully devised and included a fear, an annoyance/agitation, a pride, and a humour-based message. All messages addressed the serious health issue of road safety, and in particular the risky behaviour of speeding. Participants (N = 551) were exposed to only one of the four messages and subsequently provided responses within a survey. A series of 2 (threat: low, high) x 2 (efficacy: low, high) analysis of variance was conducted for each of the appeals based on the EPPM’s message outcomes of acceptance and rejection. Support was found for the EPPM with a number of main effects of threat and efficacy emerging, reflecting that, irrespective of emotional appeal type, high levels of threat and efficacy enhanced message outcomes via maximising acceptance and minimising rejection. Theoretically, the findings provide support for the explanatory utility of the EPPM for emotion-based health messages more broadly. In an applied sense, the findings highlight the value of adopting the EPPM as a framework when devising and evaluating emotion-based health messages for serious health topics.

Inpatients had mostly negative experiences of seclusion during short term treatment in a mental health facility

Design Semi-structured interviews. Setting 2 open, acute care units of a large tertiary mental health facility in Queensland, Australia. Patients 12 patients (58% men) who were 18–52 years of age and were secluded in the previous 7 days (mean duration 3.4 h). Methods Semi-structured, thematically organised interviews were audiotaped and transcribed. Transcripts were checked for errors against the audiotaped versions and were analysed using the process of meaning categorisation. Themes were identified and coded to produce categories. All members of the research team agreed on the final categorisations. These broad categories were further analysed, and themes were used to reflect patients' experiences of seclusion. Main findings 5 recurrent themes emerged. (1) Patients described the use of seclusion. Some patients thought that seclusion was used inappropriately and that the seclusion period was of more benefit to …

Modal flexibility method for structural damage detection in suspension bridges

Suspension bridges meet the steadily growing demand for lighter and longer bridges in today’s infrastructure systems. These bridges are designed to have long life spans, but with age, their main cables and hangers could suffer from corrosion and fatigue. There is a need for a simple and reliable procedure to detect and locate such damage, so that appropriate retrofitting can be carried out to prevent bridge failure. Damage in a structure causes changes in its properties (mass, damping and stiffness) which in turn will cause changes in its vibration characteristics (natural frequencies, modal damping and mode shapes). Methods based on modal flexibility, which depends on both the natural frequencies and mode shapes, have the potential for damage detection. They have been applied successfully to beam and plate elements, trusses and simple structures in reinforced concrete and steel. However very limited applications for damage detection in suspension bridges have been identified to date. This paper examines the potential of modal flexibility methods for damage detection and localization of a suspension bridge under different damage scenarios in the main cables and hangers using numerical simulation techniques. Validated finite element model (FEM) of a suspension bridge is used to acquire mass normalized mode shape vectors and natural frequencies at intact and damaged states. Damage scenarios will be simulated in the validated FE models by varying stiffness of the damaged structural members. The capability of damage index based on modal flexibility to detect and locate damage is evaluated. Results confirm that modal flexibility based methods have the ability to successfully identify damage in suspension bridge main cables and hangers.

School nurses and partnerships for health education : team teaching in the secondary school curricula

The purpose of this research is to examine School Based Youth Health Nurses experience of partnerships for health education and team teaching. The School Based Youth Health Nurse Program is a contemporary model of school nursing in Queensland, Australia. The role of the School Based Youth Health Nurse consists of individual health consultations and health promotion. This research analyses a subset of qualitative data collected for a larger project about the experience of school based youth health nursing. The Health Promoting Schools model is used as a deductive framework. The findings reveal five subthemes across the three areas of the Health Promoting Schools approach. There are two subthemes within the curriculum, teaching and learning area; We were on the same page so to speak and I can go and do my reports or whatever. There are two sub-themes within the partnerships and services area; I had a beautiful science teacher who was just delightful and really just wanted to do things in partnerships and It’s all airy fairy arty farty stuff that’s not important. There is one theme in the school organisation, ethos and environment area; I just don’t know how well the top of these organisations communicate with the bottom of those organisations. Successful partnerships for health education and team teaching between school nurses and teachers are based on personal relationships based on rapport which lead to trust and reciprocity. Partnerships are limited by teachers understanding of the role of the school nurse and engagement with school nurses in the classroom. Administrative support from the top down is fundamental.

Conceptualising, evaluating and reporting social resilience in vulnerable regional and remote communities facing climate change in tropical Queensland : marine and tropical sciences research facility transition project final report

Regional and remote communities in tropical Queensland are among Australia’s most vulnerable in the face of climate change. At the same time, these socially and economically vulnerable regions house some of Australia’s most significant biodiversity values. Past approaches to terrestrial biodiversity management have focused on tackling biophysical interventions through the use of biophysical knowledge. An equally important focus should be placed on building regional-scale community resilience if some of the worst biodiversity impacts of climate change are to be avoided or mitigated. Despite its critical need, more systemic or holistic approaches to natural resource management have been rarely trialed and tested in a structured way. Currently, most strategic interventions in improving regional community resilience are ad hoc, not theory-based and short term. Past planning approaches have not been durable, nor have they been well informed by clear indicators. Research into indicators for community resilience has been poorly integrated within adaptive planning and management cycles. This project has aimed to resolve this problem by: * Reviewing the community and social resilience and adaptive planning literature to reconceptualise an improved framework for applying community resilience concepts; * Harvesting and extending work undertaken in MTSRF Phase 1 to identifying the learnings emerging from past MTSRF research; * Distilling these findings to identify new theoretical and practical approaches to the application of community resilience in natural resource use and management; * Reconsidering the potential interplay between a region’s biophysical and social planning processes, with a focus on exploring spatial tools to communicate climate change risk and its consequent environmental, economic and social impacts, and; * Trialling new approaches to indicator development and adaptive planning to improve community resilience, using a sub-regional pilot in the Wet Tropics. In doing so, we also looked at ways to improve the use and application of relevant spatial information. Our theoretical review drew upon the community development, psychology and emergency management literature to better frame the concept of community resilience relative to aligned concepts of social resilience, vulnerability and adaptive capacity. Firstly, we consider community resilience as a concept that can be considered at a range of scales (e.g. regional, locality, communities of interest, etc.). We also consider that overall resilience at higher scales will be influenced by resilience levels at lesser scales (inclusive of the resilience of constituent institutions, families and individuals). We illustrate that, at any scale, resilience and vulnerability are not necessarily polar opposites, and that some understanding of vulnerability is important in determining resilience. We position social resilience (a concept focused on the social characteristics of communities and individuals) as an important attribute of community resilience, but one that needs to be considered alongside economic, natural resource, capacity-based and governance attributes. The findings from the review of theory and MTSRF Phase 1 projects were synthesized and refined by the wider project team. Five predominant themes were distilled from this literature, research review and an expert analysis. They include the findings that: 1. Indicators have most value within an integrated and adaptive planning context, requiring an active co-research relationship between community resilience planners, managers and researchers if real change is to be secured; 2. Indicators of community resilience form the basis for planning for social assets and the resilience of social assets is directly related the longer term resilience of natural assets. This encourages and indeed requires the explicit development and integration of social planning within a broader natural resource planning and management framework; 3. Past indicator research and application has not provided a broad picture of the key attributes of community resilience and there have been many attempts to elicit lists of “perfect” indicators that may never be useful within the time and resource limitations of real world regional planning and management. We consider that modeling resilience for proactive planning and prediction purposes requires the consideration of simple but integrated clusters of attributes; 4. Depending on time and resources available for planning and management, the combined use of well suited indicators and/or other lesser “lines of evidence” is more flexible than the pursuit of perfect indicators, and that; 5. Index-based, collaborative and participatory approaches need to be applied to the development, refinement and reporting of indicators over longer time frames. We trialed the practical application of these concepts via the establishment of a collaborative regional alliance of planners and managers involved in the development of climate change adaptation strategies across tropical Queensland (the Gulf, Wet Tropics, Cape York and Torres Strait sub-regions). A focus on the Wet Tropics as a pilot sub-region enabled other Far North Queensland sub-region’s to participate and explore the potential extension of this approach. The pilot activities included: * Further exploring ways to innovatively communicate the region’s likely climate change scenarios and possible environmental, economic and social impacts. We particularly looked at using spatial tools to overlay climate change risks to geographic communities and social vulnerabilities within those communities; * Developing a cohesive first pass of a State of the Region-style approach to reporting community resilience, inclusive of regional economic viability, community vitality, capacitybased and governance attributes. This framework integrated a literature review, expert (academic and community) and alliance-based contributions; and * Early consideration of critical strategies that need to be included in unfolding regional planning activities with Far North Queensland. The pilot assessment finds that rural, indigenous and some urban populations in the Wet Tropics are highly vulnerable and sensitive to climate change and may require substantial support to adapt and become more resilient. This assessment finds that under current conditions (i.e. if significant adaptation actions are not taken) the Wet Tropics as a whole may be seriously impacted by the most significant features of climate change and extreme climatic events. Without early and substantive action, this could result in declining social and economic wellbeing and natural resource health. Of the four attributes we consider important to understanding community resilience, the Wet Tropics region is particularly vulnerable in two areas; specifically its economic vitality and knowledge, aspirations and capacity. The third and fourth attributes, community vitality and institutional governance are relatively resilient but are vulnerable in some key respects. In regard to all four of these attributes, however, there is some emerging capacity to manage the possible shocks that may be associated with the impacts of climate change and extreme climatic events. This capacity needs to be carefully fostered and further developed to achieve broader community resilience outcomes. There is an immediate need to build individual, household, community and sectoral resilience across all four attribute groups to enable populations and communities in the Wet Tropics region to adapt in the face of climate change. Preliminary strategies of importance to improve regional community resilience have been identified. These emerging strategies also have been integrated into the emerging Regional Development Australia Roadmap, and this will ensure that effective implementation will be progressed and coordinated. They will also inform emerging strategy development to secure implementation of the FNQ 2031 Regional Plan. Of most significance in our view, this project has taken a co-research approach from the outset with explicit and direct importance and influence within the region’s formal planning and management arrangements. As such, the research: * Now forms the foundations of the first attempt at “Social Asset” planning within the Wet Tropics Regional NRM Plan review; * Is assisting Local government at regional scale to consider aspects of climate change adaptation in emerging planning scheme/community planning processes; * Has partnered the State government (via the Department of Infrastructure and Planning and Regional Managers Coordination Network Chair) in progressing the Climate Change adaptation agenda set down within the FNQ 2031 Regional Plan; * Is informing new approaches to report on community resilience within the GBRMPA Outlook reporting framework; and * Now forms the foundation for the region’s wider climate change adaptation priorities in the Regional Roadmap developed by Regional Development Australia. Through the auspices of Regional Development Australia, the outcomes of the research will now inform emerging negotiations concerning a wider package of climate change adaptation priorities with State and Federal governments. Next stage research priorities are also being developed to enable an ongoing alliance between researchers and the region’s climate change response.

Small firms and health and safety harmonisation : potential regulatory effects of a dominant narrative

Small firms are popularly viewed as resistant to complying with regulation. Harmonisation of Australia’s state-based work health and safety regimes is a significant regulatory change. In this article, we consider the likely responses of small firms to work health and safety harmonisation and argue that a range of choices are open to small firm owner-managers. These choices are shaped by individuals’ world views and are influenced by elements in the firms’ context. A significant element is the public narrative of work health and safety harmonisation, which can be understood by using discourse and sense-making concepts. Our analysis of small firm owner-manager choices takes into account small firms’ embeddedness in their regulatory context and the influence on organisational decision-making of the narrative of work health and safety harmonisation. The dominant narrative is arguably silent on the benefits of the work health and safety regulatory change and therefore the response of small firms is likely to be avoidance or minimalism. Non-compliance could be the result due to poor awareness of opportunities arising from this regulatory change.

Economic evaluation of adolescent reproductive health education interventions in Chilinh, Vietnam

This research was an economic analysis of two novel health education interventions compared to existing practice for reproductive health among young people in northern Vietnam. The research showed that implementing an educational intervention including school-based and health facility-based components was cost effective for males and females. The findings will assist decision makers in efficient allocation of scarce resources for adolescent health promotion in Vietnam and similar socio-economic contexts in Asia.

Superpixel-based appearance change prediction for long-term navigation across seasons

Changing environments pose a serious problem to current robotic systems aiming at long term operation under varying seasons or local weather conditions. This paper is built on our previous work where we propose to learn to predict the changes in an environment. Our key insight is that the occurring scene changes are in part systematic, repeatable and therefore predictable. The goal of our work is to support existing approaches to place recognition by learning how the visual appearance of an environment changes over time and by using this learned knowledge to predict its appearance under different environmental conditions. We describe the general idea of appearance change prediction (ACP) and investigate properties of our novel implementation based on vocabularies of superpixels (SP-ACP). Our previous work showed that the proposed approach significantly improves the performance of SeqSLAM and BRIEF-Gist for place recognition on a subset of the Nordland dataset under extremely different environmental conditions in summer and winter. This paper deepens the understanding of the proposed SP-ACP system and evaluates the influence of its parameters. We present the results of a large-scale experiment on the complete 10 h Nordland dataset and appearance change predictions between different combinations of seasons.

Past, present and the evolving future of public health and health promotion: Reflections on dismantling in Queensland Australia

Objective For more than ten years the public health and health promotion workforce in the Australian state of Queensland grew dramatically. This growth was most pronounced in the disciplines of Health Promotion and in Public Health Nutrition, both regionally and corporately. In 2012 political change led to an abrupt dismantling of its public and preventive health services across the state. Individual responsibility was declared. Method This presentation provides a qualitative narrative description of past achievements and activities, the current situation and provides a perspective towards the future. Findings Government reports over several years described the growing burden of chronic disease arising from conditions such as obesity, physical inactivity, and poor nutrition in Queensland. By 2008, obesity had overtaken smoking as the single greatest risk factor to the health of Queenslanders. In 2010, the Chief Health Officer called for an increased focus on prevention to address the continuing need for more beds in hospitals. However, with political change in 2012 resulted in the dismantling and dismissal of preventive health services across the state. The following year, despite outcry, sexual health services were also axed. At present, outbreaks of vaccine preventable diseases such as measles are occurring. The epidemics of chronic disease, obesity and physical inactivity continue to grow. Conclusion The evolution of public health is not necessarily progressive, but cyclic. Challenges include political change, health practice and the interplay of health policy. A lack of an embedded emphasis on systematic review translation is one potential contributor. Perhaps the warning of Lang & Rayner should be heeded: “public health proponents have allowed themselves to be corralled into the narrow language of individualism and choice”.

Use of modal flexibility method to detect damage in suspended cables and the effects of cable parameters

Modal flexibility is a widely accepted technique to detect structural damage using vibration characteristics. Its application to detect damage in long span large diameter cables such as those used in suspension bridge main cables has not received much attention. This paper uses the modal flexibility method incorporating two damage indices (DIs) based on lateral and vertical modes to localize damage in such cables. The competency of those DIs in damage detection is tested by the numerically obtained vibration characteristics of a suspended cable in both intact and damaged states. Three single damage cases and one multiple damage case are considered. The impact of random measurement noise in the modal data on the damage localization capability of these two DIs is next examined. Long span large diameter cables are characterized by the two critical cable parameters named bending stiffness and sag-extensibility. The influence of these parameters in the damage localization capability of the two DIs is evaluated by a parametric study with two single damage cases. Results confirm that the damage index based on lateral vibration modes has the ability to successfully detect and locate damage in suspended cables with 5% noise in modal data for a range of cable parameters. This simple approach therefore can be extended for timely damage detection in cables of suspension bridges and thereby enhance their service during their life spans.

Contribution of psychosocial factors to the association between socioeconomic position and takeaway food consumption

Objective To examine whether psychosocial factors mediate (explain) the association between socioeconomic position and takeaway food consumption. Design A cross-sectional postal survey conducted in 2009. Setting Participants reported their usual consumption of 22 takeaway food items, and these were grouped into a “healthy” and “less healthy” index based on each items' nutritional properties. Principal Components Analysis was used to derive three psychosocial scales that measured beliefs about the relationship between diet and health (α = 0.73), and perceptions about the value (α = 0.79) and pleasure (α = 0.61) of takeaway food. A nutrition knowledge index was also used. Socioeconomic position was measured by highest attained education level. Subjects Randomly selected adults (n = 1,500) aged between 25–64 years in Brisbane, Australia (response rate  =  63.7%, N = 903). Results Compared with those with a bachelor degree or higher, participants with a diploma level of education were more likely to consume “healthy” takeaway food (p = 0.023) whereas the least educated (high school only) were more likely to consume “less healthy” choices (p = 0.002). The least educated were less likely to believe in a relationship between diet and health (p<0.001), and more likely to have lower nutritional knowledge compared with their highly educated counterparts (p<0.001). Education differences in beliefs about the relationship between diet and health partly and significantly mediated the association between education and “healthy” takeaway food consumption. Diet- and health-related beliefs and nutritional knowledge partly and significantly mediated the education differences in “less healthy” takeaway food consumption. Conclusions Interventions that target beliefs about the relationship between diet and health, and nutritional knowledge may reduce socioeconomic differences in takeaway food consumption, particularly for “less healthy” options.

IQAFAL - Índice Fuzzy de Qualidade de Água para Ambiente Lótico.

A divulgação de informação sobre qualidade das águas para um público não especialista é fundamental para subsidiar ações políticas e institucionais de gestão dos ambientes aquáticos. Para tanto, índices de qualidade de água têm sido propostos por serem capazes de sintetizar em um único valor ou categoria a informação normalmente descrita a partir de um conjunto extenso de variáveis químicas, físicas e biológicas de qualidade de água. A maioria das metodologias propostas para o desenvolvimento de índices de qualidade de água é baseada no conhecimento de especialistas quanto à escolha das variáveis a serem utilizadas, a ponderação da importância relativa de cada variável e métodos utilizados para agregar os dados das variáveis em um único valor. Este trabalho propõe um novo índice de qualidade de água, baseado em lógica nebulosa e direcionado para o ambiente lótico. Esse índice, o IQAFAL, foi desenvolvido com a colaboração de especialistas com ampla e comprovada experiência na área de qualidade de água. A essência do desenvolvimento de um índice, usando-se lógica nebulosa, está na capacidade dessa metodologia representar, de forma mais eficiente e clara, os limites dos intervalos de variação dos parâmetros de qualidade de água para um conjunto de categorias subjetivas, quando esses limites não são bem definidos ou são imprecisos. O índice proposto neste trabalho foi desenvolvido com base no conhecimento dos especialistas em qualidade de água do Instituto Estadual do Ambiente - INEA e aplicado aos dados de qualidade de água do Rio Paraíba do Sul, obtidos pelo INEA, nos anos de 2002 a 2009. Os resultados do IQAFAL mostraram que esse índice foi capaz de sintetizar a qualidade da água deste trecho do Rio Paraíba do Sul correspondendo satisfatoriamente às avaliações de qualidade de água descritas nos relatórios disponíveis. Verificou-se também que com essa metodologia foi possível evitar que a influência de uma variável em condições críticas fosse atenuada pela influência das outras variáveis em condições favoráveis produzindo um resultado indesejável no índice final.

Índice de saúde social do adolescente baseado em lógica nebulosa.

Este trabalho consiste de uma análise exploratória sobre municípios do Sudeste com população acima de 100mil habitantes abordando dois problemas: a violência e a educação. Na violência abordaremos índices de homicídios na adolescência trabalhando com a faixa de adolescentes de 12 a 18 anos. Na educação trabalharemos com o Índice de Desenvolvimento Educacionail Brasileiro referenciado ao último ano do ensino fundamental. Trabalhando com os indicadores citados, abordaremos esses problemas gerando um Índice de Saúde social do Adolescente utilizando a lógica Fuzzy, conjunto nebuloso. Classificando os municípios do Sudeste visando identificar municípios com qualidade de vida melhor para esses adolescentes, expectativa de vida e melhoria na educação. Baixos índices de homicídios e altos índices educacionais desenvolvendo uma ferramenta útil para auxiliar na tomada de decisões no tocante a políticas públicas nos Municípios e Estados gerando um indicador de municípios com qualidade de vida para os adolescentes! Trabalhamos com dados do ano de 2007 tanto para o homicídio quanto para a educação, os valores apresentados nos índices foram divididos em quintis, processados via o software MATLAB utilizando lógica nebulosa (fuzzy), classificados e apresentados nas formas de valores alfanuméricos em tabelas espaciais com o software Quantum Gis através de mapas temáticos das regiões estudadas.