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Muthayya S.,Sax Institute | Rah J.H.,United Nations Childrens Fund UNICEF India | Sugimoto J.D.,University of Florida | Sugimoto J.D.,Fred Hutchinson Cancer Research Center | And 2 more authors.
PLoS ONE | Year: 2013

The unified global efforts to mitigate the high burden of vitamin and mineral deficiency, known as hidden hunger, in populations around the world are crucial to the achievement of most of the Millennium Development Goals (MDGs). We developed indices and maps of global hidden hunger to help prioritize program assistance, and to serve as an evidence-based global advocacy tool. Two types of hidden hunger indices and maps were created based on i) national prevalence data on stunting, anemia due to iron deficiency, and low serum retinol levels among preschool-aged children in 149 countries; and ii) estimates of Disability Adjusted Life Years (DALYs) attributed to micronutrient deficiencies in 136 countries. A number of countries in sub-Saharan Africa, as well as India and Afghanistan, had an alarmingly high level of hidden hunger, with stunting, iron deficiency anemia, and vitamin A deficiency all being highly prevalent. The total DALY rates per 100,000 population, attributed to micronutrient deficiencies, were generally the highest in sub-Saharan African countries. In 36 countries, home to 90% of the world's stunted children, deficiencies of micronutrients were responsible for 1.5-12% of the total DALYs. The pattern and magnitude of iodine deficiency did not conform to that of other micronutrients. The greatest proportions of children with iodine deficiency were in the Eastern Mediterranean (46.6%), European (44.2%), and African (40.4%) regions. The current indices and maps provide crucial data to optimize the prioritization of program assistance addressing global multiple micronutrient deficiencies. Moreover, the indices and maps serve as a useful advocacy tool in the call for increased commitments to scale up effective nutrition interventions. © 2013 Muthayya et al.


Randall D.A.,University of Western Sydney | Jorm L.R.,University of Western Sydney | Lujic S.,University of Western Sydney | O'Loughlin A.J.,University of Western Sydney | And 4 more authors.
Circulation | Year: 2013

Background-This study examined revascularization rates after acute myocardial infarction (AMI) for Aboriginal and non-Aboriginal patients sequentially controlling for admitting hospital and risk factors. Methods and Results-Hospital data from the state of New South Wales, Australia (July 2000 through December 2008) were linked to mortality data (July 2000 through December 2009). The study sample were all people aged 25 to 84years admitted to public hospitals with a diagnosis of AMI (n=59 282). Single level and multilevel Cox regression was used to estimate rates of revascularization within 30 days of admission. A third (32.9%) of Aboriginal AMI patients had a revascularization within 30 days compared with 39.7% non-Aboriginal patients. Aboriginal patients had a revascularization rate 37% lower than non-Aboriginal patients of the same age, sex, year of admission, and AMI type (adjusted hazard ratio, 0.63; 95% confidence interval, 0.57-0.70). Within the same hospital, however, Aboriginal patients had a revascularization rate 18% lower (adjusted hazard ratio, 0.82; 95% confidence interval, 0.74-0.91). Accounting for comorbidities, substance use and private health insurance further explained the disparity (adjusted hazard ratio, 0.96; 95% confidence interval, 0.87-1.07). Hospitals varied markedly in procedure rates, and this variation was associated with hospital size, remoteness, and catheterization laboratory facilities. Conclusions-Aboriginal Australians were less likely to have revascularization procedures after AMI than non-Aboriginal Australians, and this was largely explained by lower revascularization rates at the hospital of first admission for all patients admitted to smaller regional and rural hospitals, a higher comorbidity burden for Aboriginal people, and to a lesser extent a lower rate of private health insurance among Aboriginal patients. © 2012 American Heart Association, Inc.


Holliday E.G.,Hunter Medical Research Institute | Magee C.A.,University of Wollongong | Kritharides L.,University of Sydney | Banks E.,Australian National University | And 2 more authors.
PLoS ONE | Year: 2013

Epidemiologic studies have observed association between short sleep duration and both cardiovascular disease (CVD) and type 2 diabetes, although these results may reflect confounding by pre-existing illness. This study aimed to determine whether short sleep duration predicts future CVD or type 2 diabetes after accounting for baseline health. Baseline data for 241,949 adults were collected through the 45 and Up Study, an Australian prospective cohort study, with health outcomes identified via electronic database linkage. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals. Compared to 7h sleep, <6h sleep was associated with incident CVD in participants reporting ill-health at baseline (HR=1·38 [95% CI: 1·12-1·70]), but not after excluding those with baseline illness and adjusting for baseline health status (1·03 [0·88-1·21]). In contrast, the risk of incident type 2 diabetes was significantly increased in those with <6h versus 7h sleep, even after excluding those with baseline illness and adjusting for baseline health (HR=1·29 [1·08-1·53], P=0.004). This suggests the association is valid and does not simply reflect confounding or reverse causation. Meta-analysis of ten prospective studies including 447,124 participants also confirmed an association between short sleep and incident diabetes (1·33 [1·20-1·48]). Obtaining less than 6 hours of sleep each night (compared to 7 hours) may increase type 2 diabetes risk by approximately 30%. © 2013 Holliday et al.


People who leave school without a school certificate are more than twice as likely to have a heart attack as those with a university degree, according to groundbreaking new Australian research from the largest ongoing study of healthy ageing in the Southern Hemisphere, the Sax Institute's 45 and Up Study. Researchers investigated the links between education and cardiovascular disease events (such as a heart attack or stroke) by following 267,153 men and women in the state of New South Wales aged over 45, who are part of the Sax Institute's 45 and Up Study, for over five years. The results were published in the International Journal for Equity in Health and were the subject of discussion today at the Cardiovascular Disease Inequalities Partnership Project meeting in the nation's capital, Canberra. "The lower your education, the more likely you are to have a heart attack or a stroke - that's the disturbing but clear finding from our research," said lead researcher Dr Rosemary Korda, a Fellow at the National Centre for Epidemiology and Population Health at The Australian National University (ANU). "Our study found that in adults aged 45-64 years, heart attack rates among those with no educational qualifications were more than double (around 150% higher) those of people with a university degree. The risk was around two-thirds (70%) higher among those with intermediate levels of education (non-university qualifications). "Mid-age adults who hadn't completed high school were 50% more likely to have a first stroke than those with a university degree; those with intermediate levels of education (non-university qualifications) were 20% more likely." Dr Korda said a similar pattern of inequality existed between household income and cardiovascular disease events. "What these differences in cardiovascular disease rates between more and less disadvantaged groups show us is just how much cardiovascular disease in the population can be prevented. The Cardiovascular Disease Inequalities Partnership Project is continuing research in this area to better understand what is driving these socioeconomic differences." Professor Emily Banks, Scientific Director of the 45 and Up Study and Head of Epidemiology for Policy and Practice at ANU, said these findings demonstrated the value of the 45 and Up Study as an unparalleled Australian research resource making it possible for researchers to investigate big questions in large numbers of people and to get faster answers that are useful for policy makers. "This research demonstrates, now that we have more robust data, how much worse the inequalities in cardiovascular disease are than we previously thought," said Professor Banks. "This research also provides important clues about how much cardiovascular disease can be prevented." CEO of the Heart Foundation New South Wales Kerry Doyle said that heart disease was the single leading cause of death in Australia, with an average of one Australian dying every 27 minutes. "We know that a good education impacts long term health by influencing what type of job you have, where you live and what food choices you make," said Ms Doyle. "This research provides an opportunity to further unpack the specific relationship between educational achievement and cardiovascular disease risk, and what can be done to reduce this risk," she added. The Sax Institute is an independent Australian leader in helping decision makers find and make best use of research to solve real-world health and social problems. The Cardiovascular Disease Inequalities Partnership Project is collaboration between the Australian National University, The Agency for Clinical Innovation, The Consumers Health Forum of Australia and The National Heart Foundation. It is partly funded by the National Health and Medical Research Council and The National Heart Foundation. About the 45 and Up Study: The Sax Institute's 45 and Up Study is the largest ongoing study of healthy ageing in the Southern Hemisphere, involving a quarter of a million people - one in every 10 men and women aged 45 and over in New South Wales. It is a major national research tool being used by both researchers and policy makers to better understand how Australians are ageing, how they're using health services, how to prevent and manage ill-health and disability and how this can guide decisions on our health system. Over time, we are asking all participants ongoing questions about their health, lifestyle, and the medications they use. This is providing the first large-scale, comprehensive measure of health as people move from mid to later life and allowing governments and health policy makers to better plan health services and programs for our ageing population.


News Article | February 15, 2017
Site: www.eurekalert.org

Public officials faced with the tough task of communicating risk on contentious issues like vaccination or fluoridation - where the actual risk is low but public concern remains high - need to show that they care, demonstrate that they are taking action and strategically engage with the media. That's the message of a paper published today in the Sax Institute's Public Health Research & Practice journal. "With the rise of 'alternative facts' and the tendency for people to seek information that confirms their existing beliefs, it is no longer enough to simply have the right policy," said lead author Dr Claire Hooker from the Centre for Values, Ethics and Law in Medicine at the University of Sydney. "In circumstances where public concern and outrage is high even though the absolute risk is low, good quality scientific studies are not enough to ensure we protect the public's health. It's equally important to have the best approach to communicating with the public. "In situations of public health and environmental concerns - such as vaccinations, water fluoridation and the risk of Ebola outbreaks in Australia ? officials and experts are often anxious that community criticism of proven health interventions will prevent good policy. But our research suggests that trying to shut off this criticism can make things worse, particularly as it's now almost impossible to effectively control the flow of information on social media." Dr Hooker said there were best-practice strategies that Australian public health and environmental officials could look to adopt. "Research shows that when people are emotional about an issue they have more difficulty hearing and processing information, and are more likely to pay attention to negative information. That's why the golden rule of successful risk communication is that people need to hear that you care before they will care about what they hear. Officials need to communicate early and often, be upfront about areas of uncertainty or complexity, and prioritise building trust over trying to push a message. "Actions, of course, speak far louder than words. People don't want the 'official line' on a topic, they want to know what actions are been taken. Finally, communication is most effective when public health officials engage directly with affected communities and with the media, including local and community-based social media. This way local communities know that authorities have integrity, are competent and can be trusted - the key to reassuring people and reducing outrage," said Dr Hooker. Dr Hooker's paper was published in the latest issue of the Sax Institute's Public Health Research & Practice journal, which this month focuses on the theme of knowledge translation. "The transfer of evidence into the policy making process is rarely a simple and smooth process. The types of evidence used and the way that evidence is practically applied in policy processes varies and that's why there is a focus on the skill of knowledge translation itself, to improve this process where possible," according to Guest Editor Dr Andrew Milat from the NSW Ministry of Health. Communicating about risk: strategies for situations where public concern is high but the risk is low Public link once embargo lifts (for inclusion in news articles) http://bit.


Walter S.R.,University of New South Wales | Olivier J.,University of New South Wales | Churches T.,Sax Institute | Grzebieta R.,University of New South Wales
Accident Analysis and Prevention | Year: 2011

The study aimed to assess the effect of compulsory cycle helmet legislation on cyclist head injuries given the ongoing debate in Australia as to the efficacy of this measure at a population level. We used hospital admissions data from New South Wales, Australia, from a 36 month period centred at the time legislation came into effect. Negative binomial regression of hospital admission counts of head and limb injuries to cyclists were performed to identify differential changes in head and limb injury rates at the time of legislation. Interaction terms were included to allow different trends between injury types and pre- and post-law time periods. To avoid the issue of lack of cyclist exposure data, we assumed equal exposures between head and limb injuries which allowed an arbitrary proxy exposure to be used in the model. As a comparison, analyses were also performed for pedestrian data to identify which of the observed effects were specific to cyclists. In general, the models identified a decreasing trend in injury rates prior to legislation, an increasing trend thereafter and a drop in rates at the time legislation was enacted, all of which were thought to represent background effects in transport safety. Head injury rates decreased significantly more than limb injury rates at the time of legislation among cyclists but not among pedestrians. This additional benefit was attributed to compulsory helmet legislation. Despite numerous data limitations, we identified evidence of a positive effect of compulsory cycle helmet legislation on cyclist head injuries at a population level such that repealing the law cannot be justified. © 2011 Elsevier Ltd.


Van Der Ploeg H.P.,University of Sydney | Chey T.,University of Sydney | Korda R.J.,Australian National University | Banks E.,Sax Institute | And 2 more authors.
Archives of Internal Medicine | Year: 2012

Background: Prolonged sitting is considered detrimental to health, but evidence regarding the independent relationship of total sitting time with all-cause mortality is limited. This study aimed to determine the independent relationship of sitting time with all-cause mortality. Methods:Welinked prospective questionnaire data from 222 497 individuals 45 years or older from the 45 and Up Study to mortality data from the New South Wales Registry of Births, Deaths, and Marriages (Australia) from February 1, 2006, through December 31, 2010. Cox proportional hazards models examined all-cause mortality in relation to sitting time, adjusting for potential confounders that included sex, age, education, urban/rural residence, physical activity, body mass index, smoking status, self-rated health, and disability. Results: During 621 695 person-years of follow-up (mean follow-up, 2.8 years), 5405 deaths were registered. Allcause mortality hazard ratios were 1.02 (95% CI, 0.95- 1.09), 1.15 (1.06-1.25), and 1.40 (1.27-1.55) for 4 to less than 8, 8 to less than 11, and 11 or more h/d of sitting, respectively, compared with less than 4 h/d, adjusting for physical activity and other confounders. The population- attributable fraction for sitting was 6.9%. The association between sitting and all-cause mortality appeared consistent across the sexes, age groups, body mass index categories, and physical activity levels and across healthy participants compared with participants with preexisting cardiovascular disease or diabetes mellitus. Conclusions: Prolonged sitting is a risk factor for allcause mortality, independent of physical activity. Public health programs should focus on reducing sitting time in addition to increasing physical activity levels. ©2012 American Medical Association. All rights reserved.


Milat A.J.,New South Wales Ministry of Health | Milat A.J.,University of Sydney | Bauman A.E.,University of Sydney | Redman S.,University of Sydney | Redman S.,Sax Institute
Health Research Policy and Systems | Year: 2015

Background: Research funding agencies continue to grapple with assessing research impact. Theoretical frameworks are useful tools for describing and understanding research impact. The purpose of this narrative literature review was to synthesize evidence that describes processes and conceptual models for assessing policy and practice impacts of public health research. Methods: The review involved keyword searches of electronic databases, including MEDLINE, CINAHL, PsycINFO, EBM Reviews, and Google Scholar in July/August 2013. Review search terms included 'research impact', 'policy and practice', 'intervention research', 'translational research', 'health promotion', and 'public health'. The review included theoretical and opinion pieces, case studies, descriptive studies, frameworks and systematic reviews describing processes, and conceptual models for assessing research impact. The review was conducted in two phases: initially, abstracts were retrieved and assessed against the review criteria followed by the retrieval and assessment of full papers against review criteria. Results: Thirty one primary studies and one systematic review met the review criteria, with 88% of studies published since 2006. Studies comprised assessments of the impacts of a wide range of health-related research, including basic and biomedical research, clinical trials, health service research, as well as public health research. Six studies had an explicit focus on assessing impacts of health promotion or public health research and one had a specific focus on intervention research impact assessment. A total of 16 different impact assessment models were identified, with the 'payback model' the most frequently used conceptual framework. Typically, impacts were assessed across multiple dimensions using mixed methodologies, including publication and citation analysis, interviews with principal investigators, peer assessment, case studies, and document analysis. The vast majority of studies relied on principal investigator interviews and/or peer review to assess impacts, instead of interviewing policymakers and end-users of research. Conclusions: Research impact assessment is a new field of scientific endeavour and there are a growing number of conceptual frameworks applied to assess the impacts of research. © 2015 Milat et al.


Milat A.J.,Sax Institute | King L.,University of Sydney | Bauman A.E.,University of Sydney | Redman S.,Sax Institute
Health Promotion International | Year: 2013

Increased focus on prevention presents health promoters with new opportunities and challenges. In this context, the study of factors influencing policy-maker decisions to scale up health promotion interventions from small projects or controlled trials to wider state, national or international roll-out is increasingly important. This study aimed to: (i) examine the perspectives of senior researchers and policy-makers regarding concepts of 'scaling up' and 'scalability'; (ii) generate an agreed definition of 'scalability' and (iii) identify intervention and research design factors perceived to increase the potential for interventions to be implemented on a more widespread basis or 'scaled up'. A two-stage Delphi process with an expert panel of senior Australian public health intervention researchers (n = 7) and policy-makers (n = 7) and a review of relevant literature were conducted. Through this process 'scalability' was defined as: the ability of a health intervention shown to be efficacious on a small scale and or under controlled conditions to be expanded under real world conditions to reach a greater proportion of the eligible population, while retaining effectiveness. Results showed that in health promotion research insufficient attention is given to issues of effectiveness, reach and adoption; human, technical and organizational resources; costs; intervention delivery; contextual factors and appropriate evaluation approaches. If these issues were addressed in the funding, design and reporting of intervention research, it would advance the quality and usability of research for policy-makers and by doing so improve uptake and expansion of promising programs into practice. © 2013 © The Author (2012). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.


Liu B.,University of Western Sydney | Jorm L.,University of Western Sydney | Jorm L.,Sax Institute | Banks E.,Sax Institute | Banks E.,Australian National University
Diabetes Care | Year: 2010

OBJECTIVE - To examine the effect of childbearing and maternal breastfeeding on a woman's subsequent risk of developing type 2 diabetes. RESEARCH DESIGN AND METHODS- Using information on parity, breastfeeding, and diabetes collected from 52,731 women recruited into a cohort study, we estimated the risk of type 2 diabetes using multivariate logistic regression. RESULTS- A total of 3,160 (6.0%) women were classified as having type 2 diabetes. Overall, nulliparous and parous women had a similar risk of diabetes. Among parous women, there was a 14% (95% CI 10-18%, P < 0.001) reduced likelihood of diabetes per year of breastfeeding. Compared to nulliparous women, parous women who did not breastfeed had a greater risk of diabetes (odds ratio 1.48, 95% CI 1.26-1.73, P < 0.001), whereas for women breastfeeding, the risk was not significantly increased. CONCLUSIONS- Compared with nulliparous women, childbearing women who do not breastfeed have about a 50% increased risk of type 2 diabetes in later life. Breastfeeding substantially reduces this excess risk. © 2010 by the American Diabetes Association.

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