Asaduzzaman Khan

Promoting reasoned argumentation, problem-solving and learning during small-group work

Teaching children to ask and answer questions is critically important if they are to engage in reasoned argumentation, problem‐solving and learning. This study describes how teachers can be taught to challenge childrens cognitive and metacognitive thinking during cooperative learning and the affect this has on childrens discourse and follow‐up performance on classroom‐based reasoning and problem‐solving tasks. The study involved two cohorts of teachers, the cooperative+questioning condition (n = 14) and the cooperative condition (n = 11) and two groups of students (3–4 person groups of mixed ability) from each teachers class. The results show that the teachers in the cooperative+questioning condition used more challenging and scaffolding behaviours than the teachers in the cooperative condition. The study also shows that the children in the cooperative+questioning condition provided more elaborations, reasons, and justifications for their responses than their peers in the cooperative condition. However, results on the follow up reasoning and problem‐solving (RP‐S) activity indicated that these oral discourse skills did not transfer to the written task, possibly because the children may not have enough time to consolidate their application in another context requiring them to work independently of their peers. Teachers need to be mindful of the apparent delay many students experience in being able to transfer the skills of problem‐solving, reasoning, and justifying demonstrated in oral discourse to written text and to provide for more instruction and reflection for these skills to emerge.

Does physician bias affect the quality of care they deliver? Evidence in the care of sexually transmitted infections

Background: Primary care providers are well placed to control the spread of sexually transmitted infections (STI); however, care is likely to be influenced by their attitudes and beliefs. The present study investigates the relationship between general practitioner’s (GP) self-reported level of comfort in dealing with patients with STI and the care they deliver. Methods: A postal survey was conducted using a stratified random sample of 15% of GPs practising in New South Wales, Australia, to assess practitioners’ management of STI. A total of 409 GPs participated in the study yielding a response rate of 45.4%. Results: Although over two-thirds (69–72%) of GPs were comfortable in managing STI in heterosexual or young patients, fewer than half (40–46%) felt comfortable caring for patients who were sex workers, indigenous, people who inject drugs, gay or lesbian. Practitioners who were comfortable were more likely to offer sexual risk assessment, safe-sex counselling, and were less likely to report limited ability to influence patients’ risk behaviours. Practitioner discomfort was positively associated with reporting constraints in sexual history-taking and the need for training in sexual health. Conclusions: Practitioners’ care and support for patients with STI are influenced by their inexperience, lack of skills and/or attitudes. The reasons for GP discomfort in managing STI patients need further exploration as does its impact on patient care.

How, where and with whom? Physical activity context preferences of three adult groups at risk of inactivity

Background Strategies to promote physical activity may be more successful if they reflect peoples interests. Purpose To explore physical activity contexts preferred by three adult groups at risk of inactivity: older adults, those with low income and those with high body mass index (BMI). Methods Cross-sectional data were from a mail survey of 7873 adults aged 42–67 years. Respondents indicated the extent of disagreement or agreement with a preference for each of 14 contexts relating to format (eg, vigorous), location (eg, outdoors) and social setting (eg, done alone). Data were analysed using multilevel multinomial logistic regression. Adjusted OR and 95% CI are reported. Results Those aged 60–67 (vs 42–49) years had significantly higher odds to prefer activities with people of same age, and significantly lower odds to prefer activities that are at a fixed time with scheduled sessions, competitive, team-based or vigorous. Adults with low (vs high) income had significantly higher odds to prefer activities that are low cost, not just about exercise, team-based, supervised, skill-based or that can be done alone, and significantly lower odds to prefer vigorous or outdoor activities. Adults with BMI 30+ (vs<25) had significantly higher odds to prefer activities that are supervised, with people the same sex, team-based, with people the same age, or at a fixed time with scheduled sessions. Conclusions These three groups had distinct preferences for how, where and with whom the physical activity is done. This information could be used by those who promote, design, deliver and evaluate physical activity opportunities.

The association between sedentary leisure and physical activity in middle-aged adults

Aim The aim of this study was to examine the association between time spent in sedentary leisure and physical activity level in mid-aged men and women. Methods Data were from the 2007 HABITAT study in Brisbane, Australia. A mail survey sent to 17 000 adults (40–65 years) provided 11 037 responses (68.5%), and 9121 (82.6%) were analysed. Sedentary leisure was quantified as hours/day spent sitting watching television, in home computer use, in general leisure, and overall, on a usual week and weekend day. Physical activity level (no activity, low, recommended, high, very high) included walking, moderate and vigorous activity combined into a measure of MET.min/week. Data were analysed separately for men and women using multilevel multinomial logistic regression with adjustment for sociodemographic and health variables. Results The only significant negative associations were between watching television on a week day and high activity in men (0.91; 0.83–0.98), and home computer use on a weekend day and very high activity in men (0.89; 0.81–0.98). For both men and women, there were significant positive associations between overall sedentary leisure time on a week day and very high activity (men: 1.07, 1.02–1.13; women: 1.10, 1.04–1.16), home computer use on a week day and very high activity (men: 1.11, 1.01–1.22; women: 1.15, 1.04–1.27) and general leisure on a week day and most activity levels. Conclusions Sedentary leisure is mainly independent of physical activity and does not preclude meeting physical activity recommendations.

Work engagement in cancer workers in Queensland: The flip side of burnout

Introduction: The study aimed to investigate factors associated with work engagement and burnout in cancer workers in Queensland.

Correlates of sexually transmitted infections in young Australian women

The study examined correlates of three common sexually transmitted infections (STIs) among Australian women. The sample comprised 9582 women aged 22–27 years who took part in the second postal survey in 2000, of the young cohort of the Australian Longitudinal Study on Womens Health. Self-reported rates of diagnosis in past four years were: chlamydia 1.47%(n = 141), genital herpes 1.75% (n = 168), and genital warts 3.45% (n = 331). Multivariate analyses revealed that the odds of all three STIs increased with number of male sexual partners and illicit drug use. Younger and rural women had higher odds of being diagnosed with chlamydia. The odds of both genital herpes and genital warts were higher with longer oral contraceptive pill use and higher stress, while women who had experienced violence were found to have higher odds of herpes. The identification of factors associated with common STIs among young Australian women will inform better-targeted health promotion and disease prevention programmes.

Randomized controlled trial of three burns dressings for partial thickness burns in children

BACKGROUND This study compared the effects of three silver dressing combinations on small to medium size acute partial thickness burns in children, focusing on re-epithelialization time, pain and distress during dressing changes. METHOD Children (0-15 years) with clean, ≤ 10% total body surface area (TBSA) partial thickness burns who met the inclusion criteria were included in the study. Children received either (1) Acticoat™; (2) Acticoat™ with Mepitel™; or (3) Mepilex Ag™ dressings. Measures of burn re-epithelialization, pain, and distress were recorded at dressing changes every 3-5 days until full re-epithelialization occurred. RESULTS One hundred and three children were recruited with 96 children included for analysis. No infections were detected for the course of the study. When adjusted for burn depth, Acticoat™ significantly increased the expected days to full re-epithelialization by 40% (IRR = 1.40; 95% CI: 1.14-1.73, p < 0.01) and Acticoat™ with Mepitel™ significantly increased the expected days to full re-epithelialization by 33% (IRR = 1.33; 95% CI: 1.08-1.63, p ≤ 0.01) when compared to Mepilex Ag™. Expected FLACC scores in the Mepilex Ag™ group were 32% lower at dressing removal (p = 0.01) and 37% lower at new dressing application (p = 0.04); and scores in the Acticoat™ with Mepitel™ group were 23% lower at dressing removal (p = 0.04) and 40% lower at new dressing application (p < 0.01), in comparison to the Acticoat™ group. Expected Visual Analog Scale-Pain (VAS-P) scores were 25% lower in the Mepilex Ag™ group at dressing removal (p = 0.04) and 34% lower in the Acticoat™ with Mepitel™ group (p = 0.02) at new dressing application in comparison to the Acticoat™ group. There was no significant difference between the Mepilex Ag™ and the Acticoat™ with Mepitel™ groups at all timepoints and with any pain measure. CONCLUSION Mepilex Ag™ is an effective silver dressing, in terms of accelerated wound re-epithelialization time (compared to Acticoat™ and Acticoat™ with Mepitel™) and decreased pain during dressing changes (compared to Acticoat™), for clean, < 10% TBSA partial thickness burns in children.

Rasch-based scoring offered more precision in differentiating patient groups in measuring upper limb function

OBJECTIVE To compare the discriminatory ability of Rasch-based and summative scoring in the context of assessing upper limb function of patients with stroke. STUDY DESIGN AND SETTING Data were from a cohort study of 497 adults with stroke undergoing physiotherapy. Upper limb function was assessed at admission and discharge using the upper limb subscale of the Motor Assessment Scale (UL-MAS). Rasch analysis was used to transform raw UL-MAS scores into interval measures. A relative precision (RP) index was used to differentiate patients by discharge destination. RESULTS The analysis confirmed the unidimensional structure of UL-MAS at both admission and discharge and demonstrated the adequate fit of the items. The RP index favored the Rasch-based scoring over the summative scoring in differentiating between the two patient groups, with significant gains in precision at admission (15%) and discharge (11%). When examining patients in the upper or lower quartile of UL-MAS, the gains in precision were statistically significant in favor of the Rasch-based scoring, with 20% precision at admission and 19% precision at discharge. CONCLUSION Rasch-based scoring was more precise in differentiating patient groups by discharge destination than the summative scoring used to measure upper limb function, especially at the extreme range of the scale.

Are specialist breast nurses available to Australian women with breast cancer

Despite evidence of benefit, little is know about Australian womens access to and perceptions of specialist breast nurse (SBN) care. The aims of this study were to: explore access to SBNs by Australian women with breast cancer; identify factors associated with receiving systematic SBN care (at least 3 SBN contacts including preoperatively and postoperatively and at follow-up); and explore the impact of systematic SBN care on womens perceptions of treatment and support. A population-based sample of 544 women with early breast cancer was randomly selected through state and territory cancer registries. Participants completed a structured telephone interview. Over half (52%) of the women had no SBN contact and only 11% received systematic SBN care. Factors associated with systematic SBN care were being treated in a public hospital and receiving systemic adjuvant therapy. Women who received systematic SBN care were more likely to report receiving enough support for themselves and their families, and enough information about where to get more support or counseling and the costs of treatment. In conclusion, systematic SBN contact was uncommon in this population-based sample but positively influenced womens perceptions of care, particularly in relation to the provision of support.

Statistical modelling of falls count data with excess zeros

Objective To examine the appropriateness of different statistical models in analysing falls count data. Methods Six count models (Poisson, negative binomial (NB), zero-inflated Poisson (ZIP), zero-inflated NB (ZINB), hurdle Poisson (HP) and hurdle NB (HNB)) were used to analyse falls count data. Empirical evaluation of the competing models was performed using model selection criteria and goodness-of-fit through simulation. Data used were from a prospective cohort study of women aged 40–80 years. Results Of the 465 women analysed, 330 (71%) did not fall at all. The analyses identified strong evidence of overdispersion in the falls data. The NB-based regression models (HNB, ZINB, NB) were better performed than the Poisson-based regression models (Poisson, ZIP, HP). Vuong tests favoured the HNB model over the NB and ZINB models and the NB model over the ZINB model. Model accuracy measures and Monte Carlo simulation of goodness-of-fit confirmed the lack of fit of the Poisson-based regression models and demonstrated the best fit for the HNB model with comparable good fit for the ZINB and NB models. Conclusions Falls count data consisting of a considerable number of zeros can be appropriately modelled by the NB-based regression models, with the HNB model offering the best fit. The evaluation procedure presented in this paper provides a defensible guideline to appropriately model falls or similar count data with excess zeros.