ORCID Profile
0000-0002-3007-0216
Current Organisation
University of New South Wales
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Publisher: CSIRO Publishing
Date: 22-10-2020
DOI: 10.1071/AH19285
Abstract: Objectives General practitioner (GP) follow-up after a hospital admission is an important indicator of integrated care. We examined the characteristics of patients who saw a GP within 2 weeks of hospital discharge in the Central and Eastern Sydney (CES) region, Australia, and the relationship between GP follow-up and subsequent hospitalisation. Methods This data linkage study used a cohort of 10 240 people from the 45 and Up Study who resided in CES and experienced an overnight hospitalisation in the 5 years following recruitment (2007–14). Characteristics of participants who saw a GP within 2 weeks of discharge were compared with those who did not using generalised linear models. Time to subsequent hospitalisation was compared for the two groups using Cox proportional hazards regression models stratified by prior frequency of GP use. Results Within 2 weeks of discharge, 64.3% participants saw a GP. Seeing a GP within 2 weeks of discharge was associated with lower rates of rehospitalisation for infrequent GP users (i.e. visits in year before the index hospitalisation hazard ratio (HR) 0.83 95% confidence interval (CI) 0.70–0.97) but not frequent GP users (i.e. ≥8 plus visits HR 1.02 95% CI 0.90–1.17). Conclusion The effect of seeing a GP on subsequent hospitalisation was protective but differed depending on patient care needs. What is known about the topic? There is general consensus among healthcare providers that primary care is a significant source of ongoing health care provision. What does this paper add? This study explored the relationship between GP follow-up after an uncomplicated hospitalisation and its effect on rehospitalisation. What are the implications for practitioners? Discharge planning and the transfer of care from hospital to GP through discharge arrangements have substantial benefits for both patients and the health system.
Publisher: AMPCo
Date: 10-2011
DOI: 10.5694/MJA11.10836
Abstract: To determine the current level of knowledge of first aid for a burn injury and sources of this knowledge among the general population of New South Wales. People aged 16 years or older were interviewed as part of the 2007 NSW Population Health Survey, a continuous telephone survey of NSW residents. Weighted proportion of the population with optimal first aid knowledge for burns. In total, 7320 respondents were asked questions related to burn injuries and first aid. Of the surveyed population, 82% reported that they would cool a burn with water, and 9% reported that they would cool the burn for the recommended 20 minutes. Few respondents reported that they would remove the patient's clothing and keep the injured person warm. The most common sources of first aid information were a first aid book (42%) and the internet (33%). Speaking a language other than English at home, and being over 65 years of age were associated with a lack of first aid knowledge. A minority of people living in NSW know the optimal time for cooling a burn injury and other appropriate first aid steps for burns. This study demonstrates a gap in the public's knowledge, especially among non-English speaking people and older people, and highlights the need for a clear, consistent first aid message.
Publisher: Informa UK Limited
Date: 09-09-2017
Publisher: SAGE Publications
Date: 13-03-2017
Abstract: A binary health outcome may be regressed on covariates using a log link, rather than more typical link functions such as the logit. This allows the exponentiated regression coefficient for each covariate to be interpreted as a relative risk conditional on the remaining covariates. Relative risks are simpler to interpret than the odds ratios which arise with a logit link. There are practical and conceptual challenges in log-link binary regression, mainly due to the requirement that probabilities are less than or equal to 1. Viable probabilities are now usually achieved by the imposition of a constraint on the parameter space, but the log link function is still more work to apply in practice. We propose instead a new smooth link function which is equal to the log up to a cutoff and a linearly scaled logit function above the cutoff. The new approach is conceptually clearer, simpler to implement and generally less biased, and it retains the relative risk interpretation for all but the highest risk in iduals. Alternative binary regressions are compared using a simulation study and a diabetic retinopathy dataset.
Publisher: Springer Science and Business Media LLC
Date: 12-2012
Publisher: Elsevier BV
Date: 10-1999
DOI: 10.1016/S0165-0327(99)00004-X
Abstract: Recent work has demonstrated that the lifetime suicide risk for patients with DSM IV Major Depression cannot mathematically approximate the accepted figure of 15%. Gender and age significantly affect both the prevalence of major depression and suicide risk. Gender and age stratified calculations were made on the entire population of the USA in 1994 using a mathematical algorithm. Sex specific corrections for under-reporting were incorporated into the design. The lifetime suicide risks for men and women were 7% and 1%, respectively. The combined risk was 3.4%. The male:female ratio for suicide risk in major depression was 10:1 for youths under 25, and 5.6:1 for adults. Suicide in major depression is predominantly a male problem, although complacency towards female sufferers is to be avoided. Diagnosis of major depression is of limited help in predicting suicide risk compared to case specific factors. The male experience of depression that leads to suicide is often not identified as a legitimate medical complaint by either sufferers or professionals. Increasing help-accessing by males is a priority. Patients with a history of hospitalisation comorbidity, especially for substance abuse and who are male, require greater vigilance for suicide risk. It may be that for males the threshold for diagnosing and treating major depression needs to be lowered. This research is based on a mathematical algorithm to approximate a life-long longitudinal study that identifies community cases of depression. Our findings therefore rely on the validity of the statistics used. Extrapolation is limited to populations with an actual suicide rate of 17/100,000 or less and a lifetime prevalence of major depression of 17% or more.
Publisher: JMIR Publications Inc.
Date: 19-11-2021
Abstract: ardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) are posing a huge burden on health care systems worldwide. Mobile apps can deliver behavior change interventions for chronic disease prevention on a large scale, but current evidence for their effectiveness is limited. his paper reported on the development and user testing of a mobile app that aims at increasing risk awareness and engaging users in behavior change. It would form part of an intervention for primary prevention of CVD and T2DM. he theoretical framework of the app design was based on the Behaviour Change Wheel, combined with the capability, opportunity, and motivation for behavior change system and the behavior change techniques from the Behavior Change Technique Taxonomy (version 1). In addition, evidence from scientific literature has guided the development process. The prototype was tested for user-friendliness via an iterative approach. We conducted semistructured interviews with in iduals in the target populations, which included the System Usability Scale. We transcribed and analyzed the interviews using descriptive statistics for the System Usability Scale and thematic analysis to identify app features that improved utility and usability. he target population was Australians aged ≥45 years. The app included 4 core modules (risk score, goal setting, health measures, and education). In these modules, users learned about their risk for CVD and T2DM set goals for smoking, alcohol consumption, diet, and physical activity and tracked them. In total, we included 12 behavior change techniques. We conducted 2 rounds of usability testing, each involving 5 participants. The average age of the participants was 58 (SD 8) years. Totally, 60% (6/10) of the participants owned iPhone Operating System phones, and 40% (4/10) of them owned Android phones. In the first round, we identified a technical issue that prevented 30% (3/10) of the participants from completing the registration process. Among the 70% (7/10) of participants who were able to complete the registration process, 71% (5/7) rated the app above average, based on the System Usability Scale. During the interviews, we identified some issues related to functionality, content, and language and clarity. We used the participants’ feedback to improve these aspects. e developed the app using behavior change theory and scientific evidence. The user testing allowed us to identify and remove technical errors and integrate additional functions into the app, which the participants had requested. Next, we will evaluate the feasibility of the revised version of the app developed through this design process and usability testing.
Publisher: Hindawi Limited
Date: 16-08-2023
DOI: 10.1155/2023/5032583
Abstract: Carers are a large portion of the Australian community. In 2018, 2.65 million Australians identified as carers, and almost one-third (32.6%) of this group were primary carers. There is currently a lack of understanding of the impact of being a carer on a person’s health and wellbeing compared to non-carers. This research was undertaken to understand the health status, health risks, and health outcomes for carers in Central and Eastern Sydney, Australia (CES), who are 45 years of age or over. A record linkage study using data from the 45 and Up Study, Medicare Benefit Scheme claims, hospitalisations, and deaths was undertaken on participants in CES (n = 29,489). Characteristics of carers were described and outcomes over an eight-year period were also calculated. Around 12% of the cohort was carers at a given time, though most transitioned in and out of caring roles over a five-year period. Compared with non-carers, carers in CES had higher rates of self-reported smoking, anxiety, psychological distress, heart disease, and self-rated poor quality of life. Carers had higher rates of general practitioner use than non-carers (Adj. HR (95% CI): 1.21 (1.13, 1.30)). However, hospital admissions and mortality were not significantly different. This study confirms that a small proportion of carers remain in carer roles for many years. Caring often starts suddenly, and people need to quickly adapt to their new role. The finding that carers are well-engaged with GPs suggests they may play an important role in identifying carers who are struggling, and delivering interventions for carers.
Publisher: Cold Spring Harbor Laboratory
Date: 18-11-2018
DOI: 10.1101/473348
Abstract: Population health research is increasingly focused on the genetic determinants of healthy ageing, but there is no public resource of whole genome sequences and phenotype data from healthy elderly in iduals. Here we describe the Medical Genome Reference Bank (MGRB), comprising whole genome sequence and phenotype of 2,570 elderly Australians depleted for cancer, cardiovascular disease, and dementia. We analysed the MGRB for single-nucleotide, indel and structural variation in the nuclear and mitochondrial genomes. In iduals in the MGRB had fewer disease-associated common and rare germline variants, relative to both cancer cases and the gnomAD and UK BioBank cohorts, consistent with risk depletion. Pervasive age-related somatic changes were correlated with grip strength in men, suggesting blood-derived whole genomes may also provide a biologic measure of age-related functional deterioration. The MGRB provides a broadly applicable reference cohort for clinical genetics and genomic association studies, and for understanding the genetics of healthy ageing. This research has been conducted using the UK Biobank Resource under Application Number 17984.
Publisher: Springer Science and Business Media LLC
Date: 12-08-2014
Publisher: Springer Science and Business Media LLC
Date: 23-01-2020
DOI: 10.1038/S41467-019-14079-0
Abstract: Population health research is increasingly focused on the genetic determinants of healthy ageing, but there is no public resource of whole genome sequences and phenotype data from healthy elderly in iduals. Here we describe the first release of the Medical Genome Reference Bank (MGRB), comprising whole genome sequence and phenotype of 2570 elderly Australians depleted for cancer, cardiovascular disease, and dementia. We analyse the MGRB for single-nucleotide, indel and structural variation in the nuclear and mitochondrial genomes. MGRB in iduals have fewer disease-associated common and rare germline variants, relative to both cancer cases and the gnomAD and UK Biobank cohorts, consistent with risk depletion. Age-related somatic changes are correlated with grip strength in men, suggesting blood-derived whole genomes may also provide a biologic measure of age-related functional deterioration. The MGRB provides a broadly applicable reference cohort for clinical genetics and genomic association studies, and for understanding the genetics of healthy ageing.
Publisher: Wiley
Date: 03-1997
DOI: 10.1111/J.1600-0447.1997.TB09629.X
Abstract: For 25 years the medical profession has accepted that of every 100 in iduals with major depressive disorder (MDD), 15 subjects will ultimately commit suicide. The present paper demonstrates that the lifetime suicide risk in this condition cannot be so high. Conservative age-specific calculations give a lifetime suicide risk in MDD of 3.5%. Selection of hospital-based, high suicide risk, study populations in the index research, when most sufferers are out-patients, is the primary contributor to the overestimation of suicide risk. Evolving classification systems are a further factor. In terms of suicide risk, MDD is not a homogenous diagnostic category. As has been reliably replicated, the small subgroup of patients who have experienced hospital admission do experience a much greater lifetime suicide risk.
Publisher: JMIR Publications Inc.
Date: 22-01-2023
Abstract: he Health eLiteracy for Prevention in General Practice (HeLP-GP) trial is a primary healthcare-based behavior change intervention for weight loss in overweight and obese Australians from lower socioeconomic areas. In iduals from these areas are known to have low levels of health literacy and are particularly at risk for chronic conditions, including diabetes and cardiovascular disease. The intervention comprised health check visits with a practice nurse, a purpose-built patient-facing mobile app (mysnapp) and referral to telephone coaching his study aimed to assess the mysnapp app use within the HeLP-GP trial and its effects on study outcomes. n 2018, we recruited 22 general practices from 2 Australian states and randomized them by cluster to the intervention or usual care. Patients who met the main eligibility criteria (i.e. BMI 28 in previous 12 months and aged 40-74 years) were identified through the clinical software. The practice staff then provided the patients with details about the study. The intervention consisted of a health check with a practice nurse and a lifestyle app, a telephone coaching program, or both depending on the participants' choice. We collected data directly through the app and combined it with data from the 6-week health check with the practice nurses, the telephone coaching, and the participants' questionnaires at baseline, and 6-month follow-up. The analyses comprised descriptive and inferential statistics. f the 120 participants who received the intervention, 62 (52%) participants chose to use the app. The two groups did not differ significantly in demographics or recent hospital admissions. The median time between first and last app use was 52 (IQR 4-95) days, with a median of 5 (IQR 2-10) active days. App users were significantly more likely to attend the 6-week health check (χ21=6.4, P=.010) and participate in the telephone coaching (χ22=25.0, P .001) than non-app users. here seemed to be no differences in demographics or recent hospital admissions between those who chose to use the app and those who did not. App users were more likely to attend the 6-week health check and participate in telephone coaching. These finding suggest that participants who opted for several intervention components felt more committed to the study. NZCTR.org.au ACTRN12617001508369 R2-10.1136/bmjopen-2018-023239
Publisher: Springer Science and Business Media LLC
Date: 02-04-2007
Publisher: JMIR Publications Inc.
Date: 06-04-2022
Abstract: ardiovascular disease and type 2 diabetes mellitus are two of the most prevalent chronic conditions worldwide. An unhealthy lifestyle greatly contributes to someone’s risk of developing these conditions. Mobile health is an emerging technology that can help deliver health promotion interventions to the population, for ex le, in the form of health apps. he aim of this study was to test the feasibility of an app-based intervention for cardiovascular and diabetes risk awareness and prevention by measuring nonusage, dropout, adherence to app use, and usability of the app over 3 months. articipants were eligible if they were aged 45 years or older, resided in Australia, were free of cardiovascular disease and diabetes, were fluent in English, and owned a smartphone. In the beginning, participants received an email with instructions on how to install the app and a user guide. After 3 months, they received an email with an invitation to an end-of-study survey. The survey included questions about general smartphone use and the user version of the Mobile Application Rating Scale. We analyzed app-generated and survey data by using descriptive and inferential statistics as well as thematic analysis for open-text comments. ecruitment took place between September and October 2021. Of the 46 participants who consented to the study, 20 (44%) never used the app and 15 (33%) dropped out. The median age of the app users at baseline was 62 (IQR 56-67) years. Adherence to app use, that is, using the app at least once a week over 3 months, was 17% (8/46) of the total s le and 31% (8/26) of all app users. The mean app quality rating on the user version of the Mobile Application Rating Scale was 3.5 (SD 0.6) of 5 points. The app scored the highest for the information section and the lowest for the engagement section of the scale. onusage and dropouts were too high, and the adherence was too low to consider the intervention in its current form feasible. Potential barriers that we identified include the research team not actively engaging with participants early in the study to verify that all participants could install the app, the intervention did not involve direct contact with health care professionals, and the app did not have enough interactive features.
Publisher: Wiley
Date: 19-11-2009
DOI: 10.1111/J.1440-1584.2009.01108.X
Abstract: To determine factors associated with risk perception of continuing drought in Australia. Computer Assisted Telephone Interview survey. The s le was weighted to the New South Wales population. A total of 2004 adults aged 16 years and over. Overall 55.9% of the respondents thought drought was extremely or very likely to continue, 60.1% were extremely or very concerned that they or their family would be affected, and 86.3% reported that they had made some level of change to the way that they lived their lives because of the perceived risk of continuing drought. After controlling for confounding factors, the odds of perceived drought being extremely or very likely to continue, concern for self or family and making changes to behaviour because of the possibility of continuing drought were significantly higher in women than men by 43%, 59% and 86%, respectively. Compared with those who lived in highly accessible geographical areas, respondents who lived in remote or very remote geographical areas were 3.22 (adjusted odds ratios = 3.22 95% CI, 1.69-6.14) times more likely to think that drought would continue and were 3.72 (adjusted odds ratios = 3.72 95% CI, 1.10-12.56) times more likely to have changed the way they lived their lives because of the possibility of continuing drought. Over half of the New South Wales population thought drought was very or extremely likely to continue. The baseline data collected in this survey will be useful for monitoring changes over time in the population's perceptions of continuing drought.
Publisher: Elsevier BV
Date: 04-2000
DOI: 10.1111/J.1467-842X.2000.TB00139.X
Abstract: Excessive sun exposure in childhood has been associated with the development of skin cancer, and appropriate levels of sun protection during the early years of a child's life can significantly reduce the risks. A survey of 133 mothers was undertaken in south-east Queensland to examine the levels of sun exposure and skin protection of infants and young children. Among this s le of 133 mothers, use of appropriate skin protection was relatively high for themselves and their children. However, even by six months of age, a third had been sunburnt and 15% had experienced painful sunburn. By three years of age, 82% had been sunburnt and one-third had experienced painful sunburn, though mothers' knowledge levels of sun safety issues were very high. The predictors associated with primary prevention varied across the type of prevention behaviour, but indicated that interventions should focus on susceptibility to sunburn and history of sunburn. Similar programs could be applicable across a broad range of socio-demographic groups, but require attention to mother's country of birth as a factor that significantly influences their use of protection for their young children. Ongoing public education that targets specific groups and settings may contribute to adoption of appropriate sun protective behaviours for young children. Results of the study provide some of the needed baseline data to assist future skin cancer prevention c aigns for young children and infants. A similar study of levels of sun exposure and skin protection for children during summer is under way.
Publisher: Informa UK Limited
Date: 05-1992
Publisher: Springer Science and Business Media LLC
Date: 27-03-2009
Publisher: Elsevier BV
Date: 11-2010
DOI: 10.1016/J.ENVRES.2010.09.007
Abstract: According to the World Health Organisation (WHO), global warming has the potential to dramatically disrupt some of life's essential requirements for health, water, air and food. Understanding how Australians perceive the risk of global warming is essential for climate change policy and planning. The aim of this study was to determine the prevalence of, and socio-demographic factors associated with, high levels of perceived likelihood that global warming would worsen, concern for self and family and reported behaviour changes. A module of questions on global warming was incorporated into the New South Wales Population Health Survey in the second quarter of 2007. This Computer Assisted Telephone Interview (CATI) was completed by a representative s le of 2004 adults. The weighted s le was comparable to the Australian population. Bivariate and multivariate statistical analyses were conducted to examine the socio-demographic and general health factors. Overall 62.1% perceived that global warming was likely to worsen 56.3% were very or extremely concerned that they or their family would be directly affected by global warming and 77.6% stated that they had made some level of change to the way they lived their lives, because of the possibility of global warming. After controlling for confounding factors, multivariate analyses revealed that those with high levels of psychological distress were 2.17 (Adjusted Odds Ratio (AOR)=2.17 CI: 1.16-4.03 P=0.015) times more likely to be concerned about global warming than those with low psychological distress levels. Those with a University degree or equivalent and those who lived in urban areas were significantly more likely to think that global warming would worsen compared to those without a University degree or equivalent and those who lived in the rural areas. Females were significantly (AOR=1.69 CI: 1.23-2.33 P=0.001) more likely to report they had made changes to the way they lived their lives due to the risk of global warming. A high proportion of respondents reported that they perceived that global warming would worsen, were concerned that it would affect them and their families and had already made changes in their lives because of it. These findings support a readiness in the population to deal with global warming. Future research and programs are needed to investigate population-level strategies for future action.
Publisher: Springer Science and Business Media LLC
Date: 22-11-2012
Publisher: Cambridge University Press (CUP)
Date: 2019
DOI: 10.1017/S146342361900077X
Abstract: To describe the characteristics of people in Central and Eastern Sydney (CES), NSW, who had a General Practice Management Plan (GPMP) and claimed for at least one private allied health service item and to examine if allied health service use results in less hospitalisations over a five-year period. The number of people living with chronic health conditions is increasing in Australia. The Chronic Disease Management programme was introduced to the Medicare Benefits Schedule (MBS) to provide a more structured approach to managing patients with chronic conditions and complex care needs. The programme supports general practitioners claiming up to one GPMP and one Team Care Arrangement every year, and the patient additionally claiming for up to five private allied health services visits. A prospective longitudinal study was conducted. The s le consisted of 5771 participants in CES who had a GPMP within a two-year health service utilisation baseline period (2007–2009). The analysis used the 45 and Up Study questionnaire data linked to the MBS, hospitalisation, death and emergency department data for the period 2006–2014. Of the eligible participants, 43% (2460) had at least one allied health service item claim in the subsequent 12 months. Allied health services were reported as physiotherapy, podiatry and other allied health services. The highest rates of allied health service use were among participants aged 85 years and over (49%). After controlling for confounding factors, a significant difference was found between having claimed for five or more physiotherapy services and emergency admissions (HR: 0.83 95% CI: 0.72–0.95) and potentially preventable hospitalisations (HR: 0.79 95% CI: 0.64–0.96) in the subsequent five years. Use of allied health service items was well targeted towards those with chronic and complex care needs, and use of physiotherapy services was associated with less avoidable hospitalisations.
Publisher: JMIR Publications Inc.
Date: 07-09-2022
DOI: 10.2196/37343
Abstract: The digital transformation has the potential to change health care toward more consumers’ involvement, for ex le, in the form of health-related apps which are already widely available through app stores. These could be useful in helping people understand their risk of chronic conditions and helping them to live more healthily. With this study, we assessed mobile health app use among older Australians in general and among those who were at risk of cardiovascular disease or type 2 diabetes mellitus. In this cross-sectional analysis, we used data from the second follow-up wave of the 45 and Up Study. It is a cohort study from New South Wales, Australia, with 267,153 participants aged 45 years and older that is based on a random s le from the Services Australia (formerly the Australian Government Department of Human Services) Medicare enrollment database. The 2019 follow-up questionnaire contained questions about technology and mobile health use. We further used data on prescribed drugs and hospitalizations to identify participants who already had cardiovascular disease or diabetes or who were at risk of these conditions. Our primary outcome measure was mobile health use, defined as having used a mobile health app before. We used descriptive statistics and multivariate logistic regression to answer the research questions. Overall, 31,946 in iduals with a median age of 69 (IQR 63-76) years had completed the follow-up questionnaire in 2019. We classified half (16,422/31,946, 51.41%) of these as being at risk of cardiovascular disease or type 2 diabetes mellitus and 38.04% (12,152/31,946) as having cardiovascular disease or type 1 or type 2 diabetes mellitus. The proportion of mobile health app users among the at-risk group was 31.46% (5166/16,422) compared to 29.16% (9314/31,946) in the total s le. Those who used mobile health apps were more likely to be female, younger, without physical disability, and with a higher income. People at risk of cardiovascular disease or type 2 diabetes mellitus were not statistically significantly more likely to use mobile health than were people without risk (odds ratio 1.06, 95% CI 0.97-1.16 P=.18 adjusted for age, sex, income, and physical disability). People at risk of cardiovascular disease or type 2 diabetes mellitus were not more likely to use mobile health apps than were people without risk. Those who used mobile health apps were less likely to be male, older, with a physical disability, and with a lower income. From the results, we concluded that aspects of equity must be considered when implementing a mobile health intervention to reach all those that can potentially benefit from it.
Publisher: Elsevier BV
Date: 02-2013
Publisher: Springer Science and Business Media LLC
Date: 24-02-2006
Abstract: Computer assisted telephone interviewing (CATI) is widely used for health surveys. The advantages of CATI over face-to-face interviewing are timeliness and cost reduction to achieve the same s le size and geographical coverage. Two major CATI s ling procedures are used: s ling directly from the electronic white pages (EWP) telephone directory and list assisted random digit dialling (LA-RDD) s ling. EWP s ling covers telephone numbers of households listed in the printed white pages. LA-RDD s ling has a better coverage of households than EWP s ling but is considered to be more expensive due to interviewers dialling more out-of-scope numbers. This study compared an EWP s le and a LA-RDD s le from the New South Wales Population Health Survey in 2003 on demographic profiles, health estimates, coefficients of variation in weights, design effects on estimates, and cost effectiveness, on the basis of achieving the same level of precision of estimates. The LA-RDD s le better represented the population than the EWP s le, with a coefficient of variation of weights of 1.03 for LA-RDD compared with 1.21 for EWP, and average design effects of 2.00 for LA-RDD compared with 2.38 for EWP. Also, a LA-RDD s le can save up to 14.2% in cost compared to an EWP s le to achieve the same precision for health estimates. A LA-RDD s le better represents the population, which potentially leads to reduced bias in health estimates, and rather than costing more than EWP actually costs less.
Publisher: Elsevier BV
Date: 04-2009
DOI: 10.1016/J.YPMED.2009.02.010
Abstract: To examine population trends in lifestyle walking in New South Wales (NSW), Australia between 1998 and 2006. Computer Assisted Telephone Interviewing surveys were conducted in 1998 and annually from 2002 to 2006. The weighted and standardized prevalence estimates of any walking (AW) for exercise, recreation or travel (i.e. > or =10 min/week) and of regular walking (RW) (i.e. > or =150 mins/week over > or =5 occasions) in population sub-groups were determined for each year. Adjusted annual change was calculated using multiple regression analyses. The prevalence of AW was high in 1998 (80.0%, 95% CI: 79.4%-80.6%) and increased to 83.5% (95% CI: 82.7%-84.3%) in 2006. The prevalence of RW was stable between 1998 and 2003 ( approximately 29%), and gradually increased between 2004 (32.9%, 95% CI: 32.0%-33.8%) and 2006 (36.5%, 95% CI: 35.4%-37.6%). The yearly increases differed in magnitude but were significant for all population sub-groups including 75 years and older, the obese, people living in remote locations and those in the most disadvantaged socio-economic status quintile. Socio-economic differential in RW was no longer significant in 2006. Over time, everyday walking has the potential to reduce health inequalities that is due to inactivity. Public health efforts to promote active living and address obesity, as well as a rise in gasoline prices, might have contributed to this trend.
Publisher: Western Sydney University
Date: 2020
Publisher: Wiley
Date: 27-06-2022
DOI: 10.1111/AJAG.13110
Abstract: To investigate characteristics of frequent users of general practice (GP ≥21 visits in a year), medical specialist (≥10 visits), emergency department (ED ≥2 presentations) and hospital services (≥2 overnight hospitalisations) and the association with mortality for people aged over 75 years. The study included residents from Central and Eastern Sydney, Australia, aged over 75 years who participated in a large community‐dwelling cohort study. Demographic, social and health characteristics data were extracted from the 45 and Up Study survey. Health service (GP, medical specialist, ED and hospitalisations) use and mortality data were extracted from linked administrative data. We calculated adjusted prevalence ratios to identify independent characteristics associated with frequent users of services at baseline (approx. 2008) and adjusted hazard ratios to assess the association between frequent users of services and mortality. Frequent users of services (GPs, medical specialists, EDs and hospitals) were more likely to be associated with ever having had heart disease and less likely to be associated with reporting good quality of life. Characteristics varied by service type. Frequent users of services were 1.5–2.0 times more likely to die within 7 years compared to those who were less frequent service users after controlling for all significant factors. Our analysis found that frequent service users aged over 75 years had poorer quality of life, more complex health conditions and higher mortality and so their health service use was not inappropriate. However, better management of these frequent service users may lead to better health outcomes.
Publisher: Wiley
Date: 2000
DOI: 10.1562/0031-8655(2000)071<0060:CBRAMU>2.0.CO;2
Abstract: Cumulative and intermittent sun exposure are risk factors for skin cancer, highlighting the need to monitor exposure during childhood. There is currently very little available information concerning the accuracy of self-reported levels of sun exposure, particularly for very young children. In this study, UV radiation (UVR) exposure measured by polysulfone dosimeters worn on the wrist was compared with a measure of estimated exposure using a diary based on recall at the end of the 4 day study period and ambient dosimetric measures. Results of the study indicate that the relative UVR exposures expressed as a fraction of daily total ambient received during the 4 day period by young children and mothers are similar. A high level of association was obtained for the estimated levels of exposure between young children and their mothers. Moderate correlations were evident for dosimeter readings of mother and child on weekends with no significant association on weekdays. The association between estimated exposure and dosimeter readings was poor and needs improvement. This may be achieved by greater consideration of structural and environmental factors that influence the levels of UVR exposure received by in iduals and by increasing the level of specificity in the measurement instruments. Methodological issues such as recall of exposure after several days, quantity of sun exposure and more precise measurement of grades of exposure when outside may have more impact than previously expected, and further information is being sought with a larger s le for exposure during the summer months.
Publisher: JMIR Publications Inc.
Date: 07-2022
DOI: 10.2196/38469
Abstract: Cardiovascular disease and type 2 diabetes mellitus are two of the most prevalent chronic conditions worldwide. An unhealthy lifestyle greatly contributes to someone’s risk of developing these conditions. Mobile health is an emerging technology that can help deliver health promotion interventions to the population, for ex le, in the form of health apps. The aim of this study was to test the feasibility of an app-based intervention for cardiovascular and diabetes risk awareness and prevention by measuring nonusage, dropout, adherence to app use, and usability of the app over 3 months. Participants were eligible if they were aged 45 years or older, resided in Australia, were free of cardiovascular disease and diabetes, were fluent in English, and owned a smartphone. In the beginning, participants received an email with instructions on how to install the app and a user guide. After 3 months, they received an email with an invitation to an end-of-study survey. The survey included questions about general smartphone use and the user version of the Mobile Application Rating Scale. We analyzed app-generated and survey data by using descriptive and inferential statistics as well as thematic analysis for open-text comments. Recruitment took place between September and October 2021. Of the 46 participants who consented to the study, 20 (44%) never used the app and 15 (33%) dropped out. The median age of the app users at baseline was 62 (IQR 56-67) years. Adherence to app use, that is, using the app at least once a week over 3 months, was 17% (8/46) of the total s le and 31% (8/26) of all app users. The mean app quality rating on the user version of the Mobile Application Rating Scale was 3.5 (SD 0.6) of 5 points. The app scored the highest for the information section and the lowest for the engagement section of the scale. Nonusage and dropouts were too high, and the adherence was too low to consider the intervention in its current form feasible. Potential barriers that we identified include the research team not actively engaging with participants early in the study to verify that all participants could install the app, the intervention did not involve direct contact with health care professionals, and the app did not have enough interactive features.
Publisher: JMIR Publications Inc.
Date: 06-06-2020
Abstract: igital technology is an opportunity for public health interventions to reach a large part of the population. his systematic literature review aimed to assess the effectiveness of mobile health–based interventions in reducing the risk of cardiovascular disease and type 2 diabetes mellitus. e conducted the systematic search in 7 electronic databases using a predefined search strategy. We included articles published between inception of the databases and March 2019 if they reported on the effectiveness of an intervention for prevention of cardiovascular disease or type 2 diabetes via mobile technology. One researcher performed the search, study selection, data extraction, and methodological quality assessment. The steps were validated by the other members of the research team he search yielded 941 articles for cardiovascular disease, of which 3 met the inclusion criteria, and 732 for type 2 diabetes, of which 6 met the inclusion criteria. The methodological quality of the studies was low, with the main issue being nonblinding of participants. Of the selected studies, 4 used SMS text messaging, 1 used WhatsApp, and the remaining ones used specific smartphone apps. Weight loss and reduction in BMI were the most reported successful outcomes (reported in 4 studies). vidence on the effectiveness of mobile health-based interventions in reducing the risk for cardiovascular disease and type 2 diabetes is low due to the quality of the studies and the small effects that were measured. This highlights the need for further high-quality research to investigate the potential of mobile health interventions. nternational Prospective Register of Systematic Reviews (PROSPERO) CRD42019135405 www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=135405
Publisher: Springer Science and Business Media LLC
Date: 14-10-2010
Abstract: Populations around the world are facing an increasing number of adversities such as the global financial crisis, terrorism, conflict, and climate change. The aim of this paper was to investigate self-reported strategies and sources of support used to get through "tough times" in an Australian context and to identify patterns of response in the general population and differences in potentially vulnerable subgroups. Data were collected through a cross-sectional survey of the New South Wales population in Australia. The final s le consisted of 3,995 New South Wales residents aged 16 years and above who responded to the question: "What are the things that get you through tough times?" Respondents provided brief comments that were coded into 14 main subject-area categories. The most frequently reported responses were family and self (52%) friends and neighbors (21%) use of positive emotional and philosophical strategies (17%), such as sense of humor, determination, and the belief that things would get better and religious beliefs (11%). The responses of four population subgroups were compared, based on gender, household income, level of psychological distress, and whether a language other than English was spoken at home. Women reported greater use of friends and neighbors and religious or spiritual beliefs for support, whereas men reported greater use of drinking/smoking and financial supports. Those with lower incomes reported greater reliance on positive emotional and philosophical strategies and on religious or spiritual beliefs. Those with high levels of psychological distress reported greater use of leisure interests and hobbies, drinking/smoking, and less use of positive lifestyle strategies, such as adequate sleep, relaxation, or work/life balance. Those who spoke a language other than English at home were less likely to report relying on self or others (family/friends) or positive emotional and philosophical strategies to get through tough times. Understanding strategies and sources of support used by the population to get through adversity is the first step toward identifying the best approaches to build and support strengths and reduce vulnerabilities. It is also possible to reflect on how large-scale threats such as pandemics, disasters, conflict, bereavement, and loss could impact in idual and population resilience.
Publisher: JMIR Publications Inc.
Date: 29-10-2020
DOI: 10.2196/21159
Abstract: Digital technology is an opportunity for public health interventions to reach a large part of the population. This systematic literature review aimed to assess the effectiveness of mobile health–based interventions in reducing the risk of cardiovascular disease and type 2 diabetes mellitus. We conducted the systematic search in 7 electronic databases using a predefined search strategy. We included articles published between inception of the databases and March 2019 if they reported on the effectiveness of an intervention for prevention of cardiovascular disease or type 2 diabetes via mobile technology. One researcher performed the search, study selection, data extraction, and methodological quality assessment. The steps were validated by the other members of the research team The search yielded 941 articles for cardiovascular disease, of which 3 met the inclusion criteria, and 732 for type 2 diabetes, of which 6 met the inclusion criteria. The methodological quality of the studies was low, with the main issue being nonblinding of participants. Of the selected studies, 4 used SMS text messaging, 1 used WhatsApp, and the remaining ones used specific smartphone apps. Weight loss and reduction in BMI were the most reported successful outcomes (reported in 4 studies). Evidence on the effectiveness of mobile health-based interventions in reducing the risk for cardiovascular disease and type 2 diabetes is low due to the quality of the studies and the small effects that were measured. This highlights the need for further high-quality research to investigate the potential of mobile health interventions. International Prospective Register of Systematic Reviews (PROSPERO) CRD42019135405 www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=135405
Publisher: MDPI AG
Date: 08-02-2022
DOI: 10.3390/NU14030704
Abstract: Most studies disregard long-term dairy consumption behaviour and how it relates to mortality. We examined four different types of long-term milk consumption, namely whole milk, reduced fat milk, skim milk and soy milk, in relation to mortality among adults diagnosed with cardiovascular disease (CVD). A retrospective population-based study was conducted in Australia (the 45 and Up Study) linking baseline (2006–2009) and follow-up data (2012–2015) to hospitalisation and mortality data up to 30 September 2018. A total of 1,101 deaths occurred among 7236 participants with CVD over a mean follow-up of 8.4 years. Males (Hazard Ratio, HR = 0.69, 95% CI (0.54 0.89)) and females (HR = 0.59 (0.38 0.91)) with long-term reduced fat milk consumption had the lowest risk of mortality compared to counterparts with long-term whole milk consumption. Among participants with ischemic heart disease, males with a long-term reduced fat milk consumption had the lowest risk of mortality (HR = 0.63, 95% CI: 0.43 0.92). We conclude that among males and females with CVD, those who often consume reduced fat milk over the long-term present with a 31–41% lower risk of mortality than those who often consume whole milk, supporting dairy advice from the Heart Foundation of replacing whole milk with reduced fat milk to achieve better health.
Publisher: Wiley
Date: 10-1993
DOI: 10.1111/J.1475-1313.1993.TB00491.X
Abstract: In previous studies, we have observed that young normal subjects show an increase in intraocular pressure (IOP) after sleep. Here we describe three experiments which investigated: (i) the effects of sleep in five groups of subjects: glaucoma, suspect glaucoma, young high-normal IOP, old high-normal IOP groups and an elderly control group, (ii) the effect of exposure to bright light (2500 lux) during sleep on associated IOP changes, and (iii) the relationship between changes in IOP and plasma melatonin during sleep. For all experiments IOP was measured before and after sleep. We found that IOP increased significantly after sleep. There was also a significant difference between the five groups with the old high-normal group showing the greatest increase, and the young high-normal group showing the lowest increase in IOP. The increase in IOP after sleep was reduced when the same subjects slept in bright light compared to that recorded when subjects slept in the dark. Plasma melatonin levels, as well as IOP, increased after sleep in the dark although there was no correlation between these changes for in idual subjects.
Publisher: Wiley
Date: 03-2000
DOI: 10.1046/J.1440-1762.2000.00345.X
Abstract: The effects of a quality improvement intervention were evaluated in a before-after time-series study of 649 consecutive patients suffering acute myocardial infarction (AMI) in the West Moreton Health District over 2.5 years from March 1996 through to August 1998. After a 6-month baseline period, clinical practice guidelines were issued followed by sequential feedback to providers of clinical indicator data over a 1-year period. Resultant changes in practice were then evaluated during a 12-month post-intervention period. The proportion of eligible patients receiving early thrombolysis, lipid-lowering drugs and cardiac rehabilitation increased, respectively, from 30.8 to 70.0% (P = 0.001), from 23.4 to 56.4% (P = 0.003), and from 23.6 to 54.3% (P = 0.003). The in-hospital death rate, incidence of postinfarct angina and mean length of stay decreased, respectively, from 15.8 to 8.6% (P = 0.02), from 30.1 to 14.3% (P < 0.001), and from 7.4 to 6.3 days (P = 0.001). Despite the absence of control groups, the present study suggested that clinical guidelines combined with feedback of clinical indicators were useful in improving quality of care.
Publisher: Ubiquity Press, Ltd.
Date: 08-08-2019
DOI: 10.5334/IJIC.S3160
Publisher: CSIRO Publishing
Date: 2019
DOI: 10.1071/PY18113
Abstract: The number of older people living with chronic health conditions is increasing in Australia. The Chronic Disease Management (CDM) items program was introduced to the Medicare Benefits Schedule (MBS) to encourage a more structured approach to managing patients with chronic conditions. Initial uptake was slow and recent research has suggested that uptake is decreasing. This paper examines: person MBS CDM claims in NSW between 2006 and 2014 — using baseline survey data (2006–09) from the Sax Institute’s 45 and Up Study linked to MBS and Death Registry data (2006–14) — and MBS CDM claims per 100000 population — using billing data sourced from the Medicare Australia Statistics website — to systematically examine any changes in uptake using a time-series analysis. After age adjustment, claims for initial plans increased from 11.3% in 2006 to 22.4% in 2014. Increases were also seen for allied health service claims (from 4.1% in 2006 to 20.8% in 2014) and for plan reviews (from 5.9% in 2006 to 16.0% in 2014). These increases were consistent with the MBS summary claims data. There is evidence that these plans are appropriately targeting those in most need however, there is limited evidence of their effect. Claims for plan reviews, although increasing, are suboptimal and may indicate poor continuity of care.
Publisher: SAGE Publications
Date: 12-1992
DOI: 10.1068/P210813
Abstract: The importance in mobility performance of the rate of presentation of visual information, binocular versus monocular vision, the use of multiple rather than single reference points, and local motion parallax was investigated in two experiments. In each experiment ten subjects walked a triangular mobility course in a totally darkened room the only visible targets were light emitting diodes (LEDs), mounted on poles, at the apices of the triangle. The LEDs were mounted so that one or two could be used in a trial if two were used the distance between them was varied horizontally (in experiment 1) and vertically (in experiment 2). The subjects walked around the course under a range of conditions, including two ‘optimal trials’ in full light. The LEDs were flashed for 1 ms at frequencies of 0.5, 1 and 5 Hz in experiment 1 and at 1 and 5 Hz in experiment 2. Mobility was measured with the use of an ultrasonic locator system which measured the subject's position on the course 10 times per second. The mean velocity of the subject in traversing the course was significantly reduced when the flash rate was slower, when the subject had one eye occluded, or when there was only one LED on the pole when the spacing between the LEDs was varied, either vertically or horizontally performance was unaffected. These results imply that the frequency of updating of visual information is important in determining mobility performance, as are binocular cues, but that local motion parallax is not important. The number of LEDs on each pole had a significant effect on mobility performance: an ‘object’ (two lights) gave more information than a point reference.
Publisher: Ubiquity Press, Ltd.
Date: 08-08-2019
DOI: 10.5334/IJIC.S3161
Publisher: Springer Science and Business Media LLC
Date: 12-10-2011
Publisher: Wiley
Date: 06-01-2019
DOI: 10.1111/HEX.12860
Publisher: Elsevier BV
Date: 10-2023
Publisher: BMJ
Date: 11-2022
DOI: 10.1136/BMJOPEN-2021-060393
Abstract: To evaluate a multifaceted intervention on diet, physical activity and health literacy of overweight and obese patients attending primary care. A pragmatic two-arm cluster randomised controlled trial. Urban general practices in lower socioeconomic areas in Sydney and Adelaide. We aimed to recruit 800 patients in each arm. Baseline assessment was completed by 215 patients (120 intervention and 95 control). A practice nurse-led preventive health check, a mobile application and telephone coaching. Primary outcomes were measured at baseline, 6 and 12 months, and included patient health and eHealth literacy, weight, waist circumference and blood pressure. Secondary outcomes included changes in diet and physical activity, preventive advice and referral, blood lipids, quality of life and costs. Univariate and multivariate analyses of difference-in-differences (DiD) estimates for each outcome were conducted. At 6 months, the intervention group, compared with the control group, demonstrated a greater increase in Health Literacy Questionnaire domain 8 score (ability to find good health information mean DiD 0.22 95% CI 0.01 to 0.44). There were similar differences for domain 9 score (understanding health information well enough to know what to do) among patients below the median at baseline. Differences were reduced and non-statistically significant at 12 months. There was a small improvement in diet scores at 6 months (DiD 0.78 (0.10 to 1.47) p=0.026) but not at 12 months. There were no differences in eHealth literacy, physical activity scores, body mass index, weight, waist circumference or blood pressure. Targeted recruitment and engagement were challenging in this population. While the intervention was associated with some improvements in health literacy and diet, substantial differences in other outcomes were not observed. More intensive interventions and using codesign strategies to engage the practices earlier may produce a different result. Codesign may also be valuable when targeting lower socioeconomic populations. Australian New Zealand Clinical Trials Registry (ACTRN 12617001508369) (www.ANZCTR.org.au/ACTRN12617001508369.aspx). The protocol for this trial has been published (open access ontent/8/6/e023239).
Publisher: JMIR Publications Inc.
Date: 10-05-2022
DOI: 10.2196/35065
Abstract: Cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) are posing a huge burden on health care systems worldwide. Mobile apps can deliver behavior change interventions for chronic disease prevention on a large scale, but current evidence for their effectiveness is limited. This paper reported on the development and user testing of a mobile app that aims at increasing risk awareness and engaging users in behavior change. It would form part of an intervention for primary prevention of CVD and T2DM. The theoretical framework of the app design was based on the Behaviour Change Wheel, combined with the capability, opportunity, and motivation for behavior change system and the behavior change techniques from the Behavior Change Technique Taxonomy (version 1). In addition, evidence from scientific literature has guided the development process. The prototype was tested for user-friendliness via an iterative approach. We conducted semistructured interviews with in iduals in the target populations, which included the System Usability Scale. We transcribed and analyzed the interviews using descriptive statistics for the System Usability Scale and thematic analysis to identify app features that improved utility and usability. The target population was Australians aged ≥45 years. The app included 4 core modules (risk score, goal setting, health measures, and education). In these modules, users learned about their risk for CVD and T2DM set goals for smoking, alcohol consumption, diet, and physical activity and tracked them. In total, we included 12 behavior change techniques. We conducted 2 rounds of usability testing, each involving 5 participants. The average age of the participants was 58 (SD 8) years. Totally, 60% (6/10) of the participants owned iPhone Operating System phones, and 40% (4/10) of them owned Android phones. In the first round, we identified a technical issue that prevented 30% (3/10) of the participants from completing the registration process. Among the 70% (7/10) of participants who were able to complete the registration process, 71% (5/7) rated the app above average, based on the System Usability Scale. During the interviews, we identified some issues related to functionality, content, and language and clarity. We used the participants’ feedback to improve these aspects. We developed the app using behavior change theory and scientific evidence. The user testing allowed us to identify and remove technical errors and integrate additional functions into the app, which the participants had requested. Next, we will evaluate the feasibility of the revised version of the app developed through this design process and usability testing.
Publisher: Ubiquity Press, Ltd.
Date: 2022
DOI: 10.5334/IJIC.6184
Publisher: The Sax Institute
Date: 2001
DOI: 10.1071/NB01071
Publisher: Wiley
Date: 02-2010
Publisher: Springer Science and Business Media LLC
Date: 15-09-2008
Publisher: Springer Science and Business Media LLC
Date: 22-04-2014
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 07-2011
Publisher: Elsevier BV
Date: 08-2009
DOI: 10.1111/J.1753-6405.2009.00405.X
Abstract: To determine the perceived threat of terrorist attack in Australia and preparedness to comply with public safety directives. A representative s le of 2,081 adults completed terrorism perception questions as part of the New South Wales Population Health Survey. Overall, 30.3% thought a terrorist attack in Australia was highly likely, 42.5% were concerned that self or family would be directly affected and 26.4% had changed the way they lived due to potential terrorist attacks. Respondents who spoke a language other than English at home were 2.47 times (Odds Ratios (OR=2.47, 95% CI:1.58-3.64, p<0.001) more likely to be concerned self or family would be affected and 2.88 times (OR=2.88, 95% CI:1.95-4.25, p<0.001) more likely to have changed the way they lived due to the possibility of terrorism. Those with high psychological distress perceived higher terrorism likelihood and greater concern that self or family would be directly affected (OR=1.84, 95% CI:1.05-3.22, p=0.034). Evacuation willingness was high overall but those with poor self-rated health were significantly less willing to leave their homes during a terrorism emergency. Despite not having experienced recent terrorism within Australia, perceived likelihood of an attack was higher than in comparable western countries. Marginalisation of migrant groups associated with perceived terrorism threat may be evident in the current findings. This baseline data will be useful to monitor changes in population perceptions over time and determine the impact of education and other preparedness initiatives.
Publisher: Springer Science and Business Media LLC
Date: 07-11-2019
DOI: 10.1186/S12913-019-4663-3
Abstract: The number of people living with chronic health conditions is increasing in Australia. The Chronic Disease Management program was introduced to Medicare Benefits Schedule (MBS) to provide a more structured approach to managing patients with chronic conditions and complex care needs. The program supports General Practitioners (GP)s claiming for up to one general practice management plan (GPMP) and one team care arrangement (TCA) every year and the patient claiming for up to five private allied health visits. We describe the profile of participants who claimed for GPMPs and/or TCAs in Central and Eastern Sydney (CES) and explore if GPMPs and/or TCAs are associated with fewer emergency hospitalisations (EH)s or potentially preventable hospitalisations (PPH)s over the following 5 years. This research used the CES Primary and Community Health Cohort/Linkage Resource (CES-P& CH) based on the 45 and Up Study to identify a community-dwelling population in the CES region. There were 30,645 participants recruited within the CES area at baseline. The CES-P& CH includes 45 and Up Study questionnaire data linked to MBS data for the period 2006–2014. It also includes data from the Admitted Patient Data Collection, Emergency Department Data Collection and Deaths Registry linked by the NSW Centre for Health Record Linkage. Within a two-year health service utilisation baseline period 22% (5771) of CES participants had at least one claim for a GPMP and/or TCA. Having at least one claim for a GPMP and/or TCA was closely related to the socio-demographic and health needs of participants with higher EHs and PPHs in the 5 years that followed. However, after controlling for confounding factors such as socio-demographic need, health risk, health status and health care utilization no significant difference was found between having claimed for a GPMP and/or TCA during the two-year health service utilisation baseline period and EHs or PPHs in the subsequent 5 years. The use of GPMPs and/or TCAs in the CES area appears well-targeted towards those with chronic and complex care needs. There was no evidence to suggest that the use of GPMPs and /or TCAs has prevented hospitalisations in the CES region.
Location: Papua New Guinea
No related grants have been discovered for Margo Barr.