The Sax Institute

Haymarket, Australia

The Sax Institute

Haymarket, Australia

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Banks E.,Australian National University | Banks E.,The Sax Institute | Joshy G.,Australian National University | Weber M.F.,Cancer Council NSW | And 11 more authors.
BMC Medicine | Year: 2015

Background: The smoking epidemic in Australia is characterised by historic levels of prolonged smoking, heavy smoking, very high levels of long-term cessation, and low current smoking prevalence, with 13% of adults reporting that they smoked daily in 2013. Large-scale quantitative evidence on the relationship of tobacco smoking to mortality in Australia is not available despite the potential to provide independent international evidence about the contemporary risks of smoking. Methods: This is a prospective study of 204,953 individuals aged ≥45years sampled from the general population of New South Wales, Australia, who joined the 45 and Up Study from 2006-2009, with linked questionnaire, hospitalisation, and mortality data to mid-2012 and with no history of cancer (other than melanoma and non-melanoma skin cancer), heart disease, stroke, or thrombosis. Hazard ratios (described here as relative risks, RRs) for all-cause mortality among current and past smokers compared to never-smokers were estimated, adjusting for age, education, income, region of residence, alcohol, and body mass index. Results: Overall, 5,593 deaths accrued during follow-up (874,120 person-years; mean: 4.26years); 7.7% of participants were current smokers and 34.1% past smokers at baseline. Compared to never-smokers, the adjusted RR (95% CI) of mortality was 2.96 (2.69-3.25) in current smokers and was similar in men (2.82 (2.49-3.19)) and women (3.08 (2.63-3.60)) and according to birth cohort. Mortality RRs increased with increasing smoking intensity, with around two- and four-fold increases in mortality in current smokers of ≤14 (mean 10/day) and ≥25 cigarettes/day, respectively, compared to never-smokers. Among past smokers, mortality diminished gradually with increasing time since cessation and did not differ significantly from never-smokers in those quitting prior to age 45. Current smokers are estimated to die an average of 10years earlier than non-smokers. Conclusions: In Australia, up to two-thirds of deaths in current smokers can be attributed to smoking. Cessation reduces mortality compared with continuing to smoke, with cessation earlier in life resulting in greater reductions. © 2015 Banks et al.


Magee C.A.,University of Wollongong | Holliday E.G.,Hunter Medical Research Institute | Attia J.,Hunter Medical Research Institute | Kritharides L.,University of Sydney | And 2 more authors.
Sleep Medicine | Year: 2013

Objective: To examine the relationship between sleep duration and mortality and to quantify the likely impact of residual confounding due to poor health status on any observed association. Methods: The sample included 227,815 Australian adults aged 45. years and older recruited from 2006-2009 (the 45 and Up Study). Sleep duration and relevant covariates (e.g., health status, demographic factors) were assessed through a self-report questionnaire. These data were linked with mortality data from the New South Wales Registry of Births, Deaths, and Marriages up to December 2010 (mean follow-up period, 2.8. y). Cox proportional hazards models examined the relationship between sleep duration and all-cause mortality adjusting for relevant sociodemographic covariates (e.g., age, gender, marital status), with further stratification by baseline health status based on physical functioning and preexisting disease. Results: The adjusted mortality risk was significantly higher in individuals reporting <6. hours of sleep (hazard ratio [HR], 1.13[1.01-1.25]) and ≥10. hours of sleep (HR, 1.26[1.16-1.36]), compared to those reporting 7. hours of sleep per night. These associations differed by baseline health status (p[interaction]. = 0.026) such that there was no significant relationship of sleep duration to mortality in those with good health at baseline. Conclusion: Following careful prospective controlling for baseline health, mortality risk does not significantly vary according to sleep duration. Previous findings suggesting a relationship between sleep duration and mortality could be affected by residual confounding by poor preexisting health, as reflected by a combination of preexisting illnesses and functional limitations. © 2013.


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.


Haynes A.S.,University of Sydney | Haynes A.S.,The Sax Institute | Derrick G.E.,Institute of Public Goods and Policies | Redman S.,The Sax Institute | And 4 more authors.
PLoS ONE | Year: 2012

This paper reports data from semi-structured interviews on how 26 Australian civil servants, ministers and ministerial advisors find and evaluate researchers with whom they wish to consult or collaborate. Policymakers valued researchers who had credibility across the three attributes seen as contributing to trustworthiness: competence (an exemplary academic reputation complemented by pragmatism, understanding of government processes, and effective collaboration and communication skills); integrity (independence, "authenticity", and faithful reporting of research); and benevolence (commitment to the policy reform agenda). The emphases given to these assessment criteria appeared to be shaped in part by policymakers' roles and the type and phase of policy development in which they were engaged. Policymakers are encouraged to reassess their methods for engaging researchers and to maximise information flow and support in these relationships. Researchers who wish to influence policy are advised to develop relationships across the policy community, but also to engage in other complementary strategies for promoting research-informed policy, including the strategic use of mass media. © 2012 Haynes et al.


De Morgan S.,University of Newcastle | Redman S.,The Sax Institute | D'Este C.,University of Newcastle | Rogers K.,The Sax Institute
Patient Education and Counseling | Year: 2011

Objective: To assess knowledge, satisfaction with information, decisional conflict and psychological morbidity amongst women diagnosed with ductal carcinoma in situ (DCIS) and to explore the factors associated with less knowledge and greater confusion about DCIS. Methods: A cross-sectional survey of women diagnosed with DCIS in Australia (N=144). Results: This study found misunderstanding and confusion amongst women diagnosed with DCIS and a desire for more information about their breast disease. Approximately half of participants worried about their breast disease metastasizing; approximately half expressed high decisional conflict; 12% were anxious and 2% were depressed. Logistic regression analysis demonstrated that worry about dying from the breast disease was significantly associated with not knowing that DCIS could not metastasize (OR 3.9; 95% CI 1.03-14.25); and confusion about whether DCIS could metastasize was significantly associated with dissatisfaction with information (OR 12.5; 95% CI 3.8-40.2). Conclusion: Good communication about how DCIS differs from invasive breast cancer is essential to alleviating the confusion and worry amongst women with DCIS. Practice implications: Recommendations about how best to communicate a diagnosis of DCIS, including the uncertainties, are needed to guide health professionals to promote better understanding about DCIS and increase the well-being of women with DCIS. © 2010.


Muthayya S.,The Sax Institute | Sugimoto J.D.,University of Florida | Sugimoto J.D.,Fred Hutchinson Cancer Research Center | Montgomery S.,Emory University | Maberly G.F.,Cumberland Hospital
Annals of the New York Academy of Sciences | Year: 2014

Rice is the staple food for over half the world's population. Approximately 480 million metric tons of milled rice is produced annually. China and India alone account for ∼50% of the rice grown and consumed. Rice provides up to 50% of the dietary caloric supply for millions living in poverty in Asia and is, therefore, critical for food security. It is becoming an important food staple in both Latin America and Africa. Record increases in rice production have been observed since the start of the Green Revolution. However, rice remains one of the most protected food commodities in world trade. Rice is a poor source of vitamins and minerals, and losses occur during the milling process. Populations that subsist on rice are at high risk of vitamin and mineral deficiency. Improved technologies to fortify rice have the potential to address these deficiencies and their associated adverse health effects. With the rice industry consolidating in many countries, there are opportunities to fortify a significant share of rice for distribution or for use in government safety net programs that target those most in need, especially women and children. Multisectoral approaches are needed for the promotion and implementation of rice fortification in countries. © 2014 New York Academy of Sciences.


With our rapidly ageing population there is an urgent imperative to minimise the rate of falls and associated injuries. A key challenge to public health is to better conceptualise and contextualise falls prevention evidence for more effective policy making and practice. This paper describes how NSW Health adopted the Nutbeam and Bauman Stages of Research and Evaluation Model in the strategic development of the NSW Health Plan for Prevention of Falls and Harm from Falls Among Older People: 2011-2015. Research evidence has been comprehensively applied to every stage of the development of the Plan and research and evaluation is a key action area within the new Plan. The Stages of Research and Evaluation Model provides a useful overarching framework for policy makers to contextualise and more effectively apply research evidence throughout the policy making process from problem definition to program monitoring.


Banks E.,Australian National University | Banks E.,The Sax Institute | Joshy G.,Australian National University | Abhayaratna W.P.,Australian National University | And 4 more authors.
PLoS Medicine | Year: 2013

Background: Erectile dysfunction is an emerging risk marker for future cardiovascular disease (CVD) events; however, evidence on dose response and specific CVD outcomes is limited. This study investigates the relationship between severity of erectile dysfunction and specific CVD outcomes. Methods and Findings: We conducted a prospective population-based Australian study (the 45 and Up Study) linking questionnaire data from 2006-2009 with hospitalisation and death data to 30 June and 31 Dec 2010 respectively for 95,038 men aged ≥45 y. Cox proportional hazards models were used to examine the relationship of reported severity of erectile dysfunction to all-cause mortality and first CVD-related hospitalisation since baseline in men with and without previous CVD, adjusting for age, smoking, alcohol consumption, marital status, income, education, physical activity, body mass index, diabetes, and hypertension and/or hypercholesterolaemia treatment. There were 7,855 incident admissions for CVD and 2,304 deaths during follow-up (mean time from recruitment, 2.2 y for CVD admission and 2.8 y for mortality). Risks of CVD and death increased steadily with severity of erectile dysfunction. Among men without previous CVD, those with severe versus no erectile dysfunction had significantly increased risks of ischaemic heart disease (adjusted relative risk [RR] = 1.60, 95% CI 1.31-1.95), heart failure (8.00, 2.64-24.2), peripheral vascular disease (1.92, 1.12-3.29), "other" CVD (1.26, 1.05-1.51), all CVD combined (1.35, 1.19-1.53), and all-cause mortality (1.93, 1.52-2.44). For men with previous CVD, corresponding RRs (95% CI) were 1.70 (1.46-1.98), 4.40 (2.64-7.33), 2.46 (1.63-3.70), 1.40 (1.21-1.63), 1.64 (1.48-1.81), and 2.37 (1.87-3.01), respectively. Among men without previous CVD, RRs of more specific CVDs increased significantly with severe versus no erectile dysfunction, including acute myocardial infarction (1.66, 1.22-2.26), atrioventricular and left bundle branch block (6.62, 1.86-23.56), and (peripheral) atherosclerosis (2.47, 1.18-5.15), with no significant difference in risk for conditions such as primary hypertension (0.61, 0.16-2.35) and intracerebral haemorrhage (0.78, 0.20-2.97). Conclusions: These findings give support for CVD risk assessment in men with erectile dysfunction who have not already undergone assessment. The utility of erectile dysfunction as a clinical risk prediction tool requires specific testing. Please see later in the article for the Editors' Summary. © 2013 Banks et al.


To describe the prevalence, circumstances and consequences of falls among community-dwelling older people in NSW using data from the 2009 NSW Falls Prevention Baseline Survey. Telephone interviews with a random sample of 5681 NSW residents aged 65 years and over were conducted in 2009. Of those surveyed, 25.6% reported falling in the last year. Of those who fell, 61.2% fell once, 21.4% fell twice, 7.8% fell three times, and 9.5% fell four or more times in the last year. Sixty-six percent of those who fell in the last year were injured and 20.0% visited a hospital as a result of a fall. The most common injuries were cuts, grazes or bruises (71.0%) and sprains or strains (9.9%). The findings of this survey are consistent with previous findings in the published fall injury prevention literature. The results from the survey will assist in the design of community oriented fall injury prevention strategies and will form the baseline measure for the evaluation of the impact of these strategies in NSW.


News Article | December 14, 2015
Site: news.yahoo.com

Unhealthy sleep patterns combined with other factors could increase mortality risk, according to a study in Australia of people ages 45 and older. More The actress Mae West once said, "Too much of a good thing is wonderful!" Unfortunately, in reality, most of the decadent indulgences we pursue — including alcohol and rich foods — are not at all good for us, especially when taken in large quantities. Now, a new study suggests that indulging in too much sleep and inactivity are also unhealthy. Researchers found that people who spend most of the day sitting and  sleeping too much may be as likely to die early as people who smoke or drink too much. The Sax Institute's "45 and Up" study included more than 230,000 people in Australia ages 45 and older. For each participant, the researchers counted how many unhealthy behaviors he or she engaged in, including smoking, drinking alcohol, eating unhealthy foods, being physical inactive, exhibiting sedentary behaviors and sleeping too much (which the researchers defined as more than 9 hours per night). [7 Ways the Mind and Body Change With Age] About 30 percent of the participants reported engaging in two or three of the behaviors. After six years, nearly 16,000 people in the study had died. The researchers found that  people who were not physically active were 1.6 times more likely to die than those who were physically active (defined by the study as "undertaking more than 150 minutes of moderate-to-vigorous physical activity every week.") But the study also showed that the combination of physical inactivity with sedentary behavior, or physical inactivity with too much sleep, were as strongly linked to mortality among the participants as the combination of smoking with heavy drinking. "Physical inactivity alone had a strong association with mortality," Melody Ding, lead author on the study and senior research fellow at the Sydney School of Public Health, University of Sydney, told Live Science in an email. And when people combined physical inactivity with long sleep times and extended periods of sitting, the negative effects were even more dramatic, with the combined risk for death increasing by up to four times as much as in those who were sedentary and slept too much, but at least got some exercise, Ding explained. The researchers noted they did not incorporate other long-term lifestyle practices or conditions that might have played a part in increasing some participants' mortality risks. And the participants' interpretations of their own behaviors and its health impacts could have been faulty, skewing the study's results. While the study's conclusion that healthier behaviors could reduce mortality risk seems like an obvious one, linking risky behaviors together could present new strategies for prolonging life. "Physical activity is the one factor to address first," Ding said. If certain combinations of risk behaviors pose more of a threat than risk behaviors on their own, eliminating even one of them is a good choice for overall health. The findings were published online Tuesday (Dec. 8) in the journal PLOS Medicine. Follow Mindy Weisberger on Twitter and Google+. Follow us @livescience, Facebook & Google+. Original article on Live Science. Copyright 2015 LiveScience, a Purch company. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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