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Stewart J.,Center for Epidemiology and Evidence
New South Wales public health bulletin | Year: 2012

A 5-year strategic plan for Aboriginal health research and evaluation has been developed to support the NSW Ministry of Health in its efforts to create the evidence for what works in addressing the health disparity between Aboriginal and non-Aboriginal people. The plan has the following objectives: that all Aboriginal health policies and programs are evidence informed; that programs and strategies are rigorously evaluated and contribute to building the evidence for improving Aboriginal health outcomes; that new research evidence is generated for improving Aboriginal health outcomes; and that robust monitoring and accountability mechanisms in Aboriginal health are in place, with improved data quality. This paper describes the development of the NSW Ministry of Health's Aboriginal Health Research and Evaluation Strategic Plan 2011-15, including a review of the evidence and policy documents, facilitated planning sessions, and consultation with staff within the Population and Public Health Division of the Ministry.

Scandol J.P.,Center for Epidemiology and Evidence | Scandol J.P.,Falls and Injury Prevention Group | Toson B.,Falls and Injury Prevention Group | Close J.C.T.,Falls and Injury Prevention Group | Close J.C.T.,University of New South Wales
Injury | Year: 2013

Introduction: Dementia and fall-related hip fractures both contribute significantly to the burden of illness within elderly populations in Australia and elsewhere. The research presented here uses a large probabilistically linked dataset from NSW, Australia to estimate the prevalence of dementia within hip fracture patients and investigate the impact of dementia on hospitalisation length of stay (LOS) and survival. Method: The cases considered were NSW residents aged 65 years and above who experienced a fall related hip fracture between 1 July 2000 and 30 June 2009. The prevalence of dementia was calculated for the incident hip fracture using two methods to infer dementia status. Cox proportional hazards regression modelling was used to estimate the relative rate of discharge from a hospitalisation episode, and the relative mortality rate of hip fracture patients suffering dementia versus those who were cognitively intact. Additional covariates used in the models included sex, age group at admission, the Charlson Comorbidity Index and separation mode. Results: Of the 44,143 fall-related incident hip fracture cases considered, between 24% (observed diagnosis) to 29% (inferred diagnosis) of these people had dementia. The median LOS for patients with dementia was shorter than those without dementia, but there was a strong interaction with age. The rate of discharge from the fracture-related hospitalisation episode of the cases with dementia was 40% greater (95% CI 1.4-1.5) than the non-demented group. Similarly, the relative mortality rate of those with dementia was greater (2.4, 95% CI 2.3-2.6) than the non-demented group. Both Cox analyses indicated evidence for main effects of age at admission and comorbidity, as well as interaction effects between age group and dementia status. Conclusion: The use of linked datasets with tens of thousands of cases enables the calculation of precise estimates of various parameters. People with dementia constitute a significant proportion of the total population of elderly hip fracture patients in hospitals (up to 29%). Their mortality rate is greater than those without a diagnosis of dementia and their hospital length of stay is shorter, particularly if they are discharged to a residential aged care facility. © 2012 Elsevier Ltd.

Chau J.Y.,University of Sydney | Daley M.,Heart Foundation New South Wales | Dunn S.,Heart Foundation New South Wales | Srinivasan A.,Heart Foundation New South Wales | And 4 more authors.
International Journal of Behavioral Nutrition and Physical Activity | Year: 2014

Prolonged sitting time is detrimental for health. Individuals with desk-based occupations tend to sit a great deal and sit-stand workstations have been identified as a potential strategy to reduce sitting time. Hence, the objective of the current study was to examine the effects of using sit-stand workstations on office workers' sitting time at work and over the whole day.Methods: We conducted a randomized controlled trial pilot with crossover design and waiting list control in Sydney, Australia from September 2011 to July 2012 (n = 42; 86% female; mean age 38 ± 11 years). Participants used a sit-stand workstation for four weeks in the intervention condition. In the time-matched control condition, participants received nothing and crossed over to the intervention condition after four weeks. The primary outcomes, sitting, standing and walking time at work, were assessed before and after using the workstations with ActivPALs and self-report questionnaires. Secondary outcomes, domain-specific sitting over the whole day, were assessed by self-report. Linear mixed models estimated changes in outcomes adjusting for measurement time, study grouping and covariates.Results: Intervention participants significantly reduced objectively assessed time spent sitting at work by 73 min/workday (95% CI: -106,-39) and increased standing time at work by 65 min/workday (95% CI: 47, 83); these changes were significant relative to controls (p = 0.004 and p < 0.001, respectively). Total sitting time significantly declined in intervention participants (-80 min/workday; 95% CI: -155, -4).Conclusions: This study shows that introducing sit-stand workstations in the office can reduce desk-based workers' sitting time at work in the short term. Larger scale studies on more representative samples are needed to determine the public health impact of sit-stand workstations.Trial registration: ACTRN12612000072819. © 2014 Chau et al.; licensee BioMed Central Ltd.

Ding D.,University of Sydney | Do A.,Center for Epidemiology and Evidence | Schmidt H.-M.,Center for Population Health | Bauman A.E.,University of Sydney
PLoS ONE | Year: 2015

Background Socioeconomic inequalities in health outcomes have increased over the past few decades in some countries. However, the trends in inequalities related to multiple health risk behaviours have been infrequently reported. In this study, we examined the trends in individual health risk behaviours and a summary lifestyle risk index in New South Wales, Australia, and whether the absolute and relative inequalities in risk behaviours by socioeconomic positions have changed over time. Methods Using data from the annual New South Wales Adult Population Health Survey during the period of 2002-2012, we examined four individual risk behaviours (smoking, higher than recommended alcohol consumption, insufficient fruit and vegetable intake, and insufficient physical activity) and a combined lifestyle risk indicator. Socioeconomic inequalities were assessed based on educational attainment and postal area-level index of relative socioeconomic disadvantage (IRSD), and were presented as prevalence difference for absolute inequalities and prevalence ratio for relative inequalities. Trend tests and survey logistic regression models examined whether the degree of absolute and relative inequalities between the most and least disadvantaged subgroups have changed over time. Results The prevalence of all individual risk behaviours and the summary lifestyle risk indicator declined from 2002 to 2012. Particularly, the prevalence of physical inactivity and smoking decreased from 52.6% and 22% in 2002 to 43.8% and 17.1% in 2012 (p for trend<0.001). However, a significant trend was observed for increasing absolute and relative inequalities in smoking, insufficient fruit and vegetable consumption, and the summary lifestyle risk indicator. Conclusions The overall improvement in health behaviours in New South Wales, Australia, co-occurred with a widening socioeconomic gap. © 2015 Ding et al.

Merrifield A.,Center for Epidemiology and Evidence
New South Wales public health bulletin | Year: 2012

Sample size calculations before conducting a health study or clinical trial are important to provide evidence that the proposed study is capable of detecting real associations between study factors. This review aims to clarify statistical issues related to the calculation of sample sizes and is illustrated with an example of a recent study design to improve health outcomes related to water and sewage in NSW Aboriginal communities. The effect of power, significance level and effect size on sample size are discussed. Calculations of sample sizes for individual-based studies are modified for more complex trial designs by multiplying individual-based estimates by an inflationary factor.

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