The Alcohol Intervention Training Program (AITP): A response to alcohol misuse in the farming community

BackgroundFarm men and women in Australia have higher levels of problematic alcohol use than their urban counterparts and experience elevated health risks associated with excessive alcohol consumption. The Sustainable Farm Families (SFF) program has worked successfully with farm men and women to address health, well- being and safety and has identified that further research and training is required to understand and address alcohol misuse behaviours. This project will add an innovative component to the program by training health professionals working with farm men and women to discuss and respond to alcohol-related physical and mental health problems.Methods/DesignA mixed method design with multi-level evaluation will be implemented following the development and delivery of a training program (The Alcohol Intervention Training Program {AITP}) for Sustainable Farm Families health professionals. Pre-, post- and follow-up surveys will be used to assess both the impact of the training on the knowledge, confidence and skills of the health professionals to work with alcohol misuse and associated problems, and the impact of the training on the attitudes, behaviour and mental health of farm men and women who participate in the SFF project. Evaluations will take a range of forms including self-rated outcome measures and interviews.DiscussionThe success of this project will enhance the health and well-being of a critical population, the farm men and women of Australia, by producing an evidence-based strategy to assist them to adopt more positive alcohol-related behaviours that will lead to better physical and mental health.<br /

Efficacy of blood flow restriction exercise during dialysis for end stage kidney disease patients: protocol of a randomised controlled trial

BACKGROUND: Exercise during haemodialysis improves strength and physical function. However, both patients and clinicians are time poor, and current exercise recommendations add an excessive time burden making exercise a rare addition to standard care. Hypothetically, blood flow restriction exercise performed during haemodialysis can provide greater value for time spent exercising, reducing this time burden while producing similar or greater outcomes. This study will explore the efficacy of blood flow restriction exercise for enhancing strength and physical function among haemodialysis patients. METHODS: This is a randomised controlled trial design. A total of 75 participants will be recruited from haemodialysis clinics. Participants will be allocated to a blood flow restriction cycling group, traditional cycling group or usual care control group. Both exercising groups will complete 3 months of cycling exercise, performed intradialytically, three times per week. The blood flow restriction cycling group will complete two 10-min cycling bouts separated by a 20-min rest at a subjective effort of 15 on a 6 to 20 rating scale. This will be done with pressurised cuffs fitted proximally on the active limbs during exercise at 50% of a pre-determined limb occlusion pressure. The traditional cycling group will perform a continuous 20-min bout of exercise at a subjective effort of 12 on the same subjective effort scale. These workloads and volumes are equivalent and allow for comparison of a common blood flow restriction aerobic exercise prescription and a traditional aerobic exercise prescription. The primary outcome measures are lower limb strength, assessed by a three repetition maximum leg extension test, as well as objective measures of physical function: six-minute walk test, 30-s sit to stand, and timed up and go. Secondary outcome measures include thigh muscle cross sectional area, body composition, routine pathology, quality of life, and physical activity engagement. DISCUSSION: This study will determine the efficacy of blood flow restriction exercise among dialysis patients for improving key physiological outcomes that impact independence and quality of life, with reduced burden on patients. This may have broader implications for other clinical populations with similarly declining muscle health and physical function, and those contraindicated to higher intensities of exercise.<br /

Higher social distress and lower psycho-social wellbeing: examining the coping capacity and health of people with hearing impairment

AbstractPurpose: The objectives of this paper are as follows: (1) propose an explanatory model as to how hearing disability may impact on health and (2) examine the model&rsquo;s utility.Methods: Data were collected on the psycho-social wellbeing, disability and physical health of farmers (n=56) participating in an intervention to manage the social impacts of hearing disability. Two models were proposed and examined using multiple hierarchical linear regression. Model 1 used self-rated quality of life and model 2 used capacity to manage hearing and listening impairments, as dependent variables.Results: The analyses found that physical measures of hearing impairment (audiograms) were not correlated with physical or mental health outcomes. However, in model 1, self-confidence and self-rated ability to manage hearing impairment were most closely associated with reduced quality of life (anxiety and diastolic blood pressure were positively associated with quality of life). In model 2, higher anxiety and reduced self-confidence were associated with decreasing ability to successfully manage one&rsquo;s hearing impairment.Conclusions: The findings support the explanatory model that stress is higher and wellbeing lower when the fit between the person&rsquo;s coping capacity and environmental demands is poor.<br /

Evaluation of an alcohol intervention training program for nurses in rural Australia

Aim: This paper reports on the development, implementation and evaluation of the Alcohol Intervention Training Program (AITP) designed to enhance nurses&rsquo; capacity to work with farming men and women who misuse alcohol.Background: In rural and regional areas where alcohol-related behaviours and problems are relatively elevated, nurses may be the key health professionals dealing with individuals who misuse alcohol. However, they are often ill-equipped to do this, have low confidence in their ability to do so, and perceive numerous barriers. Training is required for these nurses.Methods: We developed the AITP to enhance nurses&rsquo; capacity to work with people with alcohol-related problems. The data were collected during 2010. An intervention group of 15 rural nurses completed the AITP. Nurses&rsquo; perceived barriers, attitudes, and perceived performance in working with clients with alcohol problems, and the frequency of engaging with this client group were evaluated. Scores on these measures were compared to those of a control group of 17 nurses&rsquo; pre-treatment, post-treatment and at 3-month follow-up.Results: Participation in the AITP resulted in initial improvements in attitudes to working with alcohol problems, but no change in perceived barriers to doing so. The level of engagement with clients having alcohol-related problems increased, as did perceptions of work performance.Conclusion: The AITP enhances the ability of rural nurses to address the alcohol and associated health issues of clients in rural and regional areas. However, the program needs refinement and further evaluation.<br /

Training and experience of nurses in responding to alcohol misuse in rural communities

Objective: Alcohol misuse by farmers continues to challenge rural nurses. This article reports on the experiences of Australian nurses participating in the Alcohol Intervention Training Program (AITP)