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    Variables Impacting the Time Taken to Wean Children From Enteral Tube Feeding to Oral Intake
    (Lippincott, Williams & Wilkins, 2019-06-01) Lively, Emily; McAllister, Sue Margery; Doeltgen, Sebastian
    Objectives: This study investigated biological factors, which may influence the time taken for children to wean from enteral to oral intake. Methods: Retrospective case-note audit of 62 tube-fed children (nasogastric or percutaneous endoscopic gastrostomy) aged 6 months to 8 years, participating in an intensive tube weaning program. Program design included family-focused mealtimes, child autonomy, and appetite stimulation. A regression model was developed, which shows the combination of variables with the most predictive power for time taken to wean. Results: Data from 62 children who were highly dependent (minimum 93% of calories provided enterally) on tube feeding for an extended period of time (mean = 2.1 years) were analysed. Children's mean body mass index z score at time of weaning was -0.47 (standard deviation 1.03) (mean weight = 10.54 kg) and 54 (87%) presented with a range of medical conditions. Forty-four children (71%) remained completely tube free at 3 months postintervention and an additional 5 children (10%) were fully tube weaned within 10 months of program commencement. Type of feeding tube, medical complexity, age, and length of time tube fed all significantly correlated with time taken to wean. Logistic regression modelling indicated that the type of feeding tube in combination with the degree of medical complexity and time tube fed were the strongest predictors of time taken to wean. Conclusions: Biological factors usually considered to impact on successful weaning from tube feeding (volume of oral intake, oral skill, or mealtime behaviours) were not relevant; however, the type of feeding tube in combination with the degree of medical complexity and time tube fed were the strongest predictors. The impact of psychosocial factors should be investigated to identify if these mitigated the effects of the biological variables.
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    Addressing nutrition and social connection through community gardening: A South Australian study
    (Wiley, 2019-02-11) Mehta, Kaye Phillips; Lopresti, Silvia; Thomas, Jessica
    Background This research aimed to evaluate the benefits of the community gardening program called ‘‘Magic Harvest (MH)” with respect to its key elements: social interaction; gardening skills; and, healthier eating. The MH program supports community participants to grow food, share produce, prepare and preserve food. Methods Two focus groups were conducted with participants in MH programs in the south of Adelaide, South Australia. The MH programs were located in lower socio‐economic areas. Focus group interviews were recorded, transcribed verbatim, coded and analysed thematically. Results Thirteen participants took part in the focus groups and reported gains in community connectedness and shared learning, skills for growing food and healthy eating and making more sustainable food choices. Conclusion This study highlights the social and nutritional benefits that can be derived from a community gardening program in low‐income communities. Health practitioners and policymakers should consider community gardening as an effective health promotion strategy that can address physical and social determinants of health and nutrition for low‐income communities.
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    Evaluation of the Young Deadly Free Peer Education Training Program: Early Results, Methodological Challenges, and Learnings for Future Evaluations
    (Frontiers, 2019-04-05) D'Costa, Belinda; Lobo, Roanna; Thomas, Jessica; Ward, James Steven
    Australian Aboriginal and Torres Strait Islander people experience disproportionately higher rates of sexually transmissible infections (STIs) and blood borne viruses (BBVs) when compared with the non-Indigenous population. Both incidence and prevalence data for bacterial STIs, such as chlamydia, gonorrhea, trichomonas, and syphilis in remote areas of Australia are reported at rates many times higher than that of non-Indigenous Australians. Similarly, rates of hepatitis B are disproportionately higher for non-Indigenous people in remote communities. The Young Deadly STI and BBV Free project was designed to increase the uptake of STI and BBV testing and treatment in young Aboriginal and Torres Strait Islander people living in remote and very remote areas of South Australia, Western Australia, Queensland, and the Northern Territory. Peer education formed one component of this pilot project and involved training up to 100 young Aboriginal and Torres Strait Islander people across 19 communities in a culturally appropriate and respectful manner on the transmission, testing, and treatment of STIs and BBVs. The trained peer educators were then required to deliver three community education sessions to young people in their respective communities in an effort to raise awareness about STIs and BBVs and encourage testing and treatment uptake. Preliminary evaluation findings, limited to the trained peer educators, revealed the peer educator training program contributed to STI and BBV knowledge gains among the trained peer educators and positively influenced their behavioral intentions and attitudes pertaining to STIs and BBVs. Working with remote Aboriginal and Torres Strait Islander populations on a highly sensitive, stigmatized topic presented many methodological challenges, particularly in terms of ensuring the collection of reliable evaluation data across geographically remote communities. The challenges and strengths associated with the implementation of the peer education training program along with implications for developing culturally inclusive evaluation practices will be discussed.
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    Topic search filters: a systematic scoping review
    (Wiley, 2018-12-21) Damarell, Raechel; May, Nikki; Hammond, Sue; Sladek, Ruth; Tieman, Jennifer
    Background Searching for topics within large biomedical databases can be challenging, especially when topics are complex, diffuse, emerging or lack definitional clarity. Experimentally derived topic search filters offer a reliable solution to effective retrieval; however, their number and range of subject foci remain unknown. Objectives This systematic scoping review aims to identify and describe available experimentally developed topic search filters. Methods Reports on topic search filter development (1990‐) were sought using grey literature sources and 15 databases. Reports describing the conception and prospective development of a database‐specific topic search and including an objectively measured estimate of its performance (‘sensitivity’) were included. Results Fifty‐four reports met inclusion criteria. Data were extracted and thematically synthesised to describe the characteristics of 58 topic search filters. Discussion Topic search filters are proliferating and cover a wide range of subjects. Filter reports, however, often lack clear definitions of concepts and topic scope to guide users. Without standardised terminology, filters are challenging to find. Information specialists may benefit from a centralised topic filter repository and appraisal checklists to facilitate quality assessment. Conclusion Findings will help information specialists identify existing topic search filters and assist filter developers to build on current knowledge in the field.
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    The background and development of quality of life and family quality of life: applying research, policy, and practice to individual and family living
    (University of Victoria Victoria, BC Canada, 2018) Brown, Roy Irwin; Schippers, Alice
    This article introduces the concepts of quality of life and family quality of life and shows how they have developed in the field of intellectual and developmental disabilities in terms of concepts and principles. The article underscores the relevance of many of the principles and practices to a wide range of disabilities and challenges in the broad field of human development. Finally, the article provides an introduction to the other articles in this special issue, and considers their relationship to the broader areas of research, practice, and policy.
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    Family quality of life and the building of social connections: practical suggestions for practice and policy
    (University of Victoria Victoria, BC Canada, 2018) Edwards, Meaghan; Parmenter, Trevor; O’Brien, Patricia; Brown, Roy Irwin
    Family quality of life literature suggests that families with a member with an intellectual/developmental disability frequently face major difficulties in building social connections with others. They experience low levels of social support, face challenges in community inclusion, and are at risk of social isolation. These challenges may also be faced by other types of marginalized families. Families experiencing serious illness, families experiencing intrafamily violence, and migrant families or those seeking political asylum, for example, may also become isolated and find themselves without pathways to connections with others. We present practical suggestions intended for families and professionals interested in action and intervention at the personal, community, program, and policy levels to encourage the growth of social connections and prevent isolation of families experiencing social exclusion. The suggestions will come from families with a member with a disability and the findings of a study examining the social support of families as it relates to quality of life.
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    Family quality of life and nurturing the sibling relationship
    (University of Victoria Victoria, BC Canada, 2018) Kyrkou, Margaret Rose
    Research that gauges family quality of life in families that include a child with a disability has often focused on the relationship between parents and the child, but in doing so they underestimate the importance of the sibling relationship: siblings are in each other’s lives generally for a much longer period of time than parents are. The sibling relationship is not intrinsically positive or negative, but it is a dynamic and critical bond; from it children can learn to understand and advocate for themselves and each other in the context of the disability. The sibling relationship is a lifelong one. Nurturing it in the early stages of development will not only support family quality of life, but will set the foundation for healthy adult sibling relationships that can create positive outcomes for all members of the family. The important aspects of nurturing the sibling relationship are considered from the viewpoint of both sibling and parent. The assumptions that inform sibling relationships are discussed, and suggestions for nurturing them are provided.
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    Health-related family quality of life when a child or young person has a disability
    (University of Victoria Victoria, BC Canada, 2018) Kyrkou, Margaret Rose
    Parents of a child or young person with disability face not only the same challenges as parents of typically developing children and young people, but also the extra challenges of supporting the child or young person with disability in such a way as to maximise both their own quality of life (QOL) and family quality of life (FQOL) for all family members. Health-related quality of life (HRQOL) encompasses not only physical health but also mental and emotional health, equally important for FQOL. This article builds on information from previous publications, and illustrates relevant issues and the innovative methods parents, caregivers, and professionals have devised to enhance the HRQOL for children and young people with disability, and to improve FQOL. The author draws upon her personal lived experiences of having two daughters, the eldest an adult with disability, as well as being the medical consultant and manager of a newly created health unit tasked with supporting students with disability, who often have high health needs, in educational settings. The health conditions selected are those that have a major impact, not only on the young person with disability but also on family members. Vignettes, all deidentified true stories, will be included to illustrate the multiple issues faced by children and young people with disability, their families and extended families, and treating clinicians. These stories will hopefully resonate with families in particular.
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    The effect of group involvement on post-disaster mental health: A longitudinal multilevel analysis
    (Elsevier, 2018-11-07) Gallagher, H Colin; Block, Karen; Gibbs, Lisa; Forbes, David; Lusher, Dean; Molyneaux, Robyn; Richardson, John; Pattison, Philippa; MacDougall, Colin James; Bryant, Richard
    Involvement in voluntary associations is a key form of social capital and plays an especially important role following disaster as a venue for coordination and decision-making for the wider community. Yet, relatively little attention has been paid to how group involvement affects mental health, at either the individual or community level. The aim of this study was to assess the impact of involvement in voluntary associations on mental health among residents of bushfire-affected communities. A longitudinal sample of 642 individuals affected by the 2009 Victorian bushfires in south-eastern Australia were surveyed in 2012 and 2014 (3- and 5-years post-disaster). A further subsample (n = 552) of residents residing continuously within 22 bushfire-affected communities were examined for community-level effects using multilevel regression methods. After adjusting for demographics, disaster exposure, and network variables, group involvement at time 1 bore a curvilinear relationship with PTSD at both time points: moderate involvement was most beneficial, with no participation, or high amounts, yielding poorer outcomes. High amounts of group involvement was likewise linked to a greater risk of major depression. Furthermore, communities with higher median levels of group involvement reported lower levels of PTSD symptoms and major depression two years later. With respect to group involvement, more is not always better. For individuals, moderation – if possible – is key. Meanwhile, community-level health benefits come when most people participate to some extent, suggesting that the distribution of involvement across the community is important.
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    Root caries incidence and increment in the population – A systematic review, meta-analysis and meta-regression of longitudinal studies
    (Elsevier, 2018-06-21) Hariyani, Ninuk; Setyowati, Dini; Spencer, John; Luzzi, Liana; Do, Loc Giang
    Objectives Previous meta-analyses of root caries incidence and increment studies reported different estimates due to the limited number of studies, heterogeneity and variations in studies included. Currently, new publications and approaches to handle heterogeneity are available. This research aims to systematically review and meta-analyse root caries incidence and increment, and use meta-regression to analyse heterogeneity. Sources PUBMED and EMBASE databases were searched systematically. Study selection Longitudinal studies on root caries incidence and increment, published in English language prior to 2017, were independently checked by two authors. A pooled incidence and increment of decayed/filled root surfaces (DFS) was estimated and meta-regression analysis was performed by length of follow-up (<2 years; 2years; 3–4years and ≥5years) and study type (observational population-based and clinical trial). Data Of 737 articles, 20 were included for meta-analysis. The annualised root caries incidence and increment were 18.25%[CI = 13.22%–23.28%] and 0.45[CI = 0.37–0.53] root DFS respectively. Length of follow-up influenced the estimates, but not the study type. The annual root DFS incidence and increment from studies <2years were 32.95%[CI = 29.13%–36.77%] and 0.64[CI = 0.38–0.89] root surfaces respectively. Studies with 5+years follow-up, the annualised root caries incidence and increment were 9.4%[CI = 3.32%–15.48%] and 0.43[CI = 0.21–0.64] root surfaces respectively. Conclusions Length of follow-up influenced root caries estimates due to a bias towards relatively healthier older adults retained in the study. Root caries increased over time even among the healthier older adults. Clinical significance The increase in root caries, even among the healthier older adults, should be considered by both clinicians and healthcare planners/policy makers in their provision of services.
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    Agreement between pre-exercise screening questionnaires completed online versus face-to-face
    (Public Library of Science, 2018-06-26) Norton, Lynda; Thomas, Jessica; Bevan, Nadia; Norton, Kevin
    Objectives To investigate the levels of agreement between self-reported responses to the Adult Preexercise Screening System (APSS) questionnaire using online versus face-to-face (F2F) modalities. Design Convenience sample of adults completing a pre-exercise screening questionnaire using different modalities. Methods Adult volunteers (n = 94) were recruited to complete the APSS using both online and F2F modalities. Participants were provided a URL link to an online APSS questionnaire then followed- up the next day in a F2F interview. Objective health risk factors were also measured. Comparisons between responses were undertaken using kappa and correlation statistics to determine levels of agreement. Results The levels of agreement between online versus F2F responses for the seven compulsory Stage 1 questions (known diseases and signs and/or symptoms of disease) were >94% (kappa = 0.644±0.794). Response comparisons for Stage 2 questions on health risk factors were also generally high (>82% agreement) but there were larger differences between reported and measured risk factors in Stage 3. Conclusions Levels of agreement between the Stage 1 responses were substantial and support the use of this online option for pre-exercise screening. There were larger differences between selfreported and objectively measured health risk factors in Stages 2 and 3.
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    Safety and feasibility of a first-person view, full-body interaction game for telerehabilitation post-stroke
    (University of Pittsburgh, 2018-03) Proffitt, Rachel; Warren, Jessica; Lange, Belinda; Chang, Chien-Yen
    This study explored the feasibility and safety of pairing the Microsoft Kinect® sensor with the Oculus Rift® Head Mounted Display (HMD) as a telerehabilitation technology platform for persons post-stroke. To test initial safety, fourteen participants without disabilities (age 30 ± 8.8 years) engaged in a game-based task using the Microsoft Kinect® with a first-person view using the Oculus Rift®. These tasks were repeated for five participants post-stroke (age 56 ± 3.0 years). No significant adverse events occurred in either study population. When using the Oculus Rift® HMD, three participants without disabilities reported dizziness and nausea. All of the participants post-stroke required hands-on assistance for balance and fall prevention. The intensive nature of physical support necessary for this type of interaction limits the application as a telerehabilitation intervention. Given the increasing availability of HMDs for commercial use, it is crucial that the safety of immersive games and technologies for telerehabilitation is fully explored.
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    Expansion of Sphingosine Kinase and Sphingosine-1-Phosphate Receptor Function in Normal and Cancer Cells: From Membrane Restructuring to Mediation of Estrogen Signaling and Stem Cell Programming
    (MDPI, 2018-01-31) Sukocheva, Olga Anatolyevna
    Sphingolipids, sphingolipid metabolizing enzymes, and their receptors network are being recognized as part of the signaling mechanisms, which govern breast cancer cell growth, migration, and survival during chemotherapy treatment. Approximately 70% of breast cancers are estrogen receptor (ER) positive and, thus, rely on estrogen signaling. Estrogen activates an intracellular network composed of many cytoplasmic and nuclear mediators. Some estrogen effects can be mediated by sphingolipids. Estrogen activates sphingosine kinase 1 (SphK1) and amplifies the intracellular concentration of sphingosine-1-phosphate (S1P) in breast cancer cells during stimulation of proliferation and survival. Specifically, Estrogen activates S1P receptors (S1PR) and induces growth factor receptor transactivation. SphK, S1P, and S1PR expression are causally associated with endocrine resistance and progression to advanced tumor stages in ER-positive breast cancers in vivo. Recently, the network of SphK/S1PR was shown to promote the development of ER-negative cancers and breast cancer stem cells, as well as stimulating angiogenesis. Novel findings confirm and broaden our knowledge about the cross-talk between sphingolipids and estrogen network in normal and malignant cells. Current S1PRs therapeutic inhibition was indicated as a promising chemotherapy approach in non-responsive and advanced malignancies. Considering that sphingolipid signaling has a prominent role in terminally differentiated cells, the impact should be considered when designing specific SphK/S1PR inhibitors. This study analyzes the dynamic of the transformation of sphingolipid axis during a transition from normal to pathological condition on the level of the whole organism. The sphingolipid-based mediation and facilitation of global effects of estrogen were critically accented as a bridging mechanism that should be explored in cancer prevention.
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    Purification and functional characterization of recombinant Balsamin, a ribosomeinactivating protein from Momordica balsamina
    (Elsevier, 2018-02-16) Ajji, Parminder K.; Sonkar, Shailendra P.; Walder, Ken; Puri, Munish
    Balsamin, a type I ribosome-inactivating protein (RIP), has been shown to inhibit HIV-1 replication at the translation step. Our recent studies have shown that balsamin also possess anti-tumor, antibacterial and DNase-like activity, however, the amount of natural balsamin in Momordica balsamina seeds is limited and preclinical studies require large quantities of pure, bioactive balsamin. Therefore, in this study, we cloned the balsamin gene, expressed it in E.coli BL21 (DE3) strain and purified it by nickel affinity chromatography. Functional analysis indicated that balsamin exhibits both RNA N-glycosidase activity, releasing the Endo-fragment from rabbit reticulocyte rRNA, and DNase-like activity, converting the supercoiled form of a plasmid into the linear form in a concentration-dependent manner. Analysis of secondary structure revealed that recombinant balsamin mainly consisted of α-helical and random coiled with minimal turns and β-sheets. Recombinant balsamin was found to be stable in the temperature range of 20-60 °C and pH range of 6-9. Antimicrobial assays showed that the minimum inhibitory concentrations of recombinant balsamin for various pathogens ranged between 1.56-12.5 μg/ml. Heterologous expression and purification of balsamin carries great importance as it provides an alternative approach for large-scale preparation of biologically active recombinant balsamin, which is difficult from its natural source.
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    Feasibility of a novel participatory multi-sector continuous improvement approach to enhance food security in remote Indigenous Australian communities
    (Elsevier, 2017-06-23) Brimblecombe, Julie; Bailie, Ross; van den Boogaard, Christel; Wood, B; Liberato, Selma; Ferguson, Megan; Coveney, John David; Jaenke, Rachael; Ritchie, Jan Elizabeth
    Background Food insecurity underlies and compounds many of the development issues faced by remote Indigenous communities in Australia. Multi-sector approaches offer promise to improve food security. We assessed the feasibility of a novel multi-sector approach to enhance community food security in remote Indigenous Australia. Method A longitudinal comparative multi-site case study, the Good Food Systems Good Food for All Project, was conducted (2009–2013) with four Aboriginal communities. Continuous improvement meetings were held in each community. Data from project documents and store sales were used to assess feasibility according to engagement, uptake and sustainability of action, and impact on community diet, as well as identifying conditions facilitating or hindering these. Results Engagement was established where: the community perceived a need for the approach; where trust was developed between the community and facilitators; where there was community stability; and where flexibility was applied in the timing of meetings. The approach enabled stakeholders in each community to collectively appraise the community food system and plan action. Actions that could be directly implemented within available resources resulted from developing collaborative capacity. Actions requiring advocacy, multi-sectoral involvement, commitment or further resources were less frequently used. Positive shifts in community diet were associated with key areas where actions were implemented. Conclusion A multi-sector participatory approach seeking continuous improvement engaged committed Aboriginal and non-Aboriginal stakeholders and was shown to have potential to shift community diet. Provision of clear mechanisms to link this approach with higher level policy and decision-making structures, clarity of roles and responsibilities, and processes to prioritise and communicate actions across sectors should further strengthen capacity for food security improvement. Integrating this approach enabling local decision-making into community governance structures with adequate resourcing is an imperative.
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    Effectiveness of a Web 2.0 Intervention to Increase Physical Activity in Real-World Settings: Randomized Ecological Trial
    (JMIR Publications, 2017-11-17) Vandelanotte, Corneel; Kolt, Gregory S; Caperchione, Cristina M; Savage, Trevor N; Rosenkranz, Richard R; Maeder, Anthony; van Itallie, Anetta K; Tague, Rhys; Oldmeadow, Christopher; Mummery, W Kerry; Duncan, Mitch J
    Background: The translation of Web-based physical activity intervention research into the real world is lacking and becoming increasingly important. Objective: To compare usage and effectiveness, in real-world settings, of a traditional Web 1.0 Web-based physical activity intervention, providing limited interactivity, to a Web 2.0 Web-based physical activity intervention that includes interactive features, such as social networking (ie, status updates, online “friends,” and personalized profile pages), blogs, and Google Maps mash-ups. Methods: Adults spontaneously signing up for the freely available 10,000 Steps website were randomized to the 10,000 Steps website (Web 1.0) or the newly developed WALK 2.0 website (Web 2.0). Physical activity (Active Australia Survey), quality of life (RAND 36), and body mass index (BMI) were assessed at baseline, 3 months, and 12 months. Website usage was measured continuously. Analyses of covariance were used to assess change over time in continuous outcome measures. Multiple imputation was used to deal with missing data. Results: A total of 1328 participants completed baseline assessments. Only 3-month outcomes (224 completers) were analyzed due to high attrition at 12 months (77 completers). Web 2.0 group participants increased physical activity by 92.8 minutes per week more than those in the Web 1.0 group (95% CI 28.8-156.8; P=.005); their BMI values also decreased more (–1.03 kg/m2, 95% CI –1.65 to -0.41; P=.001). For quality of life, only the physical functioning domain score significantly improved more in the Web 2.0 group (3.6, 95% CI 1.7-5.5; P<.001). The time between the first and last visit to the website (3.57 vs 2.22 weeks; P<.001) and the mean number of days the website was visited (9.02 vs 5.71 days; P=.002) were significantly greater in the Web 2.0 group compared to the Web 1.0 group. The difference in time-to-nonusage attrition was not statistically significant between groups (Hazard Ratio=0.97, 95% CI 0.86-1.09; P=.59). Only 21.99% (292/1328) of participants (n=292 summed for both groups) were still using either website after 2 weeks and 6.55% (87/1328) were using either website after 10 weeks. Conclusions: The website that provided more interactive and social features was more effective in improving physical activity in real-world conditions. While the Web 2.0 website was visited significantly more, both groups nevertheless displayed high nonusage attrition and low intervention engagement. More research is needed to examine the external validity and generalizability of Web-based physical activity interventions.
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    Estrogen, estrogen receptors, and hepatocellular carcinoma: Are we there yet?
    (Baishideng Publishing Group Inc., 2018-01-07) Sukocheva, Olga Anatolyevna
    A protective role of the sex steroid hormone estrogen in hepatocellular carcinoma (HCC) was suggested a few decades ago according to clinical data showing higher HCC morbidity and mortality among males. Several recent studies further confirmed the anti-cancer effects of estrogen in the liver. However, it remains to be identified how to exploit estrogen signalling within clinical settings for HCC treatment. There are several unresolved issues related to the estrogen pathway in liver cells. The main problems include the absence of a clear understanding of which estrogen receptor (ER) isoform is predominantly expressed in normal and malignant liver cells, the ER isoform expression difference between males and females, and which ER isoform should be targeted when designing HCC therapy. Some of those questions were recently addressed by Iyer and co-authors. The current editorial review critically analyses the study by Iyer et al (WJG, 2017) that investigated the expression of ER subtypes in liver samples collected from patients with a healthy liver, hepatitis C virus cirrhosis, and HCC. ER presence was evaluated in association with gender, intracellular localization, inflammation marker NF-κB, and proliferation-related effector cyclin D1. The study limitations and advantages are discussed in light of recent advances in the HCC and estrogen signalling areas.
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    Two heads are better than one: Australian tobacco control experts' and mental health change champions' consensus on addressing the problem of high smoking rates among people with mental illness
    (CSIRO Publishing, 2016) Rowley, Della; Lawn, Sharon Joy; Coveney, John David
    Abstract Objective. The aims of the present study were to explore the beliefs of Australian experts in tobacco control and change champions working in mental health and tobacco cessation, and to identify measures for addressing the problem of high smoking rates for people with mental illness. Methods. Qualitative interviews were undertaken to explore participants' views, and the Delphi technique was used to achieve consensus on ways in which the problem would be best addressed. Results. This consensus centred on the need for leadership within the mental health system. The problem was reconceptualised from being solely the responsibility of the mental health sector into an issue that requires the combined resources of a partnership and shared leadership between government and non-government services, public health leaders, policy makers and people with mental illness and their families. Conclusions. Collaboration would raise the priority of the issue, reduce the debilitating effect of stigma and discrimination within the mental health sector and would place smoking reduction firmly on the political and public agenda. A recovery-orientated focus would increase the skill base and be inclusive of workers, families and carers of people with mental illness who face smoking issues on a daily basis. Reconceptualising this as an issue that would benefit from cooperation and partnerships would disrupt the notion that the problem is solely the responsibility of the mental health sector.
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    Protocol for a randomized controlled trial testing the impact of feedback on familial risk of chronic diseases on family-level intentions to participate in preventive lifestyle behaviors
    (BioMed Central, 2016) Wilson, Carlene J; de la Haye, Kayla; Coveney, John David; Hughes, Donna L; Hutchinson, Amanda; Miller, Caroline; Prichard, Ivanka Joyce; Ward, Paul Russell; Koehly, Laura M
    Background Common disease risk clusters in families due to shared genetics, exposure to environmental risk factors, and because many health behaviours are established and maintained in family environments. This randomised controlled trial will test whether the provision of a family health history (FHH) risk assessment tool increases intentions and engagement in health behaviors. Message distribution and collective behavior change within family networks will be mapped using social network analysis. The relative intervention impact will be compared between families from different ethnic backgrounds. Methods One hundred and fifty mothers (50 Anglo-Australian, 50 Italian-Australian, 50 Vietnamese-Australian) will be recruited, with four or more other family members across three generations, including a child (aged 10-18 years). Each family is randomly assigned to intervention or control. At baseline and 6-month follow-up, all participants complete surveys to assess dietary and physical activity intentions and behaviors, attitudes towards food, and perceived disease risk. Intervention families receive a visual pedigree detailing their FHH of diabetes, heart disease, breast and bowel cancer, a health education workbook to ascertain members- disease risk (i.e. average or above average risk), and screening and primary prevention recommendations. After completion of follow-up assessments, controls will receive their pedigree and workbook. The primary hypothesis is that attitudes and lifestyle behaviors will improve more within families exposed to FHH feedback, although the extent of this improvement may vary between families from different ethnic backgrounds. Additionally, the extent of improvement in the treatment group will be moderated by the level of family disease risk, with above-average risk leading to greater improvement. A secondary aim will explore different family members- roles in message distribution and collective responses to risk using social network approaches and to compare network functioning between families with different ethnic backgrounds. Discussion Results will guide future health promotion programs aimed at improving lifestyle factors. This research will assess whether FHH can motivate families to adopt family-level strategies to support health promoting behaviors. Secondary analyses aim to identify change agents within the family who are particularly effective in shifting normative behaviors.
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    'I mean I expect that it's pretty safe': Perceptions of food trust in pregnancy-implications for primary health care practice
    (Australasian Medical Journal, 2013) House, Elizabeth; Coveney, John David
    Background Pregnancy is a time in which food choice is of particular importance. Trust in the food supply and those who regulate it is receiving greater acknowledgement because of the influence of trust on food choice. No prior investigation into pregnant women and food trust has been conducted. Aims This paper identifies factors that determine the nature and extent of pregnant women's trust in food; sources of information which influence pregnant women's food choices; and how trust impacts on pregnant women's food choices. Method In-depth interviews were conducted with 13 pregnant women; nine were pregnant with their first child and four were in their second or subsequent pregnancy. Results Food choices of pregnant women w ere predominantly influenced by nutrition and perceived quality of food. Risk-taking behaviour, such as the consumption of foods considered high risk during pregnancy, was common amongst participants. The sample was characterised by a dependence on expert information, limited reflexivity in relation to food safety, and contradictory practice such as risk-taking behaviours in regard to high risk foods were observed. Conclusion Further research is needed to confirm findings in this study. Research into consumption of high-risk foods and the information received from healthcare providers would be useful in creating a clearer understanding of whether provision of information is sufficient in communicating risks and promoting a healthy pregnancy.