http://nova.newcastle.edu.au/vital/access/services/Feed ${session.getAttribute("locale")} 5 http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:11316 Cancer survivors may benefit from lifestyle interventions which can mitigate their increased risk of other health problems after a diagnosis of cancer, including heart disease, diabetes and functional impairment. There is emerging evidence that weight management and physical activity will positively impact on key outcomes measures for cancer survivors; including quality of life, cancer recurrence and survival rates. Although dietary supplement use is very common among cancer survivors, there are very few studies documenting the effect nutritional supplements have on cancer recurrence and survival. Overall, lifestyle interventions have the potential to improve the health and wellbeing of cancer survivors, in particular for women with breast cancer. Key recommendations for cancer survivors include: maintaining a healthy body weight; being physically active; eating more vegetables and fruit; and limiting or avoiding alcohol consumption. These recommendations are consistent with evidence-based advice on reducing the risk of cancer and with national dietary recommendations to promote general health and need to be considered in the context of a cancer survivor's individual health and social circumstances. Further research is required to determine the efficacy and effectiveness of specific lifestyle interventions designed for breast cancer survivors, as well as for survivors of other forms of cancer. 2012-08-22T01:10:06.924Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:11307 This review of the epidemiological evidence for diet and physical activity and the risk of cancer primarily summarises the recommendations of the World Cancer Research Fund (WCRF) and the American Institute of Cancer Research (AICR). Recommendations include the topics of: body fatness, plant foods, animal foods, alcoholic drinks, dietary supplements, and physical activity. For each of these recommendations we review the level of evidence used to determine the final recommendations, discuss potential limitations of dietary and physical activity measures, and review the study designs that underpin the existing evidence base. In addition, we briefly describe the biological mechanisms underlying the hypotheses around diet and physical activity and cancer and finally we describe more recent research published since the release of the WCRF I AICR recommendations. There is "convincing" or "probable" evidence of the positive relationship between cancer and: body and abdominal fatness; alcohol; red and processed meats; and high-dose beta-carotene supplements. There is "convincing" or "probable" evidence of a protective effect of consumption of fruit and vegetables; calcium and selenium; and physical activity on cancer risk. Lifestyle modification has the potential to result in a substantial reduction in cancer incidence. If this potential is to be realised, policies and programmes that modify behavioural and environmental factors are required. 2012-08-22T00:40:04.575Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:11154 We test the hypothesis that the odds of self-reported receipt of lifestyle advice from a health care provider will be lower among outpatient cardiac rehabilitation (OCR) nonattendees and nonreferred patients compared to OCR attendees. Logistic regression was used to analyse cross-sectional data provided by 65% (4971/7678) of patients aged 20 to 84 years discharged from public hospitals with a diagnosis indicating eligibility for OCR between 2002 and 2007. Among respondents, 71% (3518) and 55% (2724) recalled advice regarding physical activity and diet, respectively, while 88% (592/674) of smokers recalled quit advice. OCR attendance was low: 36% (1764) of respondents reported attending OCR, 11% (552) did not attend following referral, and 45% (2217) did not recall being invited. The odds of recalling advice regarding physical activity and diet were significantly lower among OCR nonattendees compared to attendees (OR 0.34, 95% CI 0.21, 0.56 and OR 0.33, 95% CI 0.25, 0.44, resp.) and among nonreferred respondents compared to OCR attendees (OR 0.10, 95% CI 0.07, 0.15 and OR 0.17, 95% CI 0.14, 0.22, resp.). Patients hospitalised for coronary heart disease should be referred to OCR or a suitable alternative to improve recall of lifestyle advice that will reduce the risk of further coronary events. 2012-07-31T01:23:51.428Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:10256 Objective: This paper aims to examine whether university human research ethics committees (HRECs) proactively seek to protect members of the research team as well as study subjects in their written documentation. Methods: A content analysis of 37 Australian university HREC application forms and attachments was undertaken. Each form was allocated to one of four predetermined categories. Results: Of the 37 forms, only three included an explicit request for the applicant to reflect on all possible aspects of safety of the researchers (physical, psychological and emotional). Conclusion: Few HRECs have taken issues of possible harm to researchers into account in their documentation. It is recommended that HRECs explicitly recognise potential risks to researchers, especially those engaged in exploration of sensitive topics, in their processes of approving human research. It is also recommended that researchers consider the possible implications of undertaking this type of research and ensure strategies are in place to minimise these risks. 2012-02-29T01:00:03.727Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:10253 Urban-rural health inequalities are linked to socioeconomic disadvantage and inequitable access to health services. In most empirical rural health research, transport availability is not considered an integral component of access for the non-metropolitan elderly population. This study examined the proportion of people aged over 65 years in the Loddon Mallee Region (LMR) of Victoria who had access to public transport according to census collection districts (COs). Using Australian Bureau of Statistics (ABS) census data, COs were mapped and identified as having access to public transport if a bus or train stop was situated within the CD boundaries. COs were classified according to the Accessibility Remoteness Index of Australia (ARIA) to determine whether there was a relationship between ARIA rating and access to public transport services. The results indicate that approximately 50% of people over 65 years do not have access to public transport. The people living in a CD with a more remote ARIA classification were less likely to have access to public transport. These results have implications for transport policy especially given the predictions of ageing rural population growth. 2012-02-29T00:30:04.339Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:10037 Background: Clinical pathways are structured multidisciplinary care plans used by health services to detail essential steps in the care of patients with a specific clinical problem. They aim to link evidence to practice and optimise clinical outcomes whilst maximising clinical efficiency. Objectives: To assess the effect of clinical pathways on professional practice, patient outcomes, length of stay and hospital costs. Search strategy: We searched the Database of Abstracts of Reviews of Effectiveness (DARE), the Effective Practice and Organisation of Care (EPOC) Register, theCochraneCentral Register ofControlledTrials (CENTRAL) and bibliographic databases including MEDLINE, EMBASE, CINAHL, NHS EED and Global Health. We also searched the reference lists of relevant articles and contacted relevant professional organisations. Selection criteria: Randomised controlled trials, controlled clinical trials, controlled before and after studies and interrupted time series studies comparing stand alone clinical pathways with usual care as well as clinical pathways as part of a multifaceted intervention with usual care. Data collection and analysis: Two review authors independently screened all titles to assess eligibility and methodological quality. Studies were grouped into those comparing clinical pathways with usual care and those comparing clinical pathways as part of a multifaceted intervention with usual care. Main results: Twenty-seven studies involving 11,398 participants met the eligibility and study quality criteria for inclusion. Twenty studies compared stand alone clinical pathways with usual care. These studies indicated a reduction in in-hospital complications (odds ratio (OR) 0.58; 95% confidence interval (CI) 0.36 to 0.94) and improved documentation (OR 11.95: 95%CI 4.72 to 30.30). There was no evidence of differences in readmission to hospital or in-hospital mortality. Length of stay was the most commonly employed outcome measure with most studies reporting significant reductions. A decrease in hospital costs/ charges was also observed, ranging from WMD +261 US$ favouring usual care toWMD -4919 US$ favouring clinical pathways (in US$ dollar standardized to the year 2000). Considerable heterogeneity prevented meta-analysis of length of stay and hospital cost results. An assessment of whether lower hospital costs contributed to cost shifting to another health sector was not undertaken. Seven studies compared clinical pathways as part of a multifaceted intervention with usual care. No evidence of differences were found between intervention and control groups. Authors’ conclusions: Clinical pathways are associated with reduced in-hospital complications and improved documentation without negatively impacting on length of stay and hospital costs. 2012-02-13T03:40:06.990Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:9945 As health researchers we need to investigate a wide range of topics to enhance our understanding of the many issues that affect health and well-being in today's society. Much of the health research undertaken today involves face-to-face encounters with participants using qualitative methodologies. There is a growing recognition that undertaking qualitative research can pose many difficulties for researchers. However, very little research has focused directly on the experiences of researchers while undertaking qualitative research and the issues that their involvement in the research raises for them. To explore these issues, one-to-one interviews were conducted with 30 qualitative health researchers. A grounded theory analysis revealed that researchers can face a number of challenges while undertaking qualitative research. These include issues relating to rapport development, use of researcher self-disclosure, listening to untold stories, feelings of guilt and vulnerability, leaving the research relationship and researcher exhaustion. These results are discussed and recommendations for researchers involved in qualitative research are made. 2012-02-08T22:50:05.564Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:9731 Background: Clinical pathways are tools used to guide evidence-based healthcare that have been implemented internationally since the 1980s. However, there is widespread lack of agreement on the impact of clinical pathways on hospital resources and patient outcomes. This can be partially attributed to the confusion for both researchers and healthcare workers regarding what constitutes a clinical pathway. This paper describes efforts made by a team of Cochrane Review authors to develop criteria to assist in the objective identification of clinical pathway studies from the literature. Methods: We undertook a four-stage process aiming to develop criteria to define a clinical pathway: (1) identify publications exploring the definition of a clinical pathway; (2) derive draft criteria; (3) pilot test the criteria; and (4) modify criteria to maximise agreement between review authors. Results: Previous literature and liaison with the European Pathways Association resulted in five criteria being used to define a clinical pathway: (1) the intervention was a structured multidisciplinary plan of care; (2) the intervention was used to translate guidelines or evidence into local structures; (3) the intervention detailed the steps in a course of treatment or care in a plan, pathway, algorithm, guideline, protocol or other 'inventory of actions'; (4) the intervention had timeframes or criteria-based progression; and (5) the intervention aimed to standardise care for a specific clinical problem, procedure or episode of healthcare in a specific population. After pilot testing it was decided that if an intervention met the first criteria (a structured multidisciplinary plan of care) plus three out of the other four criteria then it was included as a clinical pathway for the purposes of this review. In all, 27 studies were included in the final review. The authors of the included studies referred to these interventions as 'clinical pathways', 'protocols', 'care model','care map', 'multidisciplinary care', evidence-based care' and 'guideline'. Conclusions: The criteria used for the identification of relevant studies for this Cochrane Review can be used as a foundation for the development of a standardised, internationally accepted definition of a clinical pathway. 2012-01-30T05:21:42.317Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:9670 Objective: The aim of the present study was to investigate whether fruit and vegetables should be treated as separate groups in health promotion programmes by examining consumption levels, barriers, knowledge and the association between stage of change and potential predictors of fruit and vegetable intake. Design: Computer-assisted telephone interview survey of the target population. Setting: Hunter and New England regions of New South Wales, Australia. Subjects: A total of 1403 parents and carers of primary-school-aged children. Results: Consumption levels and knowledge of recommended intakes and serving size were greater for fruit than for vegetables. There were some differences in the main barriers to the consumption of fruit compared with those cited for vegetables. There was little congruence between the stages of change for fruit consumption and those for vegetable consumption. For fruit, knowledge of serving size and recommended intake, perceptions of adequate consumption, changes made to family intake and educational attainment were all correlated with stage of change categorisation. For vegetables, knowledge of recommended intake, perceptions of adequate consumption and changes made to family intake were correlated with stage of change categorisation. Conclusions: Significant differences in consumption levels, barriers, knowledge and stages of readiness for change can be shown when fruit and vegetables are treated as separate groups. Health promotion planners may need to consider interventions that focus on improving vegetable consumption in preference to fruit consumption. Messages about the recommended number of servings and serving size must be simplified and this may be achieved by targeting messages towards vegetable consumption. 2011-12-09T01:00:04.347Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:8623 It is well recognized that assessment has an important role in the teaching and learning process. In this chapter we consider the role of assessment in the undergraduate training of health practitioners, in the fields of nursing, health promotion and environmental health, but our comments apply equally to most social science courses. Research assessment can be a valuable tool in enhancing student motivation and consolidating student learning. Innovative assessment not only assists in student learning, it can also guide teachers in continually refining a curriculum that is relevant to the professional competencies recognized as essential components of practitioner training. Employing a variety of assessment tasks provides students with a rigorous framework from which to learn, use, practise and evaluate health research. 2011-08-12T05:30:11.562Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:7621 Changes in the higher education sector over the past decade have led to increasing demands on academics and resulted in increasing workloads, longer work hours and increased workplace stress. Declining government commitment to university funding has placed increasing pressure on academics to attract research funding and to publish. In addition, an individual academic's publication record is a core criterion for decisions regarding promotion and tenure at most universities. However, incentives to support and enable that writing to take place have been limited. A range of different interventions have been described in the literature to enhance research output and encourage academics to publish. However, many are expensive in terms of the financial and personal costs involved, when compared with the increased publication outputs. In this article the authors reflect on how their small university department facilitated on-site writing retreats that increased publication output, with minimal disruption and limited costs. They provide a reflective account of two such retreats conducted over a twelve-month period and make recommendations for other departments wishing to adopt a similar approach. 2011-05-02T06:00:11.730Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:7314 Abstract: Suicide mortality has become the tenth most common cause of death in many countries, especially in developing countries such as Taiwan. There are a number of cultural influences on suicide behaviour which vary significantly across countries, but a common consideration is the linking of the way suicide is reported in the media with subsequent suicide attempts, although the regulations and policy regarding media reporting vary markedly. This paper looks at observations of media reporting of suicide and parasuicide in Taiwan by analysing 131 reports of suicide or parasuicide published in the China Times newspaper over a 12-month period. It discusses the findings in relation to guidelines for media reporting of suicide and compares them with the way suicide tends to be reported in countries which are much more circumspect in their presentation of this issue. Newspaper reporting of suicide behaviour may not reflect the actual occurrence. Some types of suicide, including celebrity suicide, murdersuicide, suicide for special reasons, suicide using particular methods and successful suicides in socially unacceptable circumstances seem more likely to gain publicity. This paper argues that whilst some aspects of the detail of reporting should be curtailed in order to prevent copycat suicides, and to moderate cultural perspectives of suicide, other aspects can bring to light injustices and inequities which are culturally embedded in societies and are a primary influence on the suicide rates. The very limited reporting of suicide found mainly in Western countries is often compared favourably with the more extensive reporting in places like Taiwan, as shown in this paper. However, it may be that more balanced reporting on both sides would assist in reducing worldwide suicide statistics. 2011-02-24T05:20:03.290Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:4873 Background: Hysterectomy is a common procedure in Australia; approximately 1 in 5 Australian women undergoing a hysterectomy by the age of 50 for indications such as fibroids, disorders of menstruation (including excessive or irregular menstrual bleeding), and endometriosis. However, little is known about the characteristics of women who have had the procedure or the predictors of hysterectomy as a treatment for menstrual problems. This study of 687 middle-aged Australian women suffering from menstrual symptoms aimed to identify the common health and demographic characteristics that were likely to lead to hysterectomy for the treatment of these problems. Methods: A cross-sectional and a prospective cohort study were undertaken as a substudy of the Australian Longitudinal Study on Women’s Health (Women’s Health Australia). Women from the mid-aged cohort of the Women’s Health Australia study who identified having menstrual problems (n = 715) in the 1996 and 1998 surveys or who had undergone a hysterectomy (n = 218) during that time were recruited. A self-administered instrument was mailed to the 933 women in 2000. Data were analyzed using backward logistic regression to identify the characteristics that increased the likelihood of women undergoing hysterectomy for the treatment of menstrual problems. Results: Factors that increased the likelihood of hysterectomy as a treatment for menstrual problems were varied. They included the number of menstrual symptoms experienced (odds ratio [OR], 1.63; p < .005) or conditions diagnosed (such as fibroids or excessive menstrual bleeding; OR, 2.5; p < .0005), a perception that information was available about menstrual problems (OR, 1.16; p < .001), being influenced in the decision making process to elect a treatment option (OR, 1.25; p < .025), and dissatisfaction with the other treatments tried before hysterectomy (OR, 0.63; p < .0005). Conclusions: Hysterectomy seem to be the treatment of choice for women experiencing a number of menstrual problems and less than satisfactory outcomes with other treatment options. Importantly, women appear to be making decisions based on the perception of sufficient information available about their menstrual problems, regardless of whether or not this was actually the case. Women are being influenced in their decision-making process to undergo a hysterectomy by health professionals, such as general practitioners and gynecologists. 2010-04-27T05:00:25.911Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:5177 There is a dearth of research on the undergraduate research training provided to pharmacy students.We aimed to identify and provide examples of effective pedagogy in teaching research and evidence-based practice (EBP) to undergraduate pharmacy students. In conjunction with the professional competency standards for pharmacists, a review of the pharmacy workforce needs and the relevant pedagogical literature, a range of evidence-based approaches for selecting unit content, teaching and assessment strategies was identified. The authors reflect on the evidence and their multidisciplinary experiences in developing curriculum to demonstrate how pharmacy students can be engaged in deep learning rather than surface learning. Effective pedagogy in research training for pharmacy students will ultimately improve the quality of pharmacy education and the use of EBP principles in practice. 2010-04-27T04:46:40.409Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:5151 Traditionally, risk assessments in research have been limited to examining the risks to the research participants. Although doing so is appropriate and important, there is growing recognition that undertaking research can pose risks to researchers as well. A grounded theory study involving a range of researchers who had undertaken qualitative health research on a sensitive topic was completed. Analysis of the in-depth, face-to-face unstructured individual interviews with 30 Australian public health researchers provided evidence that researchers do confront a number of physical and emotional risks when undertaking research. Training, preparation, and supervision must be taken into account so that the risk to researchers can be minimized. Researchers need to consider occupational health and safety issues in designing research projects that deal with physical and emotional risks. Recommendations for professional supervision, policy development, and minimum training standards for researchers are provided. 2010-04-27T04:44:54.382Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:4976 Background/aim: Predischarge home assessment visits are a commonly accepted, but little researched, aspect of occupational therapy practice. The aim of this research was to systematically investigate current predischarge occupational therapy home assessment visit practices in a rehabilitation ward of a regional Australian hospital. Methods: A retrospective chart audit was conducted over a 7-month time period and included 227 patients discharged from the inpatient rehabilitation ward at the study hospital. Results: Fifty-five per cent of patients in the study sample received home assessment visits. At least one recommendation for change was made as a result of the visit for 99% of those patients receiving visits. A total of 139 visits were completed and resulted in 1179 recommendations for change. The median number of recommendations made for the home assessment visits was 10 (range 0–33). The most common types of recommendations, timing of visits, persons present during the visit and documentation of visits were also investigated. Conclusion: Although occupational therapy home assessment visits are routinely completed, there is limited research available to provide evidence-based guidelines relating to predischarge occupational therapy home assessment visit practices. Recommendations for future practice and areas for further research into occupational therapy home assessment visits are discussed. 2010-04-27T04:41:32.257Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:5708 Undertaking qualitative research on sensitive topics often raises a variety of ethical problems. Based on empirical research, this book documents experiences throughout the entire research process: from conceptualization, ethics approval, fieldwork, to analysis and publication. It presents readers with stories from the researcher's perspective and synthesizes these experiences into a conceptual framework that will assist researchers to undertake qualitative research. Each section discusses potential pitfalls, provides quotes and stories and reviews the relevant literature and theory, providing readers with a description of the process of conducting sensitive research from the perspective of those actually doing the research. 2010-04-27T04:30:23.105Z ]]>