The potential for measuring ethnicity and health in a multicultural milieu - the case of type 2 diabetes in Australia

ObjectiveEthnicity influences health in many ways. For example, type 2&nbsp;diabetes (T2DM) is disproportionately prevalent among certain ethnic groups.&nbsp;Assessing ethnicity is difficult, and numerous proxy measures are used to&nbsp;capture its various components. Australian guidelines specify a set of&nbsp;variables for measuring ethnicity, and how such parameters should be&nbsp;categorised. Using T2DM data collections as an illustrative example, this&nbsp;study sought to examine how ethnicity is measured in Australian health&nbsp;databases and, by comparing current practice with Australia&rsquo;s existing&nbsp;benchmark recommendations, to identify potential areas for improvement of&nbsp;the health data landscape.DesignWe identified databases containing information from which ethnic&nbsp;group-specific estimates of T2DM burden may be gleaned. For each&nbsp;database, details regarding ethnicity variables were extracted, and compared&nbsp;with the Australian guidelines.&nbsp;ResultsData collection instruments for 32 relevant databases were reviewed.&nbsp;Birthplace was recorded in 27 databases (84%), but mode of birthplace&nbsp;assessment varied. Indigenous status was commonly recorded (78%, n=25), but&nbsp;only nine databases recorded other aspects of self-perceived race/ethnicity. Of&nbsp;28 survey/audit databases, 14 accommodated linguistic preferences other than&nbsp;English, and 11 either excluded non-English speakers or those for whom a&nbsp;translator was not available, or only offered questionnaires in English.ConclusionsConsiderable variation exists in the measurement of ethnicity in&nbsp;Australian health data- sets. While various markers of ethnicity provide&nbsp;complementary information about the ethnic profile within a data-set, nonuniform&nbsp;measurement renders comparison between data-sets difficult. A&nbsp;standardised approach is necessary, and identifying the ethnicity variables&nbsp;that are particularly relevant to the health sector is warranted. Including self identified&nbsp;ethnicity in Australia&rsquo;s set of recommended indicators and as a core&nbsp;component of the national census should be considered. Globalisation and&nbsp;increasing migration mean that these findings have implications internationally,&nbsp;including for multi-ethnic countries throughout North America and&nbsp;Europe.</div

Environmental and social determinants of acute rheumatic fever:a longitudinal cohort study

Acute rheumatic fever (ARF), an auto-immune response to a group A Streptococcus infection and precursor to rheumatic heart disease (RHD), remains endemic in many socio-economically disadvantaged settings. A Global Resolution on ARF and RHD was recently adopted at the 71st World Health Assembly where governments committed to improving efforts to prevent and control ARF and RHD. To inform these efforts, the objectives of this study were to examine associations between childhood ARF in the UK between 1958 and 1969 and a range of environmental and social factors. Of 17 416 children from the nationally representative birth cohort of the National Child Development Study, ARF was reported in 23 children during early childhood (between birth and the 7-year follow-up) and in 29 additional children during middle childhood (between the 7- and 11-year follow-ups). Risk factors associated with ARF in both early and middle childhood were: a large family size; attendance at a private nursery or class; a history of nephritis, kidney or urinary tract infections; and a history of throat or ear infections. Risk factors for ARF in early childhood alone were families with fathers in a professional or semi-professional occupation and families who moved out of their local neighbourhood. Risk factors in late childhood alone included overcrowding and free school meals. These data suggest that prevention strategies in ARF endemic settings may be enhanced by targeting, for example, new members entering a community and children in environments of close contact, such as a nursery or shared bedrooms

A review of population-based prevalence studies of physical activity in adults in the Asia-Pacific region

Background: Physical activity (PA) surveillance is an important component of non-communicable disease risk factor monitoring, and occurs through national and international surveillance systems. This review identifies population PA estimates for adults in the Asia-Pacific region, and examines variation in trends and prevalence rates obtained using different PA measures.Methods: Data were obtained from a MEDLINE search; World Health Organization&rsquo;s Global Health Infobase; Government websites and reference lists of relevant papers. Inclusion criteria included: national studies or those reporting large scale population-level data; data published from 2000 to 2010 and trend data prior; sample sizes over n = 1000, or fewer subjects in small nations.Results: In total, 56 population surveys from 29 Asia-Pacific countries were identified. Data on &lsquo;sufficient physical activity&rsquo; amongst adults were available from 45 studies (80%), with estimates ranging from 7% to 93% (median 62%, inter-quartile range 40%-85%). For 14 countries, estimates of &lsquo;sufficient activity&rsquo; were documented in multiple surveys using different methods, with the largest variation from 18% to 92% in Nepal. Median or mean METminutes/ day, reported in 20 studies, ranged from 6 to 1356. Serial trend data were available for 11 countries (22%), for periods spanning 2-10 years. Of these, five countries demonstrated increases in physical activity over time, four demonstrated decreases and three showed no changes.Conclusions: Many countries in the Asia-Pacific region collect population-level PA data. This review highlights differences in estimates within and between countries. Some differences may be real, others due to variation in the PA questions asked and survey methods used. Use of standardized protocols and measures, and combined reporting of data are essential goals of improved international PA surveillance.<br /

Burden of cardiovascular diseases in the Eastern Mediterranean Region, 1990-2015 : findings from the Global Burden of Disease 2015 study

To report the burden of cardiovascular diseases (CVD) in the Eastern Mediterranean Region (EMR) during 1990-2015. We used the 2015 Global Burden of Disease study for estimates of mortality and disability-adjusted life years (DALYs) of different CVD in 22 countries of EMR. A total of 1.4 million CVD deaths (95% UI: 1.3-1.5) occurred in 2015 in the EMR, with the highest number of deaths in Pakistan (465,116) and the lowest number of deaths in Qatar (723). The age-standardized DALY rate per 100,000 decreased from 10,080 in 1990 to 8606 in 2015 (14.6% decrease). Afghanistan had the highest age-standardized DALY rate of CVD in both 1990 and 2015. Kuwait and Qatar had the lowest age-standardized DALY rates of CVD in 1990 and 2015, respectively. High blood pressure, high total cholesterol, and high body mass index were the leading risk factors for CVD. The age-standardized DALY rates in the EMR are considerably higher than the global average. These findings call for a comprehensive approach to prevent and control the burden of CVD in the region.Peer reviewe

Evidence, equity and health: contemporary issues in the Australian public health arena and lessons from abroad

This thesis seeks to examine a number of issues surrounding evidence, equity and health in the contemporary Australian public health arena, using cardiovascular disease and its determinants as the principal case studies. Additionally, it uses a novel epidemiological study from Finland to learn lessons from abroad. The eight case studies presented in this portfolio include in-depth examination of health associations with several socio-cultural variables: ethnicity, migrant status, residential area socio-economic status, occupation and educational attainment. Many of the findings presented in this thesis have implications for prevention policy and practice and for health surveillance efforts in Australia and beyond

Evidence, equity and health: contemporary issues in the Australian public health arena and lessons from abroad

This thesis seeks to examine a number of issues surrounding evidence, equity and health in the contemporary Australian public health arena, using cardiovascular disease and its determinants as the principal case studies. Additionally, it uses a novel epidemiological study from Finland to learn lessons from abroad. The eight case studies presented in this portfolio include in-depth examination of health associations with several socio-cultural variables: ethnicity, migrant status, residential area socio-economic status, occupation and educational attainment. Many of the findings presented in this thesis have implications for prevention policy and practice and for health surveillance efforts in Australia and beyond

Opportunistic Scheduling and Relaying in a Cooperative Cognitive Network

Abstract-This paper considers network-layer cooperation in cognitive radio networks whereby secondary users can relay primary user&apos;s packets, in return for a more favorable spectrum access rules. Under this cooperative scheme, the paper investigates whether, and under what conditions, the primary and secondary networks can be stabilized without explicit knowledge of the packet arrival-rates. We consider a deterministic and periodic primary packet arrival process and develop a relaying and scheduling algorithm using Lyapunov drift techniques that does not require knowledge of primary and secondary packet arrival rates. The algorithm is then shown to stabilize the transmission queues in the network for all secondary packet arrival rates that lie in the interior of a certain region. The region includes all secondary arrival-rate vectors that can be supported when the secondary nodes do not cooperate. Furthermore, when the primary data arrival-rate is greater than what could have been supported without relays but less than what can be maximally supported with relays, the algorithm stabilizes the network for a non-empty set of secondary arrival-rate vectors. The significance of these results is that they show that properly designed cooperation may result in a win-win scenario for both primary and secondary users (and not just for one type of users). Finally we extend our analysis to the case of a deterministic but aperiodic primary packet arrival process

Conflict-related health research in Syria, 2011–2019: a scoping review for The Lancet - AUB Commission on Syria

BACKGROUND: The volume of health-related publications on Syria has increased considerably over the course of the conflict compared with the pre-war period. This increase is largely attributed to commentaries, news reports and editorials rather than research publications. This paper seeks to characterise the conflict-related population and humanitarian health and health systems research focused inside Syria and published over the course of the Syrian conflict. METHODS: As part of a broader scoping review covering English, Arabic and French literature on health and Syria published from 01 January 2011 to 31 December 2019 and indexed in seven citation databases (PubMed, Medline (OVID), CINAHL Complete, Global Health, EMBASE, Web of Science, Scopus), we analyzed conflict-related research papers focused on health issues inside Syria and on Syrians or residents of Syria. We classified research articles based on the major thematic areas studied. We abstracted bibliometric information, study characteristics, research focus, funding statements and key limitations and challenges of conducting research as described by the study authors. To gain additional insights, we examined, separately, non-research publications reporting field and operational activities as well as personal reflections and narrative accounts of first-hand experiences inside Syria. RESULTS: Of 2073 papers identified in the scoping review, 710 (34%) exclusively focus on health issues of Syrians or residents inside Syria, of which 350 (49%) are conflict-related, including 89 (25%) research papers. Annual volume of research increased over time, from one publication in 2013 to 26 publications in 2018 and 29 in 2019. Damascus was the most frequently studied governorate (n = 33), followed by Aleppo (n = 25). Papers used a wide range of research methodologies, predominantly quantitative (n = 68). The country of institutional affiliation(s) of first and last authors are predominantly Syria (n = 30, 21 respectively), the United States (n = 25, 19 respectively) or the United Kingdom (n = 12, 10 respectively). The majority of authors had academic institutional affiliations. The most frequently examined themes were health status, the health system and humanitarian assistance, response or needs (n = 38, 34, 26 respectively). Authors described a range of contextual, methodological and administrative challenges in conducting research on health inside Syria. Thirty-one publications presented field and operational activities and eight publications were reflections or first-hand personal accounts of experiences inside Syria. CONCLUSIONS: Despite a growing volume of research publications examining population and humanitarian health and health systems issues inside conflict-ravaged Syria, there are considerable geographic and thematic gaps, including limited research on several key pillars of the health system such as governance, financing and medical products; issues such as injury epidemiology and non-communicable disease burden; the situation in the north-east and south of Syria; and besieged areas and populations. Recognising the myriad of complexities of researching active conflict settings, it is essential that research in/on Syria continues, in order to build the evidence base, understand critical health issues, identify knowledge gaps and inform the research agenda to address the needs of the people of Syria following a decade of conflict. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13031-021-00384-3

Type 2 diabetes prevalence varies by socioeconomic status within and between migrant groups: analysis and implications for Australia

BACKGROUND: Ethnic diversity is increasing through migration in many developed countries. Evidence indicates that type 2 diabetes mellitus (T2DM) prevalence varies by ethnicity and socio-economic status (SES), and that in many settings, migrants experience a disproportionate burden of disease compared with locally-born groups. Given Australia's multicultural demography, we sought to identify groups at high risk of T2DM in Victoria, Australia. METHODS: Using population data from the Australian National Census and diabetes data from the National Diabetes Services Scheme, prevalence of T2DM among immigrant groups in Victoria in January 2010 was investigated, and prevalence odds versus Australian-born residents estimated. Distribution of T2DM by SES was also examined. RESULTS: Prevalence of diagnosed T2DM in Victoria was 4.1% (n = 98671) in men and 3.5% (n = 87608) in women. Of those with T2DM, over 1 in 5 born in Oceania and in Southern and Central Asia were aged under 50 years. For both men and women, odds of T2DM were higher for all migrant groups than the Australian-born reference population, including, after adjusting for age and SES, 6.3 and 7.2 times higher for men and women born in the Pacific Islands, respectively, and 5.2 and 5.0 times higher for men and women born in Southern and Central Asia, respectively. Effects of SES varied by region of birth. CONCLUSIONS: Large socio-cultural differences exist in the distribution of T2DM. Across all socio-economic strata, all migrant groups have higher prevalence of T2DM than the Australian-born population. With increasing migration, this health gap potentially has implications for health service planning and delivery, policy and preventive efforts in Australia