Out of sight, but not out of mind: a case study of the collaborative development of a university-wide orientation resource for online students.

The global online education sector has been rising rapidly, particularly during and after the events of 2020, and is becoming mainstream much sooner than expected. Despite this, research studies report higher levels of perceived isolation, difficulties with engagement, and higher attrition rates in online compared to equivalent on-campus programs. Reasons include restrictions to the type of institutional support accessible by online students, and the lack of comprehensiveness of orientation resources. This paper describes the collaborative efforts by a cross-faculty academic team, supported by a community of practice, to create a university-wide online orientation resource-the Monash Online Learning Hub (MOLH). The development of the MOLH involved multiple phases, including an analysis of current practice, resource design and content creation, formative evaluation by staff and students, and successful integration into the university's mainstream student orientation platform for widescale implementation. The methods adopted were varied, and involved generating both qualitative and quantitative data across multiple phases of development from online education experts at the University, that culminated in the gradual building and refinement of the MOLH. Final outcomes, implications and lessons learned are also discussed in this paper.

Systematic review of incidental physical activity community interventions.

BACKGROUND: Increasing incidental physical activity (IPA) such as active transport has substantial public health potential. OBJECTIVE: This systematic review describes community-based and community-wide IPA interventions and assesses their effectiveness. METHOD: Data sources (Medline, Embase, PsycINFO and CINAHL) were searched along with the reference lists of identified systematic reviews and included articles. Eligibility criteria; 4+ weeks in duration; 20+ participants; community-based or community-wide; stated aim to increase IPA. RESULTS: Forty three studies were identified from 42 original articles; more than half (60%) aimed to increase stair use compared to escalator and/or lift use; a quarter (23%) aimed to increase active transport; and, 16% to increase playground energy expenditure. More than two-thirds of studies reported a significant increase in IPA. Accurate comparisons between studies were not possible due to substantial heterogeneity in study design. Critical appraisal of studies revealed that the level of bias was moderate-high in most of the studies (77%). CONCLUSION: Due to the heterogeneity and bias of included studies, only limited conclusions can be drawn about the effectiveness of IPA interventions. However, this systematic review provides a timely summary of current evidence that can be used to inform decision-makers in designing IPA interventions in the community.

Co-morbid depression and chronic illness related to coping and physical and mental health status.

A partial latent structural regression analysis was used to evaluate the role of coping resources, depression, diet and exercise on mental and physical health status. The sample consisted of 113 participants (59 females and 54 males) with a mean age of 59.38 years (SD = 10.52). Coping resources, depression and exercise explained 52 and 26% of the variance in mental and physical health status, respectively. Fewer coping resources predicted higher levels of depression and both predicted worse mental health. Only higher levels of depression predicted worse physical health status. There were also significant indirect effects of coping on mental and physical health status through depression. The development of cognitive, social and emotional coping strategies is important for managing depression and supporting positive mental health. These results highlight the important role of health psychologists in the care of individuals with chronic illness. Additionally, the management of depression is important in maintaining positive physical health.

A Self-Managed Online Mindfulness Program in a University-Wide Learning Management System Orientation Site: A Real-World Ecological Validation Study.

The efficacy of mindfulness-based interventions in randomised-controlled trials and large experimental studies has been demonstrated in university student populations. Whilst these investigations have provided insight into the nature of the delivery of mindfulness-based practices, there has been little research in the implementation of self-managed online student wellbeing and mindfulness programs at university. This ecological validation study conducted in 2020 evaluated a real-world implementation of a large, university-wide, online mindfulness-based program that was accessible fully online via the tertiary institutions' Learning Management System (LMS) student orientation site. The total sample included 833 participants from a range of disciplines and faculties at Monash University, Australia. At the end of the study, 236 (28.3%) participants were retained and completed the follow-up survey. Participants had the option to engage with the fully self-managed online mindfulness program for a 12-week semester. The mindfulness practices were pre-recorded, audio-guided sessions, and 10-15 min in length. Baseline and end of semester questionnaires included the 14-item Warwick-Edinburgh Mental Wellbeing Scale, 10-item Perceived Stress Scale and the 18-item Five Facet Mindfulness Questionnaire. Participants who engaged with the mindfulness program over 3 or more weeks showed significant improvements in all three outcome measures, and all participants showed significant improvements in wellbeing at the end of semester. Learning analytics obtained via the LMS revealed that 58.6% (n = 489) had not logged into the mindfulness program at all, almost a third (31.0%, n = 259) logged into the program materials once or twice, and 10.2% (n = 85) of the whole sample engaged with the program actively, having logged in three or more times. The total number of student logins peaked in week 2, reduced between week 2 and week 7 and thereafter activity remained stable until the end of the semester. We hypothesise that the changes in wellbeing, stress and mindfulness at the end of the semester seen in the low engagement participants may partly be explained by the circumstances of COVID-19 restrictions improving. This study has revealed and discusses the complexities of student behaviour and implications for implementing an online mindfulness program in the real- world setting of a university.

An Evaluation of an Online Brief Mindfulness-Based Intervention in Higher Education: A Pilot Conducted at an Australian University and a British University.

Mental ill health among higher education students is a well-established problem; therefore, it is imperative to implement preventative approaches to support wellbeing. Blended and fully online education programmes widens access for mature or returning students; however, the psychological wellbeing of this sub-group of students is under-researched. Finally, evaluating wellbeing interventions that meet the needs of university students as well as accessible for online students is required. The aim of this study was to evaluate a brief, online and mindfulness-based intervention to assist the self-management of wellbeing and stress for both online and on-campus higher education students. The total sample included 427 participants (96% psychology students) at Monash University, Australia (n=283) and King's College London (n=144), with 152 participants completing the whole study. Participants were allocated to a brief, self-guided, online and mindfulness-based intervention (over the course of one study period; n=297), or to a wait-list control group (n=148). Baseline and end of semester questionnaires included the 14-item Warwick-Edinburgh Mental Wellbeing Scale, 10-item Perceived Stress Scale and the 15-item Mindful Attention Awareness Scale. Regression modelling revealed the intervention condition accounted for up to 12% of the variability in change in student wellbeing, stress and mindfulness between the start and end of semester (when controlling for baseline). These findings support the implementation of a brief, online and asynchronous mindfulness-based intervention for supporting student mental health and psychological wellbeing. An on-going challenge in practice includes engaging and maintaining student engagement in wellbeing initiatives.

Prognosis of hyponatremia in elderly patients with fragility fractures.

BACKGROUND: Hyponatremia (serum sodium < 135 mmol/L) is the commonest electrolyte imbalance encountered in clinical practice. It is associated with multiple poor clinical outcomes including increased length of hospital stay, institutionalization and mortality. Prevalence of hyponatremia is higher in frail patient groups, and elderly patients with fragility fractures (EPFF) are particularly susceptible. This study aimed to establish the impact of hyponatremia on total length of inpatient stay (TLOS), need for inpatient rehabilitation and mortality in EPFF. METHODS: Prospective observational study of consenting adults aged ≥ 65 years admitted with a fragility fracture to a university hospital between January 7, and April 4, 2013. Demographic and clinical data, length of hospital stay, discharge destination and any participant deaths were recorded. Prevalence of hyponatremia on admission and incidence of cases developing in hospital were reported. Basic demographic data and serum sodium results were included in multivariate linear regression models for TLOS. Difference in mortality rate and proportion of individuals discharged to inpatient rehabilitation between the hyponatremic and normonatremic group were tested using Chi-squared and Fisher's exact tests. Unadjusted odds ratios (ORs) and 95% confidence intervals (CIs) were also calculated. RESULTS: Of 212 cases, 127 (60%) EPFF were recruited (mean age 79 years, 78% female). Of those not recruited, 66 had incapacity to consent and 19 refused participation. Thirty-three cases of hyponatremia were identified; point prevalence on admission was 13.4% and a further 12.6% developed hyponatremia during admission. There were no statistically significant differences in patient characteristics between the hyponatremic and normonatremic group. Hyponatremic participants had a 66.7% increased time from admission to surgery (P = 0.014) and a 51.5% increased length of index hospital stay (P = 0.006). Factors independently associated with increased TLOS were age (P = 0.03) and drop in sodium during admission (P < 0.001). Mortality rate and proportion of participants discharged to inpatient rehabilitation were higher in the hyponatremic group (OR 4.2 (95% CI: 0.9 - 19.8) and 2.2 (95% CI: 0.9 - 5.1), respectively), but figures did not reach statistical significance. CONCLUSIONS: Hyponatremia is highly prevalent in EPFF, seen in 33/127 cases (26%), and is associated with increased length of index hospital stay. Drop in serum sodium during admission was independently associated with increased TLOS.

When the cats are away: the impact of sporting events on assault- and alcohol-related emergency department attendances.

INTRODUCTION AND AIMS: Despite the attention given to the broad topic of alcohol and violence, there are few studies of this relationship in the context of sporting events and their impact on alcohol-related hospital emergency department (ED) attendances, none of which are Australian. METHODS: De-identified patient records from Barwon Health's Geelong Hospital ED were analysed from 1 July 2005 to 16 February 2010. Information contained in these records included age, gender, suburb of residence, attendance date and time, arrival mode and reason for attendance. The ED triage database was searched for attendances relating to alcohol, drugs and assault of which 16,940 cases were returned. RESULTS: There was a substantial increase in annual alcohol-related ED attendances from 2006 to 2009. Hierarchical binary logistic regression analyses showed that having a game on a particular day did not contribute to the model, but there were significantly more ED attendances for assaults on days when the Geelong Cats won. There were no significant predictors of ED attendance for alcohol-related harm in the variables studied. DISCUSSION: The findings of the study suggest that there are significantly more assault-related attendances at the ED in Geelong when the local national football team, the Geelong Cats, won. None of the variables under investigation appears to have impacted on alcohol-related attendances which were not assaults (i.e. injuries or intoxication). CONCLUSIONS: It appears that increases in ED attendances associated with the success of a local sporting team are not significantly associated with alcohol use and are more influenced by other factors.

Medical and psychology students' knowledge of and attitudes towards mindfulness as a clinical intervention.

BACKGROUND: Mindfulness is a technique for training people to pay full attention and to fully accept the reality of what they are paying attention to. The clinical efficacy of mindfulness has been increasingly demonstrated during the last two decades. Very little research, however, has been undertaken on health professionals' and students of health professions' knowledge of and attitudes towards mindfulness. These may affect the current and future level of use of a technique that offers important clinical advantages. OBJECTIVES: We aimed to compare knowledge of and attitudes towards mindfulness of medical students without exposure to it in their training with psychology students without exposure and with medical students with exposure to mindfulness in their training. METHODS: A total of 91 medical students from Monash University, 49 medical students from Deakin University, and 31 psychology students from Deakin University were given a questionnaire that elicited quantitative and qualitative responses about level of knowledge of mindfulness and willingness to administer or recommend it to their future patients. RESULTS: Psychology students without exposure to mindfulness in their training have a greater knowledge of it and are more likely to administer it or recommend it than are medical students without exposure to it in their training. Medical students with exposure to mindfulness in their course have a greater knowledge of it and are more likely to administer it or recommend it than are medical students without exposure. Knowledge of mindfulness is positively correlated with students' willingness to use or recommend it. CONCLUSIONS: Possible implications of the findings of this study are that if future doctors are routinely instructed in mindfulness as a clinical intervention they may be more likely to form a more positive attitude towards it, that is more consistent with that of nonmedical health professions such as psychologists, and that they therefore may be more likely to administer it or refer its use. The inclusion of mindfulness exposure in medical courses, and possibly also in psychology courses, may help mindfulness fulfill its clinical potential, and increasingly benefit patients who are suffering from a range of clinical conditions.

The long-term effect of lockouts on alcohol-related emergency department attendances within Ballarat, Australia.

INTRODUCTION AND AIMS: Alcohol has consistently been demonstrated to increase levels of aggression and violence, particularly in late night licensed venues. Since August 2003, Ballarat (a regional city of approximately 95,000 inhabitants, in Victoria, Australia) has implemented a 3:00 AM 'lockout' with the goal of reducing alcohol-related harms. This paper is the first long-term analysis of the effect of this type of intervention on emergency department (ED) attendances. The aim of this paper is to examine the effectiveness of a lockout intervention within the city of Ballarat, Victoria on alcohol-related ED presentations. DESIGN AND METHODS: This paper examines alcohol-related injury frequencies pre- to post-lockout intervention in Ballarat, Victoria, from 1999 to 2009, as indicated by ED International Classification of Diseases codes for acute alcohol intoxication and assault. These data are further compared with similar data from Geelong, Victoria, as a control. RESULTS: A small reduction in alcohol-related assaults and intoxication rates within Ballarat occurred before and after the introduction of the lockout. However, after this decline these rates steadily increased, surpassing Geelong by 2005. DISCUSSION AND CONCLUSIONS: There is no discernible long-term impact on alcohol-related ED attendances of the lockout intervention in Ballarat. As such, other interventions may be more appropriate to reduce alcohol-related ED attendances.

Vested interests in addiction research and policy. Alcohol industry use of social aspect public relations organizations against preventative health measures.

AIM: It has been proposed that alcohol industry 'social aspects/public relations' organizations (SAPROs) serve the agenda of lending credibility to industry claims of corporate responsibility while promoting ineffective industry-friendly interventions (such as school-based education or TV advertising campaigns) and creating doubt about interventions which have a strong evidence base (such as higher taxes on alcoholic beverages). This paper investigated whether submissions to Australia's National Preventative Health Taskforce (NPHT) from alcohol industry bodies regarding the Australian SAPRO, Drinkwise, have used this organization to demonstrate corporate responsibility while promoting industry-friendly interventions. METHOD: Submissions to the Australian National Preventative Health Taskforce (NPHT) discussion paper Australia, the healthiest country by 2020 (n = 375) were examined to identify those with primary alcohol content. A thematic analysis of the resulting 33 submissions was conducted to determine which organization, institution or individual discussed Drinkwise. SETTING: Australia. FINDINGS: Nine of the 33 submissions discussed Drinkwise; all were submitted by the alcohol industry or its affiliates. Every industry submission referred to Drinkwise either as providing evidence of social responsibility or by suggesting the industry-friendly actions of Drinkwise as alternatives to those recommended by the NPHT report. CONCLUSIONS: Drinkwise has been used by the alcohol industry to create an impression of social responsibility while promoting interventions that maintain profits and campaigning against effective interventions such as higher taxes on alcohol.