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Sarma H, Rahman M, Tariqujjaman M, Islam MA, Mbuya MNN, Aaron GJ, Askari S, Harbour C, Khondker R, Bipul M, Sultana S, Rahman MA, Shahin SA, Chowdhury M, Afsana K, Ghosh S, Banwell C, D’Este C, Salasibew M, Neufeld LM, Ahmed T. Impact of market-based home fortification with micronutrient powder on childhood anemia in Bangladesh: a modified stepped wedge design. Front Nutr 2024; 10:1271931. [PMID: 38249611 PMCID: PMC10796820 DOI: 10.3389/fnut.2023.1271931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/06/2023] [Indexed: 01/23/2024] Open
Abstract
Background Anemia poses a significant public health problem, affecting 1.6 billion people and contributing to the loss of 68.4 million disability-adjusted life years. We assessed the impact of a market-based home fortification program with micronutrient powder (MNP) called Pushtikona-5 implemented by Bangladesh Rural Advancement Committee (BRAC) on the prevalence of anemia among children aged 6-59 months in Bangladesh. Methods We used a modified stepped wedged design and conducted three baseline, two midline, and three endline surveys to evaluate the Pushtikona-5 program implemented through three BRAC program platforms. We interviewed children's caregivers, and collected finger-prick blood samples from children to measure hemoglobin concentration. We also collected data on coverage of Pushtikona-5 and infant and young child feeding (IYCF) practices. We performed bivariate and multivariable analysis and calculated adjusted risk ratios (ARRs) to assess the effect of program outcomes. Results A total of 16,936 households were surveyed. The prevalence of anemia was 46.6% at baseline, dropping to 32.1% at midline and 31.2% at endline. These represented adjusted relative reductions of 34% at midline (RR 0.66, 95%CI 0.62 to 0.71, value of p <0.001) and 32% at endline (RR 0.68, 95%CI 0.64 to 0.71, value of p <0.001) relative to baseline. Regarding MNP coverage, at baseline, 43.5% of caregivers surveyed had heard about MNP; 24.3% of children had ever consumed food with MNP, and only 1.8% had consumed three or more sachets in the 7 days preceding the survey. These increased to 63.0, 36.9, and 4.6%, respectively, at midline and 90.6, 68.9, and 11.5%, respectively, at endline. Conclusion These results show evidence of a reduction in the prevalence of anemia and an improvement in coverage. This study provides important evidence of the feasibility and potential for impact of linking market-based MNP distribution with IYCF promotion through community level health workers.
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Affiliation(s)
- Haribondhu Sarma
- National Centre for Epidemiology and Population Health, Australian National University, Acton, ACT, Australia
- Nutrition Research Division, icddr,b, Dhaka, Bangladesh
| | | | | | | | | | - Grant J. Aaron
- Global Alliance for Improved Nutrition, Geneva, Switzerland
| | - Sufia Askari
- Maternal Child Health & Nutrition, Sight and Life, Geneva, Switzerland
- The Children’s Investment Fund Foundation, London, United Kingdom
| | | | | | | | - Sabiha Sultana
- Global Alliance for Improved Nutrition, Dhaka, Bangladesh
| | | | | | | | - Kaosar Afsana
- Health, Nutrition and Population Program, BRAC, Dhaka, Bangladesh
| | - Samik Ghosh
- The Children’s Investment Fund Foundation, London, United Kingdom
| | - Cathy Banwell
- National Centre for Epidemiology and Population Health, Australian National University, Acton, ACT, Australia
| | - Catherine D’Este
- National Centre for Epidemiology and Population Health, Australian National University, Acton, ACT, Australia
| | | | | | - Tahmeed Ahmed
- Nutrition Research Division, icddr,b, Dhaka, Bangladesh
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Middleton S, Dale S, McElduff B, Coughlan K, McInnes E, Mikulik R, Fischer T, Van der Merwe J, Cadilhac D, D’Este C, Levi C, Grimshaw JM, Grecu A, Quinn C, Cheung NW, Koláčná T, Medukhanova S, Sanjuan Menendez E, Salselas S, Messchendorp G, Cassier-Woidasky AK, Skrzypek-Czerko M, Slavat-Plana M, Antonella U, Pfeilschifter W. Translation of nurse-initiated protocols to manage fever, hyperglycaemia and swallowing following stroke across Europe (QASC Europe): A pre-test/post-test implementation study. Eur Stroke J 2022; 8:132-147. [PMID: 37021183 PMCID: PMC10069193 DOI: 10.1177/23969873221126027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/24/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: Poor adoption of stroke guidelines is a problem internationally. The Quality in Acute Stroke Care (QASC) trial demonstrated significant reduction in death and disability with facilitated implementation of nurse-initiated Methods: This was a multi-country, multi-centre, pre-test/post-test study (2017–2021) comparing post implementation data with historically collected pre-implementation data. Hospital clinical champions, supported by the Angels Initiative conducted multidisciplinary workshops discussing pre-implementation medical record audit results, barriers and facilitators to FeSS Protocol implementation, developed action plans and provided education, with ongoing support co-ordinated remotely from Australia. Prospective audits were conducted 3-month after FeSS Protocol introduction. Pre-to-post analysis and country income classification comparisons were adjusted for clustering by hospital and country controlling for age/sex/stroke severity. Results: Data from 64 hospitals in 17 countries (3464 patients pre-implementation and 3257 patients post-implementation) showed improvement pre-to-post implementation in measurement recording of all three FeSS components, all p < 0.0001: fever elements (pre: 17%, post: 51%; absolute difference 33%, 95% CI 30%, 37%); hyperglycaemia elements (pre: 18%, post: 52%; absolute difference 34%; 95% CI 31%, 36%); swallowing elements (pre: 39%, post: 67%; absolute difference 29%, 95% CI 26%, 31%) and thus in overall FeSS Protocol adherence (pre: 3.4%, post: 35%; absolute difference 33%, 95% CI 24%, 42%). In exploratory analysis of FeSS adherence by countries’ economic status, high-income versus middle-income countries improved to a comparable extent. Discussion and conclusion: Our collaboration resulted in successful rapid implementation and scale-up of FeSS Protocols into countries with vastly different healthcare systems.
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Affiliation(s)
- Sandy Middleton
- Nursing Research Institute, St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne & Australian Catholic University, Sydney, NSW, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia
| | - Simeon Dale
- Nursing Research Institute, St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne & Australian Catholic University, Sydney, NSW, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia
| | - Benjamin McElduff
- Nursing Research Institute, St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne & Australian Catholic University, Sydney, NSW, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia
| | - Kelly Coughlan
- Nursing Research Institute, St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne & Australian Catholic University, Sydney, NSW, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia
| | - Elizabeth McInnes
- Nursing Research Institute, St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne & Australian Catholic University, Sydney, NSW, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia
| | - Robert Mikulik
- International Clinical Research Centre, Neurology Department, St. Ann’s University Hospital and Masaryk University, Brno, Czech Republic
| | - Thomas Fischer
- Angels Initiative, Boehringer Ingelheim International GmbH, Hamburg, Germany
| | - Jan Van der Merwe
- Angels Initiative, Boehringer Ingelheim International GmbH, Hamburg, Germany
| | - Dominique Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Catherine D’Este
- National Centre for Epidemiology and Population Health (NCEPH), Australian National University, Canberra, Australia
- Sax Institute, Sydney, Australia
| | - Christopher Levi
- John Hunter Health and Innovation Precinct, HNE LHD, New Lambton, NSW, Australia
- Department of Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Jeremy M Grimshaw
- University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Andreea Grecu
- International Clinical Research Centre, Neurology Department, St. Ann’s University Hospital and Masaryk University, Brno, Czech Republic
| | - Clare Quinn
- Prince of Wales Hospital, Randwick, Australia
| | - Ngai Wah Cheung
- Centre for Diabetes and Endocrinology Research, Westmead Hospital, University of Sydney, Sydney, NSW, Australia
| | | | | | | | | | | | | | | | - Merce Slavat-Plana
- Health Department, Agency for Health Quality and Assessment (AQuAS), CIBER Epidemiología y Salud Pública, CIBERESP, Stroke Programme, Barcelona, Spain
| | - Urso Antonella
- Hospital Network Area-Regional Health Department, Regione Lazio, Rome, Italy
| | - Waltraud Pfeilschifter
- Department of Neurology and Clinical Neurophysiology, Städtisches Klinikum Lüneburg, Lüneburg, Germany
- Department of Neurology, Goethe University, Frankfurt am Main, Germany
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McInnes E, Dale S, Craig L, Phillips R, Fasugba O, Schadewaldt V, Cheung NW, Cadilhac DA, Grimshaw JM, Levi C, Considine J, McElduff P, Gerraty R, Fitzgerald M, Ward J, D’Este C, Middleton S. Process evaluation of an implementation trial to improve the triage, treatment and transfer of stroke patients in emergency departments (T 3 trial): a qualitative study. Implement Sci 2020; 15:99. [PMID: 33148343 PMCID: PMC7640433 DOI: 10.1186/s13012-020-01057-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/19/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The implementation of evidence-based protocols for stroke management in the emergency department (ED) for the appropriate triage, administration of tissue plasminogen activator to eligible patients, management of fever, hyperglycaemia and swallowing, and prompt transfer to a stroke unit were evaluated in an Australian cluster-randomised trial (T3 trial) conducted at 26 emergency departments. There was no reduction in 90-day death or dependency nor improved processes of ED care. We conducted an a priori planned process influential factors that impacted upon protocol uptake. METHODS Qualitative face-to-face interviews were conducted with purposively selected ED and stroke clinicians from two high- and two low-performing intervention sites about their views on factors that influenced protocol uptake. All Trial State Co-ordinators (n = 3) who supported the implementation at the 13 intervention sites were also interviewed. Data were analysed thematically using normalisation process theory as a sensitising framework to understand key findings, and compared and contrasted between interviewee groups. RESULTS Twenty-five ED and stroke clinicians, and three Trial State Co-ordinators were interviewed. Three major themes represented key influences on evidence uptake: (i) Readiness to change: reflected strategies to mobilise and engage clinical teams to foster cognitive participation and collective action; (ii) Fidelity to the protocols: reflected that beliefs about the evidence underpinning the protocols impeded the development of a shared understanding about the applicability of the protocols in the ED context (coherence); and (iii) Boundaries of care: reflected that appraisal (reflexive monitoring) by ED and stroke teams about their respective boundaries of clinical practice impeded uptake of the protocols. CONCLUSIONS Despite initial high 'buy-in' from clinicians, a theoretically informed and comprehensive implementation strategy was unable to overcome system and clinician level barriers. Initiatives to drive change and integrate protocols rested largely with senior nurses who had to overcome contextual factors that fell outside their control, including low medical engagement, beliefs about the supporting evidence and perceptions of professional boundaries. To maximise uptake of evidence and adherence to intervention fidelity in complex clinical settings such as ED cost-effective strategies are needed to overcome these barriers. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ( ACTRN12614000939695 ).
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Affiliation(s)
- Elizabeth McInnes
- Nursing Research Institute - St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne & Australian Catholic University, School of Nursing, Midwifery & Paramedicine, Australian Catholic University, Level 4, Daniel Mannix Building, Brunswick Street, Fitzroy, Victoria 3065 Australia
| | - Simeon Dale
- Nursing Research Institute - St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne & Australian Catholic University, Level 5, deLacy Building, Victoria Street, Darlinghurst, New South Wales 2010 Australia
| | - Louise Craig
- Nursing Research Institute - St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne & Australian Catholic University, Level 5, deLacy Building, Victoria Street, Darlinghurst, New South Wales 2010 Australia
| | - Rosemary Phillips
- Nursing Research Institute - St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne & Australian Catholic University, Level 5, deLacy Building, Victoria Street, Darlinghurst, New South Wales 2010 Australia
| | - Oyebola Fasugba
- Nursing Research Institute - St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne & Australian Catholic University, Level 2, Signadou Building, Australian Catholic University, 223 Antill Street, Watson, Australian Capital Territory 2602 Australia
| | - Verena Schadewaldt
- Department of Neurosurgery, University of Melbourne and Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3050 Australia
- Formerly: Nursing Research Institute - St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne & Australian Catholic University, Victoria, Australia
| | - N. Wah Cheung
- Centre for Diabetes and Endocrinology Research, Westmead Hospital and University of Sydney, Westmead, Sydney, New South Wales Australia
| | - Dominique A. Cadilhac
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria Australia
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria Australia
| | - Jeremy M. Grimshaw
- Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa Hospital – General Campus, Centre for Practice-Changing Research (CPCR), 501 Smyth Road, Room 1286, Ottawa, Ontario K1H 8 L6 Canada
- Department of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H 8 M5 Canada
| | - Chris Levi
- The Sydney Partnership for Health Education Research & Enterprise (SPHERE), University of New South Wales, Liverpool, New South Wales Australia
| | - Julie Considine
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria Australia
- Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Victoria 3220 Australia
| | - Patrick McElduff
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales Australia
| | - Richard Gerraty
- Department of Medicine, Monash University, Melbourne, Victoria 3800 Australia
- Neurosciences Clinical Institute, Epworth Hospital, Richmond, Victoria 3121 Australia
| | - Mark Fitzgerald
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria 3800 Australia
- Faculty of Science, Engineering and Technology, Swinburne University of Technology, Melbourne, Australia
| | - Jeanette Ward
- Nulungu Research Institute, University of Notre Dame Australia, Broome, Western Australia Australia
| | - Catherine D’Este
- National Centre for Epidemiology and Population Health (NCEPH), Australian National University, Canberra, Australian Capital Territory 0200 Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales 2308 Australia
| | - Sandy Middleton
- Nursing Research Institute - St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne & Australian Catholic University, Level 5, deLacy Building, Victoria Street, Darlinghurst, New South Wales 2010 Australia
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Zulfiqar T, D’Este C, Strazdins L, Banwell C. Intergenerational Contradictions in Body Image Standards Among Australian Immigrant Mothers and Children: A Mixed-Methods Study. Glob J Health Sci 2020. [DOI: 10.5539/gjhs.v12n6p47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In this mixed-methods study, we explored how gender and cultural factors, including social status were linked with children’s immigrant backgrounds and their body image dissatisfaction and weight management strategies in Australia. Cross-sectional data analysis of 10-11-year-old children from the Birth cohort of the “Longitudinal Study of Australian Children” showed that approximately half of the children were dissatisfied with their body images. A higher proportion of these were children of immigrants from low-and-middle-income-countries. Additionally, about three-quarters children were actively managing their weights. Children of immigrants from low-and-middle-income-countries constituted a higher proportion of these also. Among boys, desiring a heavier body was highest for those with immigrant mothers from low-and-middle-income-countries, while the desire to be thinner was highest among girls of immigrants from low-and-middle-income-countries. Although the percentage of children who adopted strategies to gain weight was very small, boys of immigrants from low-and-middle-income-countries, in particular, were almost three times as likely as non-immigrant boys, to try to gain weight (18% vs 5.9%, respectively).
Qualitative face-to-face interviews with immigrant mothers and their 8-11-year-old children revealed intergenerational variations in body image standards. Maternal body image standards were drawn from their origin countries, but children followed Australian norms. Despite increased obesity awareness amongst mothers, they desired higher body weight for their children, due to an association with high status and health in origin countries. However, children were aware of the stigma, unpopularity, and low status associated with high body weights in Australia. To reduce cultural and status-based obesity inequalities, Australian obesity prevention plans must include culturally responsive health promotion strategies for immigrant parents and their children to improve their knowledge about healthy weights and weight management strategies.
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Kalucy D, Nixon J, Parvizian M, Fernando P, Sherriff S, McMellon J, D’Este C, Eades SJ, Williamson A. Exploring pathways to mental healthcare for urban Aboriginal young people: a qualitative interview study. BMJ Open 2019; 9:e025670. [PMID: 31371286 PMCID: PMC6677949 DOI: 10.1136/bmjopen-2018-025670] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 06/28/2019] [Accepted: 06/28/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To explore the perceptions of Aboriginal Community Controlled Health Service (ACCHS) staff involved in providing mental healthcare to Aboriginal young people of the current and ideal pathways to mental healthcare for urban Aboriginal young people attending ACCHSs, and to identify what additional supports staff may need to provide optimal mental healthcare to Aboriginal young people. DESIGN Qualitative interview study conducted during May 2016-2017. SETTING Primary care, at two ACCHSs participating in the Study of Environment on Aboriginal Resilience and Child Health in New South Wales. PARTICIPANTS Purposive sampling of staff involved in mental healthcare pathways of Aboriginal young people, including general practitioners (GPs), nurses and Aboriginal Health Workers (AHWs). RESULTS All individuals approached for interview (n=21) participated in the study. Four overarching themes and seven sub-themes were identified: availability and use of tools in practice (valuing training and desire for tools and established pathways), targeting the ideal care pathway (initiating care and guiding young people through care), influencing the care pathway (adversities affecting access to care and adapting the care pathway) and assessing future need (appraising service availability). CONCLUSIONS Participants desired screening tools, flexible guidelines and training for healthcare providers to support pathways to mental healthcare for Aboriginal young people. Both GPs and AHWs were considered key in identifying children at risk and putting young people onto a pathway to receive appropriate mental healthcare. AHWs were deemed important in keeping young people on the care pathway, and participants felt care pathways could be improved with the addition of dedicated child and adolescent AHWs. The ACCHSs were highlighted as essential to providing culturally appropriate care for Aboriginal young people experiencing mental health problems, and funding for mental health specialists to be based at the ACCHSs was considered a priority.
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Affiliation(s)
- Deanna Kalucy
- The Sax Institute, Sydney, New South Wales, Australia
| | - Janice Nixon
- The Sax Institute, Sydney, New South Wales, Australia
| | - Michael Parvizian
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Simone Sherriff
- The Sax Institute, Sydney, New South Wales, Australia
- Sydney School of Public Health, Poche Centre for Indigenous Health, Sydney, New South Wales, Australia
| | - Jennifer McMellon
- Riverina Medical and Dental Aboriginal Corporation, Wagga Wagga, New South Wales, Australia
| | - Catherine D’Este
- College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Sandra J Eades
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Anna Williamson
- The Sax Institute, Sydney, New South Wales, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Zulfiqar T, Burns RA, D’Este C, Strazdins L. BMI trajectories and risk factors among 2-11-year-old children by their immigrant status: evidence from the Longitudinal Study of Australian Children. BMJ Open 2019; 9:e026845. [PMID: 31289070 PMCID: PMC6615842 DOI: 10.1136/bmjopen-2018-026845] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 05/14/2019] [Accepted: 05/31/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE This study aimed to identify body mass index (BMI) trajectories and their predictors in Australian children by their maternal immigrant status. METHODS Data on 4142 children aged 2-3 years were drawn from the birth cohort of the Longitudinal Study of Australian Children. BMI was calculated according to the International Obesity Task Force cut-off points. Immigrant status was determined by the Australian Bureau of Statistics and the United Nations Development Programme, Human Development Index criteria. Latent class growth analysis estimated distinct BMI trajectories, and multinomial logistic regression analysis examined factors associated with these BMI trajectories. RESULTS Two BMI groups and six BMI trajectories were identified. The stable trajectories group included high-risk (10%, n=375), moderate-risk (5%, n=215) and low-risk (68%, n=2861) BMI trajectories. The changing trajectories group included delayed-risk (6%, n=234), gradual-risk (8%, n=314) and declining-risk (3%, n=143) BMI trajectories. We found some evidence that children of immigrants from low-and middle-income countries were more likely to have moderate-risk and high-risk BMI trajectories compared with low-risk BMI trajectory. However, these associations were insignificant in fully adjusted models. The explanatory risk factors for moderate-risk and high-risk BMI trajectory were birth weight, family socioeconomic position, and organised sports participation. Our results also suggest that 4-7 years of age may be important for the prevention of overweight/obesity in children. DISCUSSION A better understanding of the risk factors associated with distinct BMI trajectories in immigrant children will inform effective preventive strategies. Some of these risk factors such as non-participation in organised sports, and high screen time, may also impede the integration of immigrant children into the host culture. Obesity prevention strategies aimed at increasing physical activities in immigrant children could help deliver a social and health benefit by increasing social integration among children of immigrants and Australians.
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Affiliation(s)
- Tehzeeb Zulfiqar
- National Centre for Epidemiology & Population Health, Research School of Population Health - ANU, Canberra, Australian Capital Territory, Australia
| | - Richard A Burns
- Centre for Research on Ageing, Health & Wellbeing, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Catherine D’Este
- National Centre for Epidemiology & Population Health, College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Lyndall Strazdins
- National Centre for Epidemiology & Population Health, Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia
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Schadewaldt V, McElduff B, D’Este C, McInnes E, Dale S, Gunaratne A, Squires J, Cadilhac DA, Middleton S. Validating the Alberta Context Tool in a multi-site Australian Emergency Department nurse population. PLoS One 2019; 14:e0215153. [PMID: 30964916 PMCID: PMC6456203 DOI: 10.1371/journal.pone.0215153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 03/27/2019] [Indexed: 11/26/2022] Open
Abstract
The organisational context of healthcare settings has an essential role in how research evidence is used in clinical practice. The Alberta Context Tool (ACT) measures 10 concepts of organisational context with higher scores indicating a more positive work environment and potentially better use of research evidence in patient care. We assessed the psychometric properties of the ACT in Emergency Departments (EDs). This validation study was conducted as part of a multi-centre trial of triage, treatment and transfer (T3 Trial) of patients with stroke admitted to EDs. Stratified sampling with proportional allocation was used to recruit ED nurses from 26 participating hospitals at baseline. Nurses completed a survey containing the ACT. Structural validity was investigated by exploratory and confirmatory factor analysis. Reliability was assessed using Cronbach’s alpha and intraclass correlation coefficients. Item-rest correlations and the average inter-item correlations were also assessed. 558 ED nurses completed the survey, comprised of 433 surveys without missing data. Our exploratory factor analysis produced a 14-factor structure, explaining 62% of variance of organisational context. For eight of ten concepts, item loadings matched the factor structure of the original ACT. Confirmatory factor analysis of the 10 ACT concepts showed moderate model fit (p = 0.001, root mean square error of approximation: 0.049, standardised root mean squared residual: 0.048). Cronbach’s alphas showed very good internal consistency for nine of ten ACT concepts (α>0.7; 0.45–0.90). Item-rest correlations indicated that most ACT items (50 of 56 items) within any concept related well to the total score of the concept. Average inter-item correlations indicated potential redundant items for three concepts (feedback processes, leadership, staffing) that were above the threshold of 0.5. While identifying a few shortcomings for some ACT concepts in an ED context, the majority of findings confirm reliability and validity of the original ACT in an Australian population of ED nurses.
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Affiliation(s)
- Verena Schadewaldt
- Nursing Research Institute, Australian Catholic University and St Vincent’s Health Australia Sydney, Darlinghurst, New South Wales, Australia
| | - Benjamin McElduff
- Nursing Research Institute, Australian Catholic University and St Vincent’s Health Australia Sydney, Darlinghurst, New South Wales, Australia
| | - Catherine D’Este
- National Centre for Epidemiology and Population Health (NCEPH), Australian National University, Canberra, Australian Capital Territory, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Elizabeth McInnes
- Nursing Research Institute, Australian Catholic University and St Vincent’s Health Australia Sydney, Darlinghurst, New South Wales, Australia
| | - Simeon Dale
- Nursing Research Institute, Australian Catholic University and St Vincent’s Health Australia Sydney, Darlinghurst, New South Wales, Australia
| | - Anoja Gunaratne
- Nursing Research Institute, Australian Catholic University and St Vincent’s Health Australia Sydney, Darlinghurst, New South Wales, Australia
| | - Janet Squires
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Dominique A. Cadilhac
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Sandy Middleton
- Nursing Research Institute, Australian Catholic University and St Vincent’s Health Australia Sydney, Darlinghurst, New South Wales, Australia
- * E-mail:
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Gubhaju L, Banks E, Ward J, D’Este C, Ivers R, Roseby R, Azzopardi P, Williamson A, Chamberlain C, Liu B, Hotu C, Boyle J, McNamara B, Eades SJ. 'Next Generation Youth Well-being Study:' understanding the health and social well-being trajectories of Australian Aboriginal adolescents aged 10-24 years: study protocol. BMJ Open 2019; 9:e028734. [PMID: 30862639 PMCID: PMC6429910 DOI: 10.1136/bmjopen-2018-028734] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Australian Aboriginal and/or Torres Strait Islander (hereafter referred to as 'Aboriginal') adolescents (10-24 years) experience multiple challenges to their health and well-being. However, limited evidence is available on factors influencing their health trajectories. Given the needs of this group, the young age profile of the Aboriginal population and the long-term implications of issues during adolescence, reliable longitudinal data are needed. METHODS AND ANALYSIS The 'Next Generation: Youth Well-being Study' is a mixed-methods cohort study aiming to recruit 2250 Aboriginal adolescents aged 10-24 years from rural, remote and urban communities in Central Australia, Western Australia and New South Wales. The study assesses overall health and well-being and consists of two phases. During phase 1, we qualitatively explored the meaning of health and well-being for adolescents and accessibility of health services. During phase 2, participants are being recruited into a longitudinal cohort. Recruitment is occurring mainly through community networks and connections. At baseline, participants complete a comprehensive survey and undertake an extensive age relevant clinical assessment. Survey and clinical data will be linked to various databases including those relating to health services; medication; immunisation; hospitalisations and emergency department presentations; death registrations; education; child protection and corrective services. Participants will receive follow-up surveys approximately 2 years after their baseline visit. The 'Next Generation' study will fill important evidence gaps by providing longitudinal data on the health and social well-being of Aboriginal adolescents supplemented with narratives from participants to provide context. ETHICS AND DISSEMINATION Ethics approvals have been sought and granted. Along with peer-reviewed publications and policy briefs, research findings will be disseminated via reports, booklets and other formats that will be most useful and informative to the participants and community organisations.
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Affiliation(s)
- Lina Gubhaju
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Emily Banks
- ANU College of Medicine, Biology and Environment, Australian National University, Canberra, Australian Capital Territory, Australia
| | - James Ward
- Infection and Immunity, South Australia Health and Medical Research Centre, Adelaide, South Australia, Australia
- Flinders University Faculty of Medicine Nursing and Health Sciences, Adelaide, South Australia, Australia
| | - Catherine D’Este
- National Centre for Epidemiology and Population Health (NCEPH), ANU College of Medicine, Biology and Environment, The Australian National University, Callaghan, Western Australia, Australia
| | - Rebecca Ivers
- Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Robert Roseby
- Monash Children’s Hospital, Monash Health, Clayton, Victoria, Australia
| | - Peter Azzopardi
- Infection and Immunity, South Australia Health and Medical Research Centre, Adelaide, South Australia, Australia
- Burnet Institute, Melbourne, Victoria, Australia
| | | | - Catherine Chamberlain
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Bette Liu
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Cheri Hotu
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Jacqueline Boyle
- Monash Children’s Hospital, Monash Health, Clayton, Victoria, Australia
| | - Bridgette McNamara
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Sandra J Eades
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Gildner TE, Liebert MA, Capistrant BD, D’Este C, Snodgrass JJ, Kowal P. Perceived Income Adequacy and Well-being Among Older Adults in Six Low- and Middle-Income Countries. J Gerontol B Psychol Sci Soc Sci 2019; 74:516-525. [PMID: 27852739 PMCID: PMC7179842 DOI: 10.1093/geronb/gbw145] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 10/12/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Perceived income adequacy is positively associated with self-rated health (SRH) and quality of life (QOL) among adults in higher-income countries. Additionally, older individuals often report higher levels of income adequacy. However, it is unclear if these associations, documented primarily in high-income countries, are also evident across economically and culturally distinctive low- and middle-income countries. METHODS Data were drawn from the World Health Organization's Study on global AGEing and adult health (SAGE), a study of adults aged 50 years or older in China, Ghana, India, Mexico, the Russian Federation, and South Africa. Smaller samples of younger adults (18-49 years) were included for comparison purposes. Participants reported income adequacy, SRH, and QOL. Associations between age and income adequacy and between income adequacy and SRH/QOL were examined using country-specific logistic regression analysis. RESULTS Older adults in China and Russia were more likely to report better income adequacy than their 18- to 49-year-old counterparts; however, the opposite was observed in Ghana and India. SRH and QOL improved as income adequacy increased in all countries. DISCUSSION As expected, income adequacy was correlated with SRH and QOL. However, the relationship between age and income adequacy varied cross-culturally, potentially due to differences in familial and governmental financial support.
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Affiliation(s)
| | | | | | - Catherine D’Este
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, College of Medicine, Biology and Environment, Canberra, Australia
| | | | - Paul Kowal
- Department of Anthropology, University of Oregon, Eugene
- World Health Organization, Geneva, Switzerland
- University of Newcastle Research Centre for Generational Health and Ageing, Newcastle, New South Wales, Australia
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10
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Abstract
OBJECTIVE To systematically review the literature relating to the impact of multiple co-occurring modifiable risk factors for cognitive decline and dementia. DESIGN A systematic review and meta-analysis of the literature relating to the impact of co-occurring key risk factors for incident cognitive decline and dementia. All abstracts and full text were screened independently by two reviewers and each article assessed for bias using a standard checklist. A fixed effects meta-analysis was undertaken. DATA SOURCES Databases Medline, Embase and PsycINFO were searched from 1999 to 2017. ELIGIBILITY CRITERIA For inclusion articles were required to report longitudinal data from participants free of cognitive decline at baseline, with formal assessment of cognitive function or dementia during follow-up, and an aim to examine the impact of additive or clustered comorbid risk factor burden in with two or more core modifiable risk factors. RESULTS Seventy-nine full-text articles were examined. Twenty-two articles (18 studies) were included reporting data on >40 000 participants. Included studies consistently reported an increased risk associated with greater numbers of intraindividual risk factors or unhealthy behaviours and the opposite for healthy or protective behaviours. A meta-analysis of studies with dementia outcomes resulted in a pooled relative risk for dementia of 1.20 (95% CI 1.04 to 1.39) for one risk factor, 1.65 (95% CI 1.40 to 1.94) for two and 2.21 (95% CI 1.78 to 2.73) for three or more, relative to no risk factors. Limitations include dependence on published results and variations in study outcome, cognitive assessment, length of follow-up and definition of risk factor exposure. CONCLUSIONS The strength of the reported associations, the consistency across studies and the suggestion of a dose response supports a need to keep modifiable risk factor exposure to a minimum and to avoid exposure to additional modifiable risks. Further research is needed to establish whether particular combinations of risk factors confer greater risk than others. PROSPERO REGISTRATION NUMBER 42016052914.
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Affiliation(s)
- Ruth Peters
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Public Health, Imperial College London, London, UK
- University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Jean Peters
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Catherine D’Este
- Australian National University (ANU), Canberra, Australian Capital Territory, Australia
- University of Newcastle, Callaghan, New South Wales, Australia
| | - Kaarin J Anstey
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
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11
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Middleton S, McElduff P, Drury P, D’Este C, Cadilhac DA, Dale S, Grimshaw JM, Ward J, Quinn C, Cheung NW, Levi C. Vital sign monitoring following stroke associated with 90-day independence: A secondary analysis of the QASC cluster randomized trial. Int J Nurs Stud 2019; 89:72-79. [DOI: 10.1016/j.ijnurstu.2018.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 09/21/2018] [Accepted: 09/21/2018] [Indexed: 01/04/2023]
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12
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Zulfiqar T, Strazdins L, Dinh H, Banwell C, D’Este C. Drivers of Overweight/Obesity in 4–11 Year Old Children of Australians and Immigrants; Evidence from Growing Up in Australia. J Immigr Minor Health 2018; 21:737-750. [DOI: 10.1007/s10903-018-0841-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Jones R, Thurber KA, Chapman J, D’Este C, Dunbar T, Wenitong M, Eades SJ, Strelein L, Davey M, Du W, Olsen A, Smylie JK, Banks E, Lovett R. Study protocol: Our Cultures Count, the Mayi Kuwayu Study, a national longitudinal study of Aboriginal and Torres Strait Islander wellbeing. BMJ Open 2018; 8:e023861. [PMID: 29950481 PMCID: PMC6020975 DOI: 10.1136/bmjopen-2018-023861] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Aboriginal and Torres Strait Islander peoples are Australia's first peoples and have been connected to the land for ≥65 000 years. Their enduring cultures and values are considered critical to health and wellbeing, alongside physical, psychological and social factors. We currently lack large-scale data that adequately represent the experiences of Aboriginal and Torres Strait Islander people; the absence of evidence on cultural practice and expression is particularly striking, given its foundational importance to wellbeing. METHOD AND ANALYSIS Mayi Kuwayu: The National Study of Aboriginal and Torres Strait Islander Wellbeing (Mayi Kuwayu Study) will be a large-scale, national longitudinal study of Aboriginal and Torres Strait Islander adults, with linkage to health-related administrative records. The baseline survey was developed through extensive community consultation, and includes items on: cultural practice and expression, sociodemographic factors, health and wellbeing, health behaviours, experiences and environments, and family support and connection. The baseline survey will be mailed to 200 000 Aboriginal and Torres Strait Islander adults (≥16 years), yielding an estimated 16 000-40 000 participants, supplemented through face-to-face recruitment. Follow-up surveys will be conducted every 3-5 years, or as funding allows. The Mayi Kuwayu Study will contribute to filling key evidence gaps, including quantifying the contribution of cultural factors to wellbeing, alongside standard elements of health and risk. ETHICS AND DISSEMINATION This study has received approval from national Human Research Ethics Committees, and from State and Territory committees, including relevant Aboriginal and Torres Strait Islander organisations. The study was developed and is conducted in partnership with Aboriginal and Torres Strait Islander organisations across states and territories. It will provide an enduring and shared infrastructure to underpin programme and policy development, based on measures and values important to Aboriginal and Torres Strait Islander peoples. Approved researchers can access confidentialised data and disseminate findings according to study data access and governance protocols.
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Affiliation(s)
- Roxanne Jones
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Acton, Australia
| | - Katherine A Thurber
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Acton, Australia
| | - Jan Chapman
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Acton, Australia
| | - Catherine D’Este
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Acton, Australia
| | - Terry Dunbar
- University of Adelaide, Adelaide, South Australia, Australia
| | - Mark Wenitong
- Apunipima Cape York Health Council, Bungalow, Queensland, Australia
| | - Sandra J Eades
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Lisa Strelein
- Australian Institute of Aboriginal and Torres Strait Islander Studies, Acton, Australia
| | - Maureen Davey
- Tasmanian Aboriginal Centre, Hobart, Tasmania, Australia
| | - Wei Du
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Acton, Australia
| | - Anna Olsen
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Acton, Australia
| | - Janet K Smylie
- Centre for Research on Inner City Health, Saint Michael’s Hospital, Toronto, Ontario, Canada
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Acton, Australia
- Sax Institute, Haymarket, New South Wales, Australia
| | - Raymond Lovett
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Acton, Australia
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14
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Mackenzie LJ, Carey ML, Suzuki E, Sanson-Fisher RW, Asada H, Ogura M, D’Este C, Yoshimura M, Toi M. Agreement between patients' and radiation oncologists' cancer diagnosis and prognosis perceptions: A cross sectional study in Japan. PLoS One 2018; 13:e0198437. [PMID: 29883453 PMCID: PMC5993258 DOI: 10.1371/journal.pone.0198437] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 05/18/2018] [Indexed: 12/01/2022] Open
Abstract
This study assessed agreement between radiation oncologist- and cancer patient-reported perceptions about cancer diagnosis, time since diagnosis, treatment purpose, and whether life expectancy had been discussed; and described preferences for prognosis discussions. Adult cancer patients receiving radiotherapy at a Japanese hospital were invited to complete a touchscreen tablet survey. Patient survey responses were linked and comparisons made with a survey completed by their radiation oncologist. Among 146 cancer patient-oncologist dyads, there was almost perfect agreement on cancer diagnosis (ĸ = 0.88, 95% CI: 0.82–0.94), substantial agreement on time since diagnosis (ĸ = 0.70, 95% CI: 0.57–0.83) and moderate agreement on whether treatment goal was curative or palliative (ĸ = 0.44, 95% CI: 0.28–0.57; all p’s < 0.0001). Agreement about whether a life expectancy discussion had occurred was less than expected by chance (κ = -0.06, p = 0.9). Radiation oncologists reported that they had spoken to over two thirds of patients about this, whilst less than one third of patients stated that this discussion had occurred with their radiation oncologist. Over half of the patients who had not discussed life expectancy wanted to. Patients had variable preferences for whether they (80%), their radiation oncologist (78%) or their partner/family (52%) should decide whether they discuss their life expectancy. Although patient self-reported information about diagnosis and time since diagnosis appears to be reasonably accurate (compared with clinician-reported information), limitations of self-reported data about prognostic discussions were highlighted by poor agreement between patient- and clinician-reported information about whether prognostic discussions have occurred. Additional support is needed to improve prognosis communication and understanding in radiation oncology settings.
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Affiliation(s)
- Lisa Jane Mackenzie
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Graduate School of Medicine, Kyoto University Hospital, Kyoto, Japan
- * E-mail:
| | - Mariko Leanne Carey
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Eiji Suzuki
- Breast Surgery, Kyoto University Hospital, Kyoto, Japan
| | | | - Hiromi Asada
- Department of Nursing, Kyoto University Hospital, Kyoto, Japan
| | - Masakazu Ogura
- Department of Radiation Oncology and Image Applied Therapy, Kyoto University Hospital, Kyoto, Japan
| | - Catherine D’Este
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Acton, Australian Capital Territory, Australia
| | - Michio Yoshimura
- Department of Radiation Oncology and Image Applied Therapy, Kyoto University Hospital, Kyoto, Japan
| | - Masakazu Toi
- Breast Surgery, Kyoto University Hospital, Kyoto, Japan
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15
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Kim S, McMaster M, Torres S, Cox KL, Lautenschlager N, Rebok GW, Pond D, D’Este C, McRae I, Cherbuin N, Anstey KJ. Protocol for a pragmatic randomised controlled trial of Body Brain Life-General Practice and a Lifestyle Modification Programme to decrease dementia risk exposure in a primary care setting. BMJ Open 2018; 8:e019329. [PMID: 29550779 PMCID: PMC5875671 DOI: 10.1136/bmjopen-2017-019329] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION It has been estimated that a 10%-25% reduction in seven key risk factors could potentially prevent 1.1-3.0 million Alzheimer's disease cases globally. In addition, as dementia is preceded by more subtle cognitive deficits which have substantial social and economic impact, effective preventative interventions would likely have more extensive benefits. The current study evaluates in primary care a multidomain risk-reduction intervention targeting adults with high risk of developing dementia. METHODS AND ANALYSIS A randomised controlled trial (RCT) is being conducted to evaluate three intervention programmes using a pragmatic approach suitable to the clinic: (1) a 12-week online and face-to-face dementia risk-reduction intervention (Body Brain Life-General Practice (BBL-GP)); (2) a 6-week face-to-face group lifestyle modification programme (LMP); and (3) a 12-week email-only programme providing general health information. We aim to recruit 240 participants, aged 18 and over, to undergo a comprehensive cognitive and physical assessment at baseline and follow-ups (postintervention, 18, 36 and 62 weeks). The primary outcome is dementia risk measured with the modified version of the Australian National University-Alzheimer's Disease Risk Index Short Form. Secondary outcomes are cognitive function measured with Trails A and B, and the Digit Symbol Modalities Test; physical activity with moderate-vigorous physical activity and the International Physical Activity Questionnaire; depression with the Centre for Epidemiological Studies Depression; cost evaluation with the 12-item Short Form Health Survey, Framingham Coronary Heart Disease Risk Score and Australian Type 2 Diabetes Risk Assessment Tool; diet quality with the Australian Recommended Food Score; and sleep quality with the Pittsburgh Sleep Quality Index. ETHICS AND DISSEMINATION This RCT is a novel pragmatic intervention applied in a primary care setting to reduce the dementia risk exposure in adults at high risk. If successful, BBL-GP and LMP will provide a versatile, evidence-based package that can be easily and quickly rolled out to other primary care settings and which can be scaled up at relatively low cost compared with other strategies involving intensive interventions. TRIAL REGISTRATION NUMBER ACTRN12616000868482.
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Affiliation(s)
- Sarang Kim
- Centre for Research on Ageing, Health and Wellbeing, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Mitchell McMaster
- Centre for Research on Ageing, Health and Wellbeing, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Susan Torres
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Kay L Cox
- Medical School, University of Western Australia, Crawley, Western Australia, Australia
| | - Nicola Lautenschlager
- Academic Unit for Psychiatry of Old Age, University of Melbourne, Melbourne, Victoria, Australia
| | - George W Rebok
- Johns Hopkins Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Dimity Pond
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Catherine D’Este
- National Centre for Epidemiology and Population Health (NCEPH), Australian National University, Canberra, Australian Capital Territory, Australia
| | - Ian McRae
- Centre for Research on Ageing, Health and Wellbeing, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Nicolas Cherbuin
- Centre for Research on Ageing, Health and Wellbeing, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Kaarin J Anstey
- Centre for Research on Ageing, Health and Wellbeing, Australian National University, Canberra, Australian Capital Territory, Australia
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Neuroscience Research Australia, Sydney, New South Wales, Australia
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16
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Maduka C, Gunaratne AW, Dale S, Mnatzaganian G, D’Este C, McInnes E, Middleton S. Abstract TP361: The Association Between Socioeconomic Factors And Arrival Time To Emergency Departments After Stroke - The T
3
Trial. Stroke 2018. [DOI: 10.1161/str.49.suppl_1.tp361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Socio-economic factors (SES) are associated with mortality, morbidity and access to health services. For optimal outcomes following stroke, it is critical that patients present to Emergency Departments (ED) with minimal delay after the onset of stroke symptoms.
Purpose:
To identify the relationship between residential postcode-based Socio-Economic Indexes For Areas (SEIFA), which ranks geographical areas in terms of relative socioeconomic advantage and disadvantage, and time to ED presentation after the onset of stroke symptoms.
Methods:
We used data from the pre-implementation cohort of the Triage, Treatment and Transfer of patients with stroke in ED’s (T
3
trial) - a cluster randomized controlled trial conducted in 26 Hospitals in three states and one territory in Australia. SEIFA index scores were categorised into tertiles. A multivariable Cox regression modeled the relationship between SEIFA groups and time to ED presentation from symptom onset, adjusting for highest education level, age, sex, modified Rankin Scale (mRS), stroke severity and correlation of arrival time within hospitals using the cluster Huber-White sandwich estimator.
Results:
Of 689 patients, time to arrival was known for 669 (97%). Median arrival time was 2 hours (hrs) (Interquartile range (IQR) 5.5, range 0.05-46). Median arrival time for patients in the lowest SEIFA group was 3 hrs (IQR 6.5, range 0.05-46) compared to 2 hrs (IQR 3.5, range 0.5-38) and 2.5 hrs (IQR 6, range 0.5-26) in those in the middle and higher SEIFA strata, respectively, p=0.2. Multivariable analysis showed that older age (Hazard ratio (HR); 1.56, 95% Confidence interval (CI): 1.14-2.13), female sex (HR; 1.15, 95% CI: 1.03-1.28), moderate or severe stroke severity (HR; 1.44, 95% CI: 1.08-1.92) and middle SEIFA level (HR; 1.29, 95% CI: 1.04-1.59) were all significantly associated with longer time to ED presentation. A disability mRS score of 2 or more (HR; 0.74, 95% CI: 0.58-0.93) was inversely associated with the time to ED presentation, with shorter time to ED presentation observed with increasing disability.
Conclusions:
Targeted education for people with stroke symptoms and the importance of getting to hospital rapidly may help to reduce arrival time to ED and access to critical treatments.
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Affiliation(s)
- Chinonyelum Maduka
- El Cntr Cntr of Excellence for Health Disparities Rsch, Coral Gables, FL
| | | | - Simeon Dale
- Nursing Rsch Institute, Darlinghurst, Australia
| | | | - Catherine D’Este
- National Cntr for Epidemiology and Population Health (NCEPH), Canberra, Australia
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Alam M, D’Este C, Banwell C, Lokuge K. The impact of mobile phone based messages on maternal and child healthcare behaviour: a retrospective cross-sectional survey in Bangladesh. BMC Health Serv Res 2017; 17:434. [PMID: 28645278 PMCID: PMC5482970 DOI: 10.1186/s12913-017-2361-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 06/07/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Mobile phones are gradually becoming an integral part of healthcare services worldwide. We assessed the association between Aponjon mobile phone based messaging services and practices regarding childbirth and care of mother and neonates in selected areas in Bangladesh. METHODS In early 2014, 476 subscriber mothers whose last born child's age was between 3 and 18 months, were recruited to the study by Dnet from selected areas of Bangladesh. One group of mothers received the early warning messages from Aponjon during pregnancy (exposed; n = 210) while the other group of new mothers did not receive the messages during pregnancy as they had enrolled in the service after childbirth (non-exposed; n = 266). We undertook regression analyses to investigate the relationship between timing of exposure to Aponjon messages and socio-economic factors and outcomes of safe delivery, immediate breastfeeding post birth, delayed bathing of the neonate, and number of postnatal care (PNC) visits. RESULTS Women reported delivering babies at home without a skilled birth attendant (SBA) (n = 58, 12%), at home with SBA (n = 111, 23%) and at health facilities (n = 307, 65%). Most (n = 443, 93%) women breastfed babies immediately post birth. Babies were bathed after 72 h (n = 294, 62%), between 48 and 72 (n = 100, 21%) and between 0 and 47 (n = 80, 17%) hours after birth. PNC frequencies were reported as none (n = 273, 57%), 1 (n = 79, 17%), 2 (n = 54, 11%), 3 (n = 34, 7%) and 4 (n = 36, 8%). There was no significant association between exposure to Aponjon messages during pregnancy and presence of a SBA at birth, breastfeeding practices, and postnatal care visits, although delayed bathing up to 48 h was significant at the 10% but not 5% level (RRR 1.7; 95% CI 0.93-3.0; p = 0.083). Women with higher education, from higher income, older in age, with birth order 1 or 2 were more likely to birth at health facilities. Facility based delivery was an independent factor for delayed bathing and having postnatal care visits. CONCLUSIONS Low cost mobile phone messages may have the potential to positively influence maternal and child healthcare behaviours, such as delayed timing of first bath, in resource-poor settings. Further studies are needed, with adequate sample size to detect significant change.
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Affiliation(s)
- Mafruha Alam
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Catherine D’Este
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Cathy Banwell
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Kamalini Lokuge
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia
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Middleton S, Coughlan K, Mnatzaganian G, Low Choy N, Dale S, Jammali-Blasi A, Levi C, Grimshaw JM, Ward J, Cadilhac DA, McElduff P, Hiller JE, D’Este C. Mortality Reduction for Fever, Hyperglycemia, and Swallowing Nurse-Initiated Stroke Intervention. Stroke 2017; 48:1331-1336. [DOI: 10.1161/strokeaha.116.016038] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 02/02/2017] [Accepted: 02/08/2017] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Implementation of nurse-initiated protocols to manage fever, hyperglycemia, and swallowing dysfunction decreased death and disability 90 days poststroke in the QASC trial (Quality in Acute Stroke Care) conducted in 19 Australian acute stroke units (2005–2010). We now examine long-term all-cause mortality.
Methods—
Mortality was ascertained using Australia’s National Death Index. Cox proportional hazards regression compared time to death adjusting for correlation within stroke units using the cluster sandwich (Huber–White estimator) method. Primary analyses included treatment group only unadjusted for covariates. Secondary analysis adjusted for age, sex, marital status, education, and stroke severity using multiple imputation for missing covariates.
Results—
One thousand and seventy-six participants (intervention n=600; control n=476) were followed for a median of 4.1 years (minimum 0.3 to maximum 70 months), of whom 264 (24.5%) had died. Baseline demographic and clinical characteristics were generally well balanced by group. The QASC intervention group had improved long-term survival (>20%), but this was only statistically significant in adjusted analyses (unadjusted hazard ratio [HR], 0.79; 95% confidence interval [CI], 0.58–1.07;
P
=0.13; adjusted HR, 0.77; 95% CI, 0.59–0.99;
P
=0.045). Older age (75–84 years; HR, 4.9; 95% CI, 2.8–8.7;
P
<0.001) and increasing stroke severity (HR, 1.5; 95% CI, 1.3–1.9;
P
<0.001) were associated with increased mortality, while being married (HR, 0.70; 95% CI, 0.49–0.99;
P
=0.042) was associated with increased likelihood of survival. Cardiovascular disease (including stroke) was listed either as the primary or secondary cause of death in 80% (211/264) of all deaths.
Conclusions—
Our results demonstrate the potential long-term and sustained benefit of nurse-initiated multidisciplinary protocols for management of fever, hyperglycemia, and swallowing dysfunction. These protocols should be a routine part of acute stroke care.
Clinical Trial Registration—
URL:
http://www.anzctr.org.au
. Unique identifier: ACTRN12608000563369.
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Affiliation(s)
- Sandy Middleton
- From the Nursing Research Institute, St Vincent’s Health Australia (Sydney) and Australian Catholic University, St Vincent’s Hospital, New South Wales (S.M., K.C., S.D., A.J.-B.); College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia (G.M.); School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Queensland (N.L.C.); John Hunter Hospital and Centre for Translational Neuroscience and Mental Health, University of
| | - Kelly Coughlan
- From the Nursing Research Institute, St Vincent’s Health Australia (Sydney) and Australian Catholic University, St Vincent’s Hospital, New South Wales (S.M., K.C., S.D., A.J.-B.); College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia (G.M.); School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Queensland (N.L.C.); John Hunter Hospital and Centre for Translational Neuroscience and Mental Health, University of
| | - George Mnatzaganian
- From the Nursing Research Institute, St Vincent’s Health Australia (Sydney) and Australian Catholic University, St Vincent’s Hospital, New South Wales (S.M., K.C., S.D., A.J.-B.); College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia (G.M.); School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Queensland (N.L.C.); John Hunter Hospital and Centre for Translational Neuroscience and Mental Health, University of
| | - Nancy Low Choy
- From the Nursing Research Institute, St Vincent’s Health Australia (Sydney) and Australian Catholic University, St Vincent’s Hospital, New South Wales (S.M., K.C., S.D., A.J.-B.); College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia (G.M.); School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Queensland (N.L.C.); John Hunter Hospital and Centre for Translational Neuroscience and Mental Health, University of
| | - Simeon Dale
- From the Nursing Research Institute, St Vincent’s Health Australia (Sydney) and Australian Catholic University, St Vincent’s Hospital, New South Wales (S.M., K.C., S.D., A.J.-B.); College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia (G.M.); School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Queensland (N.L.C.); John Hunter Hospital and Centre for Translational Neuroscience and Mental Health, University of
| | - Asmara Jammali-Blasi
- From the Nursing Research Institute, St Vincent’s Health Australia (Sydney) and Australian Catholic University, St Vincent’s Hospital, New South Wales (S.M., K.C., S.D., A.J.-B.); College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia (G.M.); School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Queensland (N.L.C.); John Hunter Hospital and Centre for Translational Neuroscience and Mental Health, University of
| | - Chris Levi
- From the Nursing Research Institute, St Vincent’s Health Australia (Sydney) and Australian Catholic University, St Vincent’s Hospital, New South Wales (S.M., K.C., S.D., A.J.-B.); College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia (G.M.); School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Queensland (N.L.C.); John Hunter Hospital and Centre for Translational Neuroscience and Mental Health, University of
| | - Jeremy M. Grimshaw
- From the Nursing Research Institute, St Vincent’s Health Australia (Sydney) and Australian Catholic University, St Vincent’s Hospital, New South Wales (S.M., K.C., S.D., A.J.-B.); College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia (G.M.); School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Queensland (N.L.C.); John Hunter Hospital and Centre for Translational Neuroscience and Mental Health, University of
| | - Jeanette Ward
- From the Nursing Research Institute, St Vincent’s Health Australia (Sydney) and Australian Catholic University, St Vincent’s Hospital, New South Wales (S.M., K.C., S.D., A.J.-B.); College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia (G.M.); School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Queensland (N.L.C.); John Hunter Hospital and Centre for Translational Neuroscience and Mental Health, University of
| | - Dominique A. Cadilhac
- From the Nursing Research Institute, St Vincent’s Health Australia (Sydney) and Australian Catholic University, St Vincent’s Hospital, New South Wales (S.M., K.C., S.D., A.J.-B.); College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia (G.M.); School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Queensland (N.L.C.); John Hunter Hospital and Centre for Translational Neuroscience and Mental Health, University of
| | - Patrick McElduff
- From the Nursing Research Institute, St Vincent’s Health Australia (Sydney) and Australian Catholic University, St Vincent’s Hospital, New South Wales (S.M., K.C., S.D., A.J.-B.); College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia (G.M.); School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Queensland (N.L.C.); John Hunter Hospital and Centre for Translational Neuroscience and Mental Health, University of
| | - Janet E. Hiller
- From the Nursing Research Institute, St Vincent’s Health Australia (Sydney) and Australian Catholic University, St Vincent’s Hospital, New South Wales (S.M., K.C., S.D., A.J.-B.); College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia (G.M.); School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Queensland (N.L.C.); John Hunter Hospital and Centre for Translational Neuroscience and Mental Health, University of
| | - Catherine D’Este
- From the Nursing Research Institute, St Vincent’s Health Australia (Sydney) and Australian Catholic University, St Vincent’s Hospital, New South Wales (S.M., K.C., S.D., A.J.-B.); College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia (G.M.); School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Queensland (N.L.C.); John Hunter Hospital and Centre for Translational Neuroscience and Mental Health, University of
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Middleton S, Levi C, Dale S, Cheung NW, McInnes E, Considine J, D’Este C, Cadilhac DA, Grimshaw J, Gerraty R, Craig L, Schadewaldt V, McElduff P, Fitzgerald M, Quinn C, Cadigan G, Denisenko S, Longworth M, Ward J. Triage, treatment and transfer of patients with stroke in emergency department trial (the T 3 Trial): a cluster randomised trial protocol. Implement Sci 2016; 11:139. [PMID: 27756434 PMCID: PMC5069775 DOI: 10.1186/s13012-016-0503-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 10/07/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Internationally recognised evidence-based guidelines recommend appropriate triage of patients with stroke in emergency departments (EDs), administration of tissue plasminogen activator (tPA), and proactive management of fever, hyperglycaemia and swallowing before prompt transfer to a stroke unit to maximise outcomes. We aim to evaluate the effectiveness in EDs of a theory-informed, nurse-initiated, intervention to improve multidisciplinary triage, treatment and transfer (T3) of patients with acute stroke to improve 90-day death and dependency. Organisational and contextual factors associated with intervention uptake also will be evaluated. METHODS This prospective, multicentre, parallel group, cluster randomised trial with blinded outcome assessment will be conducted in EDs of hospitals with stroke units in three Australian states and one territory. EDs will be randomised 1:1 within strata defined by state and tPA volume to receive either the T3 intervention or no additional support (control EDs). Our T3 intervention comprises an evidence-based care bundle targeting: (1) triage: routine assignment of patients with suspected stroke to Australian Triage Scale category 1 or 2; (2) treatment: screening for tPA eligibility and administration of tPA where applicable; instigation of protocols for management of fever, hyperglycaemia and swallowing; and (3) transfer: prompt admission to the stroke unit. We will use implementation science behaviour change methods informed by the Theoretical Domains Framework [1, 2] consisting of (i) workshops to determine barriers and local solutions; (ii) mixed interactive and didactic education; (iii) local clinical opinion leaders; and (iv) reminders in the form of email, telephone and site visits. Our primary outcome measure is 90 days post-admission death or dependency (modified Rankin Scale >2). Secondary outcomes are health status (SF-36), functional dependency (Barthel Index), quality of life (EQ-5D); and quality of care outcomes, namely, monitoring and management practices for thrombolysis, fever, hyperglycaemia, swallowing and prompt transfer. Outcomes will be assessed at the patient level. A separate process evaluation will examine contextual factors to successful intervention uptake. At the time of publication, EDs have been randomised and the intervention is being implemented. DISCUSSION This theoretically informed intervention is aimed at addressing important gaps in care to maximise 90-day health outcomes for patients with stroke. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ACTRN12614000939695 . Registered 2 September 2014.
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Affiliation(s)
- Sandy Middleton
- Nursing Research Institute, St Vincent’s Health Australia (Sydney) and Australian Catholic University, Executive Suite, Level 5 DeLacy Building, St Vincent’s Hospital, Victoria Road, Darlinghurst, 2010 New South Wales Australia
| | - Chris Levi
- John Hunter Hospital, Newcastle, Australia
- Centre for Translational Neuroscience and Mental Health, University of Newcastle/Hunter Medical Research Institute, Newcastle, Australia
| | - Simeon Dale
- Nursing Research Institute, St Vincent’s Health Australia (Sydney) and Australian Catholic University, Executive Suite, Level 5 DeLacy Building, St Vincent’s Hospital, Victoria Road, Darlinghurst, 2010 New South Wales Australia
| | - N. Wah Cheung
- Centre for Diabetes and Endocrinology Research, Westmead Hospital and University of Sydney, Westmead, Sydney, New South Wales Australia
| | - Elizabeth McInnes
- Nursing Research Institute, St Vincent’s Health Australia (Sydney) and Australian Catholic University, Executive Suite, Level 5 DeLacy Building, St Vincent’s Hospital, Victoria Road, Darlinghurst, 2010 New South Wales Australia
| | - Julie Considine
- Faculty of Health, Eastern Health - Deakin University Nursing and Midwifery Research Centre School of Nursing and Midwifery, Burwood, Victoria 3125 Australia
| | - Catherine D’Este
- National Centre for Epidemiology and Population Health (NCEPH), Australian National University, Canberra, Australian Capital Territory Australia
| | - Dominique A. Cadilhac
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Melbourne, Victoria Australia
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria Australia
| | - Jeremy Grimshaw
- Clinical Epidemiology Program, Ottawa Health Research Institute, 1053 Carling Avenue, Administration Building, Room 2-017, Ottawa, Ontario K1Y 4E9 Canada
- Department of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H 8M5 Canada
| | - Richard Gerraty
- Department of Medicine, Monash University, Melbourne, Australia
- Neurosciences Clinical Institute, Epworth Hospital, Richmond, Victoria 3121 Australia
| | - Louise Craig
- Nursing Research Institute, St Vincent’s Health Australia (Sydney) and Australian Catholic University, Executive Suite, Level 5 DeLacy Building, St Vincent’s Hospital, Victoria Road, Darlinghurst, 2010 New South Wales Australia
| | - Verena Schadewaldt
- Nursing Research Institute, St Vincent’s Health Australia (Sydney) and Australian Catholic University, Executive Suite, Level 5 DeLacy Building, St Vincent’s Hospital, Victoria Road, Darlinghurst, 2010 New South Wales Australia
| | - Patrick McElduff
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales 2300 Australia
| | - Mark Fitzgerald
- Alfred Hospital, Melbourne, Victoria 3004 Australia
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
- Faculty of Science, Engineering and Technology, Swinburne University of Technology, Melbourne, Australia
| | - Clare Quinn
- Speech Pathology Department, Prince of Wales Hospital, High St, Randwick, New South Wales 2031 Australia
| | - Greg Cadigan
- Statewide Stroke Clinical Network, Brisbane, 4000 Australia
| | - Sonia Denisenko
- Department of Health Victoria, Victorian Stroke Clinical Network, Melbourne, Victoria 3000 Australia
| | - Mark Longworth
- Stroke Services NSW, NSW Agency for Clinical Innovation, Chatswood, New South Wales Australia
| | - Jeanette Ward
- School of Epidemiology, Public Health and Preventive Medicine (SEPHPM), University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H 8M5 Canada
- Nulungu Research Institute, University of Notre Dame Australia, Broome, Western Australia Australia
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20
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Schofield PW, Malacova E, Preen DB, D’Este C, Tate R, Reekie J, Wand H, Butler T. Does Traumatic Brain Injury Lead to Criminality? A Whole-Population Retrospective Cohort Study Using Linked Data. PLoS One 2015; 10:e0132558. [PMID: 26172545 PMCID: PMC4501545 DOI: 10.1371/journal.pone.0132558] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 06/17/2015] [Indexed: 12/20/2022] Open
Abstract
Background Traumatic brain injury (TBI) may be a risk factor for criminal behaviour however multiple factors potentially confound the association. Methods Record linkage and Cox proportional hazards regression analyses were used to examine the association between hospital-recorded TBI (n = 7,694) and subsequent first criminal conviction in a retrospective cohort matched 1:3 with 22,905 unaffected community controls and full-sibling controls (n = 2,397). Aboriginality, substance abuse, social disadvantage, and mental illness were included in analyses as potential confounders Results In multivariable models, relative to general population controls, TBI was associated with any conviction (males: Hazard Ratio (HR) = 1·58 (95% CI 1·46 to 1·72); females: HR = 1·52 (95% CI 1·28 to 1·81)); and similar Hazard Ratios were obtained for the sibling analyses in males (HR = 1.68 (95% CI 1.31-2.18)) and females (HR 1.27 (95% CI 0.71-2.29)). TBI was also associated with violent convictions relative to the general population, (males: HR = 1.65 (95% CI 1.42 to 1.92); females HR = 1.73 (95% CI 1.21 to 2.47)), and in analyses with sibling controls in men (HR = 1.89 (95% CI 1.20-3.00)), but not in women (HR 0.73, 95% CI 0.29-1.81)). Conclusion The results support a modest causal link between TBI and criminality after comprehensive adjustment for confounding. Reducing the rate of TBI, a major public health imperative, might have benefits in terms of crime reduction.
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Affiliation(s)
- Peter W. Schofield
- Neuropsychiatry Service, Hunter New England Local Health District, Newcastle, NSW, Australia
- Centre for Translational Neuroscience and Mental Health (CTNMH), University of Newcastle, Newcastle, NSW, Australia
- * E-mail:
| | - Eva Malacova
- Centre for Health Services Research, School of Population Health, University of Western Australia, Perth, WA, Australia
| | - David B. Preen
- Centre for Health Services Research, School of Population Health, University of Western Australia, Perth, WA, Australia
| | - Catherine D’Este
- National Centre for Epidemiology and Public Health, Australian National University, Canberra, ACT, Australia
| | - Robyn Tate
- Rehabilitation Studies Unit, University of Sydney, Sydney, NSW, Australia
| | - Joanne Reekie
- Kirby Institute, UNSW Australia, Sydney, NSW, Australia
| | - Handan Wand
- Kirby Institute, UNSW Australia, Sydney, NSW, Australia
| | - Tony Butler
- Kirby Institute, UNSW Australia, Sydney, NSW, Australia
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21
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Plotnikoff RC, Costigan SA, Short C, Grunseit A, James E, Johnson N, Bauman A, D’Este C, van der Ploeg HP, Rhodes RE. Factors associated with higher sitting time in general, chronic disease, and psychologically-distressed, adult populations: findings from the 45 & up study. PLoS One 2015; 10:e0127689. [PMID: 26039739 PMCID: PMC4454645 DOI: 10.1371/journal.pone.0127689] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 04/17/2015] [Indexed: 11/18/2022] Open
Abstract
This study examined factors associated with higher sitting time in general, chronic disease, and psychologically-distressed, adult populations (aged ≥45 years). A series of logistic regression models examined potential socio-demographic and health factors associated with higher sitting (≥6hrs/day) in adults from the 45 and Up Study (n = 227,187), including four separate subsamples for analysis comprising those who had ever had heart disease (n = 26,599), cancer (n = 36,381), diabetes (n = 19,550) or psychological distress (n = 48,334). Odds of higher sitting were significantly (p<.01) associated with a number of factors across these groups, with an effect size of ORs≥1.5 observed for the high-income ≥$70,000AUD, employed full-time and severe physical limitations demographics. Identification of key factors associated with higher sitting time in this population-based sample will assist development of broad-based, public health and targeted strategies to reduce sitting-time. In particular, those categorized as being high-income earners, full-time workers, as well as those with severe physical limitations need to be of priority, as higher sitting appears to be substantial across these groups.
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Affiliation(s)
- Ronald C. Plotnikoff
- Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Sarah A. Costigan
- Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Camille Short
- Centre for Physical Activity Studies (CPAS), Institute for Health and Social Science Research, Central Queensland University, Rockhampton, Queensland, Australia
| | - Anne Grunseit
- Prevention Research Collaboration, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Erica James
- Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, New South Wales, Australia
- School of Medicine & Public Health Discipline of Health Behaviour Science, Faculty of Health and Medicine, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Natalie Johnson
- School of Medicine & Public Health Discipline of Health Behaviour Science, Faculty of Health and Medicine, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Adrian Bauman
- Prevention Research Collaboration, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Catherine D’Este
- Research School of Population Health ANU College of Medicine, National Centre for Epidemiology & Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Hidde P. van der Ploeg
- Prevention Research Collaboration, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Ryan E. Rhodes
- Behavioural Medicine Laboratory, School of Exercise Science, University of Victoria, Victoria, British Columbia, Canada
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22
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Plotnikoff R, Costigan S, Short C, Grunseit A, James E, Johnson N, Bauman A, D’Este C, van der Ploeg H, Rhodes R. Factors associated with sitting time in adults with chronic disease or psychological distress: Findings from the 45 & Up Study. J Sci Med Sport 2014. [DOI: 10.1016/j.jsams.2014.11.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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23
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Abstract
OBJECTIVE Primary care is an important setting for the treatment of depression. The aim of the study was to describe the accuracy of unassisted general practitioner judgements of patients' depression compared to a standardised depression-screening tool delivered via touch-screen computer. METHOD English-speaking patients, aged 18 or older, completed the Patient Health Questionnaire-9 (PHQ-9) when presenting for care to one of 51 general practitioners in Australia. General practitioners were asked whether they thought the patients were clinically depressed. General practitioner judgements of depression status were compared to PHQ-9 results. RESULTS A total of 1558 patients participated. Twenty per cent of patients were identified by the PHQ-9 as being depressed. General practitioners estimated a similar prevalence; however, when compared to the PHQ-9, GP judgement had a sensitivity of 51% (95% CI [32%, 66%]) and a specificity of 87% (95% CI [78%, 93%]). CONCLUSIONS General practitioner unassisted judgements of depression in their patients lacked sensitivity when compared to a standardised psychiatric measure used in general practice.
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Affiliation(s)
- Mariko Carey
- Priority Research Centre for Health Behaviour, Faculty of Health, University of Newcastle, Callaghan, Australia,Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Kim Jones
- Priority Research Centre for Health Behaviour, Faculty of Health, University of Newcastle, Callaghan, Australia,Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Graham Meadows
- Faculty of Medicine, Nursing and Health Sciences, School of Psychology and Psychiatry, Monash University, Clayton, Australia
| | - Rob Sanson-Fisher
- Priority Research Centre for Health Behaviour, Faculty of Health, University of Newcastle, Callaghan, Australia,Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Catherine D’Este
- Hunter Medical Research Institute, New Lambton Heights, Australia,Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Callaghan, Australia
| | - Kerry Inder
- Hunter Medical Research Institute, New Lambton Heights, Australia,Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, Australia
| | - Sze Lin Yoong
- Priority Research Centre for Health Behaviour, Faculty of Health, University of Newcastle, Callaghan, Australia,Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Grant Russell
- Southern Academic Primary Care Research Unit, School of Primary Health Care, Monash University, Notting Hill, Australia
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24
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Hall A, D’Este C, Tzelepis F, Sanson-Fisher R, Lynagh M. The Survivor Unmet Needs Survey (SUNS) for haematological cancer survivors: a cross-sectional study assessing the relevance and psychometric properties. BMC Health Serv Res 2014; 14:211. [PMID: 24886475 PMCID: PMC4026596 DOI: 10.1186/1472-6963-14-211] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Accepted: 04/30/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Relevant and psychometrically sound needs assessment tools are necessary for accurate assessment of haematological cancer survivors unmet needs. No previous study has developed nor psychometrically evaluated a comprehensive needs assessment tool for use with population-based samples of haematological cancer survivors. This study aimed to assess the validity and reliability of the Survivor Unmet Needs Survey (SUNS) with haematological cancer survivors. METHODS The relevance, content and face validity of the SUNS to haematological cancer survivors was assessed using qualitative interviews. Psychometric evaluation was conducted using data collected from haematological cancer survivors, aged 18-80 years at recruitment and recruited from four Australian cancer registries. Construct, convergent and discriminant validity; internal reliability and floor and ceiling effects were assessed. A second survey was completed by a sub-sample of survivors recruited from two of the four registries to assess test-retest reliability. RESULTS Results from 17 qualitative interviews confirmed the relevance, face and content validity of the original items of the SUNS for use with haematological cancer survivors. Overall, 1,957 eligible haematological cancer survivors were contacted by the cancer registries. Of these 1,280 were sent a survey, and 715 returned a survey (37% of eligible survivors contacted and 56% of survivors sent a survey). A total of 529 survivors completed all 89 items of the SUNS and were included in the exploratory factor analysis. Exploratory factor analysis supported the original five-factor structure of the SUNS. Evidence for convergent validity was established, with all five domains of the SUNS illustrating a moderate positive correlation with all three subscales of the Depression Anxiety and Stress Scale (DASS-21). All Cronbach's alpha values were above 0.9 and all corrected item-total correlations were acceptable (>0.2). Criteria for discriminant validity was not met, with only 10 of the 15 (67%) a-priori hypotheses supported. Test-retest reliability was acceptable for 40 of the 89 items (45%) and for three of the five domains. Significant floor effects were evident for all five domains. CONCLUSIONS The SUNS demonstrates evidence for multiple features of validity and reliability as a measure of unmet needs for haematological cancer survivors. However, evidence supporting some psychometric properties was limited.
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Affiliation(s)
- Alix Hall
- Priority Research Centre for Health Behaviour, Faculty of Health, The University of Newcastle & Hunter Medical Research Institute, Callaghan, NSW, Australia
| | - Catherine D’Este
- National Centre for Epidemiology and Population Health, Research School of Population Health, ANU College of Medicine, Biology & Environment, Australian National University, Acton, Canberra, ACT, Australia
| | - Flora Tzelepis
- Priority Research Centre for Health Behaviour, Faculty of Health, The University of Newcastle & Hunter Medical Research Institute, Callaghan, NSW, Australia
| | - Rob Sanson-Fisher
- Priority Research Centre for Health Behaviour, Faculty of Health, The University of Newcastle & Hunter Medical Research Institute, Callaghan, NSW, Australia
| | - Marita Lynagh
- Priority Research Centre for Health Behaviour, Faculty of Health, The University of Newcastle & Hunter Medical Research Institute, Callaghan, NSW, Australia
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25
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Islam MR, Khan I, Attia J, Hassan SMN, McEvoy M, D’Este C, Azim S, Akhter A, Akter S, Shahidullah SM, Milton AH. Association between hypertension and chronic arsenic exposure in drinking water: a cross-sectional study in Bangladesh. Int J Environ Res Public Health 2012; 9:4522-36. [PMID: 23222207 PMCID: PMC3546776 DOI: 10.3390/ijerph9124522] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 11/27/2012] [Accepted: 11/29/2012] [Indexed: 12/12/2022]
Abstract
Chronic arsenic exposure and its association with hypertension in adults are inconclusive and this cross-sectional study investigated the association. The study was conducted between January and July 2009 among 1,004 participants from 1,682 eligible women and men aged ≥30 years living in rural Bangladesh who had continuously consumed arsenic-contaminated drinking water for at least 6 months. Hypertension was defined as systolic blood pressure ≥140 mmHg (systolic hypertension) and diastolic blood pressure ≥90 mmHg (diastolic hypertension). Pulse pressure was calculated by deducting diastolic from systolic pressure and considered to be increased when the difference was ≥55 mmHg. The prevalence of hypertension was 6.6% (95% CI: 5.1-8.3%). After adjustment for other factors, no excess risk of hypertension was observed for arsenic exposure >50 μg/L or to that of arsenic exposure as quartiles or as duration. Arsenic concentration as quartiles and >50 μg/L did show a strong relationship with increased pulse pressure (adjusted OR: 3.54, 95% CI: 1.46-8.57), as did arsenic exposure for ≥10 years (adjusted OR: 5.25, 95% CI: 1.41-19.51). Arsenic as quartiles showed a dose response relationship with increased pulse pressure. Our study suggests an association between higher drinking water arsenic or duration and pulse pressure, but not hypertension.
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Affiliation(s)
- Mohammad Rafiqul Islam
- Centre for Clinical Epidemiology & Biostatistics (CCEB), The University of Newcastle, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia; E-Mails: (M.R.I.); (J.A.); (M.M.); (C.D.)
| | - Ismail Khan
- Department of Pharmacology, Dhaka Medical College, Dhaka 1000, Bangladesh; E-Mail:
| | - John Attia
- Centre for Clinical Epidemiology & Biostatistics (CCEB), The University of Newcastle, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia; E-Mails: (M.R.I.); (J.A.); (M.M.); (C.D.)
| | | | - Mark McEvoy
- Centre for Clinical Epidemiology & Biostatistics (CCEB), The University of Newcastle, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia; E-Mails: (M.R.I.); (J.A.); (M.M.); (C.D.)
| | - Catherine D’Este
- Centre for Clinical Epidemiology & Biostatistics (CCEB), The University of Newcastle, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia; E-Mails: (M.R.I.); (J.A.); (M.M.); (C.D.)
| | - Syed Azim
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia; E-Mail:
| | - Ayesha Akhter
- Department of Obstetrics and Gynaecology, Tairunnessa Memorial Medical College, Targas, Kunia, Gazipur, Dhaka, Gazipur 1701, Bangladesh; E-Mail:
| | - Shahnaz Akter
- Department of Paediatrics, Institute of Child and Mother Health (ICMH), Matuail, Demra, Dhaka 1362, Bangladesh; E-Mail:
| | | | - Abul Hasnat Milton
- Centre for Clinical Epidemiology & Biostatistics (CCEB), The University of Newcastle, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia; E-Mails: (M.R.I.); (J.A.); (M.M.); (C.D.)
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Islam MR, Khan I, Hassan SMN, McEvoy M, D’Este C, Attia J, Peel R, Sultana M, Akter S, Milton AH. Association between type 2 diabetes and chronic arsenic exposure in drinking water: a cross sectional study in Bangladesh. Environ Health 2012; 11:38. [PMID: 22676249 PMCID: PMC3403856 DOI: 10.1186/1476-069x-11-38] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 06/07/2012] [Indexed: 05/08/2023]
Abstract
BACKGROUND Chronic exposure to high level of inorganic arsenic in drinking water has been associated with Type 2 Diabetes (T2D). Most research has been ecological in nature and has focused on high levels of arsenic exposure with few studies directly measuring arsenic levels in drinking water as an index of arsenic exposure. The effect of low to moderate levels of arsenic exposure on diabetes risk is largely unknown thus our study is adding further knowledge over previous works. METHODS This cross sectional study was conducted in 1004 consenting women and men from 1682 eligible participants yielding a participation rate of 60%. These participants are aged >30 years and were living in Bangladesh and had continuously consumed arsenic-contaminated drinking water for at least 6 months. T2D cases were diagnosed using glucometer following the new diagnostic criteria (Fasting Blood Glucose > 126 mg/dl) from the WHO guideline (WHO 2006), or a self-reported physician diagnosis of type 2 diabetes. Association between T2D and chronic arsenic exposure was estimated by multiple logistic regression with adjustment for age, sex, education, Body Mass Index (BMI) and family history of T2D. RESULTS A total of 1004 individuals participated in the study. The prevalence of T2D was 9% (95% CI 7-11%). After adjustment for diabetes risk factors, an increased risk of type 2 diabetes was observed for arsenic exposure over 50 μg/L with those in the highest category having almost double the risk of type 2 diabetes (OR=1.9 ; 95% CI 1.1-3.5). For most levels of arsenic exposure, the risk estimates are higher with longer exposure; a dose-response pattern was also observed. CONCLUSIONS These findings suggest an association between chronic arsenic exposure through drinking water and T2D. Risks are generally higher with longer duration of arsenic exposure. The risk of T2D is highest among those who were exposed to the highest concentration of arsenic for more than 10 years.
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Affiliation(s)
- Md Rafiqul Islam
- Centre for Clinical Epidemiology & Biostatistics (CCEB), The University of Newcastle, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Ismail Khan
- Department of Pharmacology, Dhaka Medical College, Dhaka, Bangladesh
| | - Sheikh Md Nazmul Hassan
- Department of Public Health, Atish Dipankar University of Science & Technology, Dhaka, Dhanmondi, Bangladesh
| | - Mark McEvoy
- Centre for Clinical Epidemiology & Biostatistics (CCEB), The University of Newcastle, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Catherine D’Este
- Centre for Clinical Epidemiology & Biostatistics (CCEB), The University of Newcastle, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - John Attia
- Centre for Clinical Epidemiology & Biostatistics (CCEB), The University of Newcastle, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Roseanne Peel
- Centre for Clinical Epidemiology & Biostatistics (CCEB), The University of Newcastle, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Munira Sultana
- Centre for Health and Development (CHAD), Gopalgonj, Bangladesh
| | - Shahnaz Akter
- Institute of Child and Mother Health (ICMH), Dhaka, Bangladesh
| | - Abul Hasnat Milton
- Centre for Clinical Epidemiology & Biostatistics (CCEB), The University of Newcastle, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
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