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Friel S.,Australian National University | Hattersley L.,Australian National University | Snowdon W.,Pacific Research Center for the Prevention of Obesity and Non Communicable Diseases | Snowdon W.,Deakin University | And 21 more authors.
Obesity Reviews | Year: 2013

Summary: The liberalization of international trade and foreign direct investment through multilateral, regional and bilateral agreements has had profound implications for the structure and nature of food systems, and therefore, for the availability, nutritional quality, accessibility, price and promotion of foods in different locations. Public health attention has only relatively recently turned to the links between trade and investment agreements, diets and health, and there is currently no systematic monitoring of this area. This paper reviews the available evidence on the links between trade agreements, food environments and diets from an obesity and non-communicable disease (NCD) perspective. Based on the key issues identified through the review, the paper outlines an approach for monitoring the potential impact of trade agreements on food environments and obesity/NCD risks. The proposed monitoring approach encompasses a set of guiding principles, recommended procedures for data collection and analysis, and quantifiable 'minimal', 'expanded' and 'optimal' measurement indicators to be tailored to national priorities, capacity and resources. Formal risk assessment processes of existing and evolving trade and investment agreements, which focus on their impacts on food environments will help inform the development of healthy trade policy, strengthen domestic nutrition and health policy space and ultimately protect population nutrition. © 2013 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of the International Association for the Study of Obesity.


Hodgson C.,Australian and New Zealand Intensive Care Research Center | Bellomo R.,Austin Health | Berney S.,Austin Health | Bailey M.,Australian and New Zealand Intensive Care Research Center | And 9 more authors.
Critical Care | Year: 2015

Introduction: The aim of this study was to investigate current mobilization practice, strength at ICU discharge and functional recovery at 6 months among mechanically ventilated ICU patients. Method: This was a prospective, multi-centre, cohort study conducted in twelve ICUs in Australia and New Zealand. Patients were previously functionally independent and expected to be ventilated for >48 hours. We measured mobilization during invasive ventilation, sedation depth using the Richmond Agitation and Sedation Scale (RASS), co-interventions, duration of mechanical ventilation, ICU-acquired weakness (ICUAW) at ICU discharge, mortality at day 90, and 6-month functional recovery including return to work. Results: We studied 192 patients (mean age 58.1±15.8 years; mean Acute Physiology and Chronic Health Evaluation (APACHE) (IQR) II score, 18.0 (14 to 24)). Mortality at day 90 was 26.6% (51/192). Over 1,351 study days, we collected information during 1,288 planned early mobilization episodes in patients on mechanical ventilation for the first 14 days or until extubation (whichever occurred first). We recorded the highest level of early mobilization. Despite the presence of dedicated physical therapy staff, no mobilization occurred in 1,079 (84%) of these episodes. Where mobilization occurred, the maximum levels of mobilization were exercises in bed (N=94, 7%), standing at the bed side (N=11, 0.9%) or walking (N=26, 2%). On day three, all patients who were mobilized were mechanically ventilated via an endotracheal tube (N=10), whereas by day five 50% of the patients mobilized were mechanically ventilated via a tracheostomy tube (N=18). Conclusions: Early mobilization of patients receiving mechanical ventilation was uncommon. More than 50% of patients discharged from the ICU had developed ICU-acquired weakness, which was associated with death between ICU discharge and day-90. © The TEAM Study Investigators.


Brock K.,University of Sydney | Huang W.-Y.,U.S. National Cancer Institute | Ke L.,The George Institute | Tseng M.,California Polytechnic State University, San Luis Obispo | And 8 more authors.
Journal of Steroid Biochemistry and Molecular Biology | Year: 2010

The aim of this study was to investigate modifiable predictors of vitamin D status in healthy individuals, aged 55-74, and living across the USA. Vitamin D status [serum 25-hydroxyvitamin D (25(OH)D)] was measured along with age and season at blood collection, demographics, anthropometry, physical activity (PA), diet, and other lifestyle factors in 1357 male and 1264 female controls selected from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO) cohort. Multivariate linear and logistic regression analyses were used to identify associations with vitamin D status. Three%, 29% and 79% of the population had serum 25(OH)D levels <25, <50 and <80nmol/L, respectively. The major modifiable predictors of low vitamin D status were low vitamin D dietary and supplement intake, body mass index (BMI) >30kg/m2, physical inactivity (PA) and low milk and calcium supplement intake. In men, 25(OH)D was determined more by milk intake on cereal and in women, by vitamin D and calcium supplement and menopausal hormone therapy (MHT) use. Thus targeting an increase in vigorous activity and vitamin D and calcium intake and decreasing obesity could be public health interventions independent of sun exposure to improve vitamin D status in middle-aged Americans. © 2010 Elsevier Ltd.


TORONTO, ON--(Marketwired - November 15, 2016) - In an informative session on Monday, November 28, 2016 at 12pm EST, George Clinical Scientific Leader, Professor Craig Anderson, Executive Director at The George Institute, China and Senior Director of the Neurological and Mental Health Division, will discuss the recent success of the SAVE trial, which recruited over 2700 patients globally, with over 63% of those participants coming from China. Professor Anderson will outline many of the opportunities that exist when conducting clinical trials in Asia, such as the SAVE trial, and debunk many of the misconceptions that exist for sponsors who have operated in the traditional clinical trial markets of the USA and Europe. The delivery of a clinical trial to the highest scientific standards can be challenging in today's complex, high-cost, high-risk clinical trials environment. The Scientific Leadership Model, championed by George Clinical may be the answer. Following the recent publication of the results of one of the largest obstructive sleep apnea medical device trials (SAVE) ever undertaken, Professor Craig Anderson, will discuss the emergence of scientific leadership as an innovative service addition to a clinical trials design and delivery. Professor Craig Anderson has conducted some of the largest global neurology and blood pressure trials ever undertaken. He is widely considered a world authority on stroke and much of his success has revolved around conducting clinical trials in Asia. For more information or to register for this complimentary event, visit: The Scientific Leadership Model: An Innovative Approach to Clinical Trial Leadership, Design and Delivery Xtalks, powered by Honeycomb Worldwide Inc., is a leading provider of educational webinars to the global Life Sciences community. Every year thousands of industry practitioners (from pharmaceutical & biotech companies, private & academic research institutions, healthcare centers, etc.) turn to Xtalks for access to quality content. Xtalks helps Life Science professionals stay current with industry developments, trends and regulations. Xtalks webinars also provide perspectives on key issues from top industry thought leaders and service providers. To learn more about Xtalks visit http://xtalks.com


Farag I.,The George Institute | Howard K.,University of Sydney | Ferreira M.L.,University of Sydney | Sherrington C.,The George Institute for Global Health
Age and Ageing | Year: 2015

Background: despite evidence on what works in falls prevention, falls in older people remain an important public health problem.Aims: the purpose of this study was to model the impact and cost-effectiveness of a public health falls prevention programme, from the perspective of the health funder.Methods: a decision analytic Markov model compared the health benefits in quality-adjusted life years (QALYs) and costs of treatment and residential aged care with and without a population heath falls prevention programme. Different intervention costs, uptake levels and programme effectiveness were modelled in sensitivity analyses. Uncertainty was explored using univariate and probabilistic sensitivity analysis.Results: widespread rollout of a public health fall prevention programme could result in an incremental cost-effectiveness ratio (ICER) of $A28,931 per QALY gained, assuming a programme cost of $700 per person and at a fall prevention risk ratio of 0.75. This ICER would be considered cost-effective at a threshold value of $A50,000 per QALY gained. Sensitivity analyses for programme cost and effectiveness indicated that the public health programme produced greater health outcomes and was less costly than no programme when programme costs were $A500 or lower and risk ratio for falls was 0.70 or lower. At a cost of $A2,500, the public health falls prevention programme ceases to be a cost-effective option.Conclusion: serious consideration should be given to implementation of a public health programme of falls prevention as a cost-effective option that enables population-wide access to the intervention strategies. © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved.


Heritier S.,The George Institute | Heritier S.,University of Sydney | Lo S.N.,The George Institute | Morgan C.C.,Cardinal Systems
Statistics in Medicine | Year: 2011

This article has been motivated by an ongoing international adaptive confirmatory trial. At the interim analysis of this two-stage trial, none, one or two active treatment regimens are selected for further study in the second stage. A combination test approach is used in this practical setting with an extension of the theory to unbalanced randomization. We show that a combination test with suitable weights can still preserve the overall Type I error rate provided that the test statistic is chosen appropriately and the unpooled Z-test for proportions is not used. The accuracy of stagewise p-values is also discussed in a more general framework. Monte Carlo simulations confirm the validity of the approach retained and evaluate the necessary sample size. Additional issues addressed during the design of the trial are also examined such as multiplicity due to testing hypotheses on key secondary endpoints, a non-inferiority comparison to an active treatment and covariate adjusted analyses for various types of outcome. © 2011 John Wiley & Sons, Ltd.


Eyles H.,University of Auckland | Rodgers A.,The George Institute | Ni Mhurchu C.,University of Auckland
Journal of Human Nutrition and Dietetics | Year: 2010

Background: Nutrition education may be most effective when personally tailored. Individualised electronic supermarket sales data offer opportunities to tailor nutrition education using shopper's usual food purchases. The present study aimed to use individualised electronic supermarket sales data to tailor nutrition resources for an ethnically diverse population in a large supermarket intervention trial in New Zealand. Methods: Culturally appropriate nutrition education resources (i.e. messages and shopping lists) were developed with the target population (through two sets of focus groups) and ethnic researchers. A nutrient database of supermarket products was developed using retrospective sales data and linked to participant sales to allow tailoring by usual food purchases. Modified Heart Foundation Tick criteria were used to identify 'healthier' products in the database suitable for promotion in the resources. Rules were developed to create a monthly report listing the tailored and culturally targeted messages to be sent to each participant, and to produce automatstailored shopping lists. Results: Culturally targeted nutrition messages (n = 864) and shopping lists (n = 3 formats) were developed. The food and nutrient database (n = 3000 top-selling products) was created using 12 months of retrospective sales data, and comprised 60%'healthier' products. Three months of baseline sales data were used to determine usual food purchases. Tailored resources were successfully mailed to 123 Māori, 52 Pacific and 346 non-Māori non-Pacific participants over the 6-month trial intervention period. Conclusions: Electronic supermarket sales data can be used to tailor nutrition education resources for a large number of ethnically diverse supermarket shoppers. © 2010 The Authors. Journal compilation © 2010 The British Dietetic Association Ltd.


Peters S.A.E.,The George Institute | Peters S.A.E.,Julius Center for Health science and Primary Care | Woodward M.,The George Institute | Woodward M.,University of Glasgow | And 5 more authors.
British Journal of Haematology | Year: 2013

There is strong evidence from meta-analyses of prospective epidemiological studies that increasing plasma fibrinogen levels are associated with an increasing risk of cardiovascular disease (CVD) and all-cause mortality. However, there are few published direct comparisons of the several different available fibrinogen assays in association with CVD or mortality. We therefore prospectively compared the standardized von Clauss assay of clottable fibrinogen with three other assays: prothrombin time (PT)-derived clottable fibrinogen, immunonephelometric fibrinogen, and heat precipitable fibrinogen in the Scottish Heart Health Extended Cohort. Hazard ratios (HRs) for a standard deviation increase in fibrinogen for risk of CVD, adjusted for age and sex, were 1·17 (95% confidence interval [CI] 1·14; 1·21) for the von Clauss assay; 1·19 (1·06; 1·33) for the heat precipitation assay; 1·16 (1·01; 1·35) for the PT-derived assay; and 1·28 (1·10; 1·51) for the immunonephelometric assay. HRs for all-cause mortality were 1·21 (1·18; 1·24); 1·13 (1·01; 1·26), 1·17 (1·00; 1·37) and 1·17 (0·99; 1·39), respectively. No significant differences were observed between the assays in such comparisons. We therefore conclude that the choice between plasma fibrinogen assays in routine clinical haematology and biochemistry laboratories should depend on practical factors, and not on expected differences in the strength of associations. © 2013 John Wiley & Sons Ltd.


Justin Zaman M.,University of Sydney | Justin Zaman M.,University College London | Patel A.,University of Sydney | Patel A.,The George Institute | And 5 more authors.
International Journal of Epidemiology | Year: 2012

Background To investigate the prevalence, screening and knowledge of cardiovascular risk factors (CVRFs) by socio-economic position (SEP) in rural India. Methods An age- and sex-stratified random sample of 4535 adults was recruited from rural Andhra Pradesh and a questionnaire was administered to assess prevalence, screening and knowledge of CVRFs and record recent attempts to modify behaviour. Education, income and occupation were used to measure SEP. Results Lower fruit intake and higher tobacco and alcohol use were found in those with lower SEP. Overweight, physical inactivity, diabetes, hypertension, family history of cardiovascular disease (CVD) and previous CVD (men only) were greater in higher SEP participants. Lower SEP participants had less blood pressure, glucose or cholesterol screening and less knowledge of nine CVRFs. Regardless of SEP, participants knowledgeable of the harms of a CVRF were more likely to have attempted to modify behaviour. For example, knowledge of benefits of smoking cessation was associated with an increased odds ratio (OR) for attempting to quit: in educated participants-OR 3.67, 95% confidence interval (CI) 2.10-6.42; in participants with no education-OR 3.98, 95% CI 2.27-6.97.Conclusions Some biological CVRFs were worse in higher SEP participants while some behavioural risk factors were worse in lower SEP participants. Lower SEP participants had less CVRF screening and knowledge of CVRFs. Those with knowledge of CVRFs were more likely to make healthy behavioural changes. Our findings suggest equipping rural Indians with knowledge about CVRFs may ameliorate projected future increases in CVD. Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2012; all rights reserved.


PubMed | The George Institute and Menzies Research Institute
Type: | Journal: International journal of obesity (2005) | Year: 2016

Overweight and obesity are associated with left ventricular (LV) dysfunction. We sought whether echocardiographic evidence of abnormal adult cardiac structure and function was related to childhood or adult adiposity.This study included 159 healthy individuals aged 7-15 years and followed until age 36-45 years. Anthropometric measurements were performed both at baseline and follow-up. Cardiac structure (indexed left atrial volume [LAVi], left ventricular mass [LVMi]) and LV function (global longitudinal strain [GLS], mitral e) were assessed using standard echocardiography at follow up. Conventional cut-offs were used to define abnormal LAVi, LVMi, GLS and mitral annular e.Childhood body mass index (BMI) was correlated with LVMi (r=0.25, P=0.002), and child waist circumference was correlated with LVMi (r=0.18, P=0.03) and LAVi (r=0.20, P=0.01), but neither were correlated with GLS. One standard deviation (by age and sex) increase in childhood BMI was associated with LV hypertrophy (RR: 2.04 [95% CI: 1.09, 3.78]) and LA enlargement (RR: 1.81 [95% CI: 1.02, 3.21]) independent of adult BMI, but the association was not observed with impaired GLS or mitral e. Cardiac functional measures were more impaired in those who had normal BMI as child but had high BMI in adulthood (P<0.03), and not different in those who were overweight or obese as a child and remained so in adulthood (P>0.33).Childhood adiposity is independently associated with structural cardiac disturbances (LVMi and LAVi). However, functional alterations (GLS and mitral e) were more frequently associated with adult overweight or obesity, independent of childhood adiposity.International Journal of Obesity accepted article preview online, 27 December 2016. doi:10.1038/ijo.2016.234.

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