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Background: Recently, we found a telephone-delivered secondary prevention programme using health coaching ('ProActive Heart') to be effective in improving a range of key behavioural outcomes for myocardial infarction (MI) patients. What remains unclear, however, is the extent to which these treatment effects translate to important psychological outcomes such as depression and anxiety outcomes, an issue of clinical significance due to the substantial proportion of MI patients who experience depression and anxiety. The objective of the study was to investigate, as a secondary hypothesis of a larger trial, the effects of a telephone-delivered health coaching programme on depression and anxiety outcomes of MI patients., Design: Two-arm, parallel-group, randomized, controlled design with six-months outcomes., Methods: Patients admitted to one of two tertiary hospitals in Brisbane, Australia following MI were assessed for eligibility. Four hundred and thirty patients were recruited and randomly assigned to usual care or an intervention group comprising up to 10 telephone-delivered 'health coaching' sessions (ProActive Heart). Regression analysis compared Hospital Anxiety and Depression Scale scores of completing participants at six months (intervention: n = 141 versus usual care: n = 156)., Results: The intervention yielded reductions in anxiety at follow-up (mean difference = -0.7, 95% confidence interval=-1.4,-0.02) compared with usual care. A similar pattern was observed in mean depression scores but was not statistically significant., Conclusions: The ProActive Heart programme effectively improves anxiety outcomes of patients following myocardial infarction. If combined with psychological-specific treatment, this programme could impact anxiety of greater intensity in a clinically meaningful way.

Background: An estimated 285 million people worldwide have diabetes and its prevalence is predicted to increase to 439 million by 2030. For the year 2010, it is estimated that 3.96 million excess deaths in the age group 20-79 years are attributable to diabetes around the world. Self-management is recognised as an integral part of diabetes care. This paper describes the protocol of a randomised controlled trial of an automated interactive telephone system aiming to improve the uptake and maintenance of essential diabetes self-management behaviours., Methods/design: A total of 340 individuals with type 2 diabetes will be randomised, either to the routine care arm, or to the intervention arm in which participants receive the Telephone-Linked Care (TLC) Diabetes program in addition to their routine care. The intervention requires the participants to telephone the TLC Diabetes phone system weekly for 6 months. They receive the study handbook and a glucose meter linked to a data uploading device. The TLC system consists of a computer with software designed to provide monitoring, tailored feedback and education on key aspects of diabetes self-management, based on answers voiced or entered during the current or previous conversations. Data collection is conducted at baseline (Time 1), 6-month follow-up (Time 2), and 12-month follow-up (Time 3). The primary outcomes are glycaemic control (HbA1c) and quality of life (Short Form-36 Health Survey version 2). Secondary outcomes include anthropometric measures, blood pressure, blood lipid profile, psychosocial measures as well as measures of diet, physical activity, blood glucose monitoring, foot care and medication taking. Information on utilisation of healthcare services including hospital admissions, medication use and costs is collected. An economic evaluation is also planned., Discussion: Outcomes will provide evidence concerning the efficacy of a telephone-linked care intervention for self-management of diabetes. Furthermore, the study will provide insight into the potential for more widespread uptake of automated telehealth interventions, globally., Trial Registration Number: ACTRN12607000594426.

Purpose: To examine the association between neighborhood disadvantage and physical activity (PA)., Methods: We use data from the HABITAT multilevel longitudinal study of PA among middle-aged (40-65 years) men and women (N = 11,037, 68.5% response rate) living in 200 neighborhoods in Brisbane, Australia. PA was measured using three questions from the Active Australia Survey (general walking, moderate, and vigorous activity), one indicator of total activity, and two questions about walking and cycling for transport. The PA measures were operationalized by using multiple categories based on time and estimated energy expenditure that were interpretable with reference to the latest PA recommendations. The association between neighborhood disadvantage and PA was examined with the use of multilevel multinomial logistic regression and Markov chain Monte Carlo simulation. The contribution of neighborhood disadvantage to between-neighborhood variation in PA was assessed using the 80% interval odds ratio., Results: After adjustment for sex, age, living arrangement, education, occupation, and household income, reported participation in all measures and levels of PA varied significantly across Brisbane's neighborhoods, and neighborhood disadvantage accounted for some of this variation. Residents of advantaged neighborhoods reported significantly higher levels of total activity, general walking, moderate, and vigorous activity; however, they were less likely to walk for transport. There was no statistically significant association between neighborhood disadvantage and cycling for transport. In terms of total PA, residents of advantaged neighborhoods were more likely to exceed PA recommendations., Conclusions: Neighborhoods may exert a contextual effect on the likelihood of residents participating in PA. The greater propensity of residents in advantaged neighborhoods to do high levels of total PA may contribute to lower rates of cardiovascular disease and obesity in these areas., (Copyright (c) 2010 Elsevier Inc. All rights reserved.)

Purpose: This prospective study used the framework of ICF components to investigate the magnitude and direction of association between body functions (depression/anxiety symptoms), activity (limitations in work activities), participation (sickness absence), and environment (psychosocial aspects) in the workplace setting., Methods: A cohort of employees completed a self-report survey at baseline and 6 months follow-up, with analysis restricted to those with at least one health condition (n = 204). Self-report measures of depression/anxiety symptoms, limitations in work activities, sickness absences, and psychosocial work environment were mapped to the corresponding ICF component. The prospective association between these components was modelled using relative risks (RR) estimated from log-binomial regression., Results: Depression/anxiety symptoms were more likely to be an outcome of other ICF components, rather than a risk factor. Sickness absence, limitations in work activities, and work environment all conferred a greater than two-fold risk of depression/anxiety symptoms 6 months later., Conclusions: The ICF offers a valuable approach to understanding the contextual influences on employee mental health and work disability. Further application of the ICF framework to mental health should improve the environmental components and encourage a wider adoption of the ICF by mental health researchers and practitioners.

We used geographic information systems and a spatial analysis approach to explore the pattern of Ross River virus (RRV) incidence in Brisbane, Australia. Climate, vegetation and socioeconomic data in 2001 were obtained from the Australian Bureau of Meteorology, the Brisbane City Council and the Australian Bureau of Statistics, respectively. Information on the RRV cases was obtained from the Queensland Department of Health. Spatial and multiple negative binomial regression models were used to identify the socioeconomic and environmental determinants of RRV transmission. The results show that RRV activity was primarily concentrated in the northeastern, northwestern, and southeastern regions in Brisbane. Multiple negative binomial regression models showed that the spatial pattern of RRV disease in Brisbane seemed to be determined by a combination of local ecologic, socioeconomic, and environmental factors.

Background: Colorectal cancer (CRC) is the most common invasive cancer in Australia. Randomised trials have shown that mortality from CRC can be reduced with the use of screening modalities such as faecal occult blood testing (FOBT). This study sought to determine current attitudes, knowledge and practices of general practitioners in relation to CRC screening., Methods: A cross sectional survey of 1500 GPs in Queensland., Results: Responses were received from 769 (55.6%) GPs. Fifty-three percent of GPs recommended using FOBT for asymptomatic patients over 50 years of age and 18.6% would recommend colonoscopy in such patients. Compared to a previous survey, GPs are now more likely to use FOBT (RR: 2.01, 95% CI: 1.58-2.56). Two-thirds (66.7%) would support a population based screening program using FOBT, an increase of 16% over 3 years., Discussion: Current use of FOBT in asymptomatic patients, support for population based FOBT, and knowledge of the benefits of CRC screening has increased significantly from previous surveys.

This study aimed to identify the major mosquito vectors of Ross River virus (family Togaviridae, genus Alphavirus, RRV) and to explore the threshold of mosquito abundance necessary for RRV transmission in Brisbane, Australia. Data on the monthly counts of RRV cases by statistical local areas from the Queensland Health and the monthly mosquito abundance in Brisbane between November 1998 and December 2001 from the Brisbane City Council were used to assess the pairwise relationship between mosquito abundance and the incidence of RRV disease over a range of time lags using cross-correlations. We used time series Poisson regression models to identify major mosquito species associated with incidence of RRV after adjusting for overdispersion, maximum temperature, autocorrelation, and seasonality. Our results show that Aedes vigilax (Skuse) (relative risk [RR] = 1.32; 95% CI = 1.01-1.74 per 100 mosquitoes per trap) and Culex annulirostris (Skuse) (RR = 1.14, 95% CI = 1.04-1.24 per 100 mosquitoes per trap) were most strongly associated with RRV transmission at a lag of 1 mo. Classification and regression tree (CART) analyses indicate that the occurrence of RRV was associated with an average monthly mosquito abundance ofAedes vigilax above 72 and Cx. annulirostris above 52. The validation analyses indicate that the crude agreement between predicted values and actual observations was 76% (sensitivity, 61%; specificity, 80%). The results may have applications as a decision support tool in planning disease control and risk-management programs.

Background: The success of a population-based screening for colorectal cancer (CRC) is determined to a large extent by general practitioner (GP) attitudes, beliefs and support. The extent to which GPs support population-based CRC screening remains unclear., Aims: To assess the knowledge, attitudes and practices of GPs in relation to CRC screening, and to identify the determinants of GP support for population-based faecal-occult blood testing (FOBT)., Methods: A cross-sectional postal survey was conducted with a random sample of 692 GPs in Queensland, -Australia. We assessed GP knowledge, attitudes and practices concerning CRC screening in relation to their stance on population-based FOBT screening., Results: Although the response rate was low (41%), participants were representative of Queensland GPs in general. Of 284 participating GPs, 143 (50.5%) indicated that they would support a population-based FOBT screening programme, 42 (14.8%) would not and 98 (34.6%) were unsure. Belief in FOBT test efficacy (P <0.001), possession of CRC guidelines (P <0.05) and belief in earlier stage detection (P <0.05) were major determinants of support for population-based FOBT screening. No significant association was observed for doctor's sex, location of practice, age, year completed medical training, membership of a Division of General Practice, number of weekly consultations, number of patients investigated for CRC per month, size of practice, own family history of CRC, interest in further information on CRC screening or treatment, and current use of FOBT with asymptomatic patients aged > or =40 years., Conclusions: GP support for FOBT population-based screening appears to have increased over recent years. The knowledge and attitudes/beliefs of GPs are key determinants of their support.

Objective: To undertake an assessment of survey participation and non-response error in a population-based study that examined the relationship between socio-economic position and food purchasing behaviour., Design and Setting: The study was conducted in Brisbane City (Australia) in 2000. The sample was selected using a stratified two-stage cluster design. Respondents were recruited using a range of strategies that attempted to maximise the involvement of persons from disadvantaged backgrounds: respondents were contacted by personal visit and data were collected using home-based face-to-face interviews; multiple call-backs on different days and at different times were used; and a financial gratuity was provided., Participants: Non-institutionalised residents of private dwellings located in 50 small areas that differed in their socio-economic characteristics., Results: Rates of survey participation - measured by non-contacts, exclusions, dropped cases, response rates and completions - were similar across areas, suggesting that residents of socio-economically advantaged and disadvantaged areas were equally likely to be recruited. Individual-level analysis, however, showed that respondents and non-respondents differed significantly in their sociodemographic and food purchasing characteristics: non-respondents were older, less educated and exhibited different purchasing behaviours. Misclassification bias probably accounted for the inconsistent pattern of association between the area- and individual-level results. Estimates of bias due to non-response indicated that although respondents and non-respondents were qualitatively different, the magnitude of error associated with this differential was minimal., Conclusions: Socio-economic position measured at the individual level is a strong and consistent predictor of survey non-participation. Future studies that set out to examine the relationship between socio-economic position and diet need to adopt sampling strategies and data collection methods that maximise the likelihood of recruiting participants from all points on the socio-economic spectrum, and particularly persons from disadvantaged backgrounds. Study designs that are not sensitive to the difficulties associated with recruiting a socio-economically representative sample are likely to produce biased estimates (underestimates) of socio-economic differences in the dietary outcome being investigated.

This qualitative study explored how influences on recreational physical activity (RPA) were patterned by socioeconomic position. Face-to-face interviews were conducted with 10 males and 10 females in three socioeconomic groups (N = 60). Influences salient across all groups included previous opportunities, physical health. social assistance. safety. environmental aesthetics and urban design, physical and health benefits, and barriers of self-consciousness, low skill, and weather/time of year. Influences more salient to the high socioeconomic group included social benefits, achieving a balanced lifestyle, and the barrier of an unpredictable lifestyle. Influences more salient to the high and mid socioeconomic groups included efficacy, perceived need, activity demands, affiliation, emotional benefits, and the barrier of competing demands. Influences more salient to the low socioeconomic group included poor health and barriers of inconvenient access and low personal functioning. Data suggest that efforts to increase RPA in the population should include both general and socioeconomically targeted strategies.

Purpose: Health promotion policy frameworks, recent theorizing, and research all emphasize understanding and mobilizing environmental influences to change particular health-related behaviors in specific settings. The workplace is a key environmental setting. The Checklist of Health Promotion Environments at Worksites (CHEW) was designed as a direct observation instrument to assess characteristics of worksite environments that are known to influence health-related behaviors., Methods: The CHEW is a 112-item checklist of workplace environmental features hypothesized to be associated, both positively and negatively, with physical activity, healthy eating, alcohol consumption, and smoking. The three environmental domains assessed are (1) physical characteristics of the worksite, (2) features of the information environment, and (3) characteristics of the immediate neighborhood around the workplace. The conceptual rationale and development studies for the CHEW are described, and data from observational studies of 20 worksites are reported., Results: The data on CHEW-derived environmental attributes showed generally good reliability and identified meaningful sets of variables that plausibly may influence health-related behaviors. With the exception of one information environment attribute, intraclass correlation coefficients ranged from 0.80 to 1.00. Descriptive statistics on selected physical and information environment characteristics indicated that vending machines, showers, bulletin boards, and signs prohibiting smoking were common across worksites. Bicycle racks, visible stairways, and signs related to alcohol consumption, nutrition, and health promotion were relatively uncommon., Conclusions: These findings illustrate the types of data on environmental attributes that can be derived, their relevance for program planning, and how they can characterize variability across worksites. The CHEW is a promising observational measure that has the potential to assess environmental influences on health behaviors and to evaluate workplace health promotion programs.

This paper describes the planning of a community-based approach to injury control and safety promotion, the Kolan Injury Prevention Program. The process involved the establishment of a local steering committee, 11 months of injury surveillance, a critical review of the evidence base, community consultations and assessment of community resources. There were 412 recorded injury cases during the surveillance period, with higher rates among men, manual workers, those aged 15-34 years, sport/leisure activities and around the home and farm. Salient issues for residents included a lack of access to safety information and skills, particularly with regard to first aid and bush fire for isolated residents and rurally inexperienced new residents. While injury prevention was identified as an important issue for the community, the rapidly changing size and nature of the community and its infrastructure made this a particularly challenging issue. Challenges included limited availability of volunteers from key sectors, lack of formal data collection systems, difficulties in mobilising support for a broad issue like injury, limited communication networks and the negative impact of distance and role uncertainty on community ownership of the program. This case study illustrates the steps involved in an effective community-based needs assessment addressing injury prevention. Such an approach, if carried out systematically, will help ensure that the strategies and programs developed will be both appropriate and likely to obtain the support of the local community.

Objective: To assess the relationship between socio-demographic factors and screening intention for colorectal cancer (CRC)., Methods: A cross-sectional survey of a random sample of 884 Queenslanders aged 40-80 years was conducted using a computer-assisted telephone interviewing system. The factors measured included socio-demographic characteristics, personal history of CRC, knowledge of others with CRC and perceived symptom status. Chi-squared and Monte Carlo estimates of Fisher Exact Tests were performed to determine the associations between socio-demographic factors and screening intention. In multivariate analyses, multinomial logistic regression (MNLR) was utilised to examine potential determinants of screening intention., Results: 77.5% (95% CI 74.0%-80.7%) of the respondents indicated their intention to participate in CRC screening if it were recommended by their doctor or health authorities. The likelihood ratio chi-squared tests in the MNLR analyses show that age (chi(df = 6)2 = 15.0; p = 0.02), education (chi(df = 8)2 = 19.4; p = 0.01), perceived symptom status (chi(df = 4)2 = 22.9; p = 0.00), sex (chi(df = 2)2 = 4.5; p = 0.11), income (chi(df = 14)2 = 19.6; p = 0.14) and personal history of CRC (chi(df = 2)2 = 4.3; p = 0.12) were potential determinants of screening intention. Other socio-demographic factors, including country of birth, private health insurance status, Socio-economic Index for Areas, and Rural and Remote Areas Classification codes, were not associated with screening intention., Conclusions and Implications: The results indicate that a variety of socio-demographic factors are associated with screening intention and need to be considered in the future development of a population-based screening program for CRC.

The findings presented in this paper are part of a research project designed to provide a preliminary indication of the support needs of postdiagnosis women with breast cancer in remote and isolated areas in Queensland. This discussion will present data that focuses on the women's expressed personal concerns. For participants in this research a diagnosis of breast cancer involves a confrontation with their own mortality and the possibility of a reduced life span. This is a definite life crisis, creating shock and needing considerable adjustment. Along with these generic issues the participants also articulated significant issues in relation to their experience as women in a rural setting. These concerns centred around worries about how their partner and families cope during their absences for treatment, the additional burden on the family of having to cope with running the property or farm during the participant's absence or illness, added financial strain brought about by the cost of travel for treatment, maintenance of properties during absences, and problems created by time off from properties or self-employment. These findings accord with other reports of health and welfare services for rural Australian and the generic literature on psycho-oncology studies of breast cancer.

This paper presents the recent findings from a study on the postdiagnosis support needs of women with breast cancer living in rural and remote Queensland. The findings presented in this discussion focus on support needs from the perspective of the women experiencing breast cancer as well as health service providers. The tyranny of distance imposes unique hardships, such as separation from family and friends, during a time of great vulnerability for treatment, the need to travel long distances for support and follow-up services, and extra financial burdens, which can combine to cause strains on the marital relationship and family cohesion. Positive indications are, however, that the rural communities operate on strong, informal networks of support. This network of family, friends and community can, and does, play an active role in the provision of emotional and practical support.

In response to concerns about the number of interstate and overseas visitors using Queensland hospital services, the present study examined a sample of 1,295 hospital records to determine the proportion of patients who were incorrectly identified as Queensland residents. Across six hospitals the overall detection rate was 4.6%. Rates varied between hospitals, with the highest detection recorded for Goondiwindi near the Queensland/New South Wales border; and the lowest for Prince Charles in Brisbane. There were also important variations across hospitals based on specific holiday periods. In particular, Goondiwindi and the Gold Coast had substantially higher detection rates for the Christmas holiday period (December-January) than for the mid-year period (June-August). These findings are discussed in terms of their implications for hospital services, especially lost revenue and increased patient load. Health information managers are identified as a key group for addressing some of the current problems in this area.