National Indigenous Palliative Care Needs Study

This study involved extensive consultation with the community to identify the needs of Aboriginal and Torres Strait Islander peoples in palliative care

Trends in U.S. Public Awareness of Racial and Ethnic Health Disparities (1999-2010): Study Brief

None provided

Trends in U.S. Public Awareness of Racial and Ethnic Health Disparities (1999-2010): 2009 General Population Toplines

Not provided

Application and review of a strength-based program in classrooms with behavior disordered children

The strength perspective of psychology involves focusing on an individual’s resources rather than weaknesses. Recent studies have found that enhancing existing strengths achieves the same outcome as the deficit approach, but with additional benefits (Larson, 2000). A specific area where strength-based assessment can be applied is with problems of school-age children. This application intends to help students flourish in their classroom setting. The present study examined the effects of a strength-focused program on the academic and behavioral performance of behavior disordered children in day treatment classes. Self-monitoring ability and level of self-concept were investigated as potential moderators of the treatment effect. Findings indicate that while there were decreases in problematic behaviors over time, they were not the direct result of the strength intervention. There were no significant changes in academic scores. Adequate construct validity of an alternative strength assessment measure was demonstrated. These findings are discussed within the context of strength-based theory. Limitations of the present study are acknowledged and directions for future research are outlined

Cross-sectional examination of sex differences in depressed youth : ruminative response theory, pubertal status, and hormones / by Jennifer L. Welsh.

"Prevalence estimates indicate that during adolescence a shift in the sex ratio of depression occurs that results in twice as many females reporting symptoms as males. The purpose of the current study was to investigate the relationship between this sex shift and a set of risk factors (ruminative coping, pubertal status, and hormones) using the tripartite model. Data were collected from 213 adolescents (between ages 12 and 19) across all stages of pubertal development (pre-, mid-, and post-puberty) through paper and pencil questionnaires and measures of hand features

Not all hours are equal: could time be a social determinant of health?

Time can be thought of as a resource that people need for good health. Healthy behaviour, accessing health services, working, resting and caring all require time. Like other resources, time is socially shaped, but its relevance to health and health inequality is yet to be established. Drawing from sociology and political economy, we set out the theoretical basis for two measures of time relevant to contemporary, market-based societies. We measure amount of time spent on care and work (paid and unpaid) and the intensity of time, which refers to rushing, effort and speed. Using data from wave 9 (N = 9177) of the Household, Income and Labour Dynamics of Australia Survey we found that time poverty (> 80 h per week on care and work) and often or always rushing are barriers to physical activity and rushing is associated with poorer self-rated and mental health. Exploring their social patterning, we find that time-poor people have higher incomes and more time control. In contrast, rushing is linked to being a woman, lone parenthood, disability, lack of control and work-family conflicts. We supply a methodology to support quantitative investigations of time, and our findings underline time's dimensionality, social distribution and potential to influence health.The research was supported by an Australian Research Council linkage grant LP100100106 in partner-ship with the Department of Social Services (DSS) and Sydney West Area Heath Service (SWAHS). Thefindings and views reported in this article are those of the authors and should not be attributed to DSS,SWAHS and cannot be taken in any way as expressions of government policy or the Melbourne Institute.Lyndall Strazdins is supported by an Australian Research Council Future Fellowship FT110100686

Associations of statin adherence and lipid targets with adverse outcomes in myocardial infarction survivors:a retrospective cohort study

Objectives: To examine associations between statin adherence and lipid target achievement in myocardial infarction (MI) survivors, and their associations with mortality and recurrent MIs. Design: Retrospective cohort study using linked clinical records within the National Health Service Greater Glasgow and Clyde (NHS GGC) Data Safe Haven. Setting: Routine clinical practice in the NHS GGC area between January 2009 and July 2017. Participants: Patients ≥18 years who experienced a non-fatal MI hospital admission (ICD10: I21, I22) between January 2009 and July 2014 (n=11 031), followed up from the date of MI admission until July 2017 or death, whichever occurred first. Primary and secondary outcome measures: Statin adherence was estimated using encashed prescriptions and lipid results from routine biochemistry data. Primary lipid and statin adherence targets were LDL ≤1.8 mmol/L and adherence ≥50%, and were related to all-cause death, deaths due to cardiovascular disease (CVD) (ICD10: I00–I99 as the underlying cause), and recurrent MI in unadjusted models and models adjusting for age, sex, socioeconomic deprivation and year of MI. Results: Over 4.5 years follow-up, 76% achieved LDL ≤1.8 mmol/L, and 84.5% had average adherence ≥50%. Patients with adherence <50% had an increased risk of not meeting LDL ≤1.8 mmol/L, in adjusted models (OR 2.03, 95% CI 1.78 to 2.31, p<0.0001). In univariable models, not meeting LDL ≤1.8 mmol/L was associated with increased risks of all-cause mortality (HR 1.27, 95% CI 1.16 to 1.39, p<0.0001) and CVD mortality (HR 1.29, 95% CI 1.11 to 1.51, p=0.0013). Adherence <50% was associated with increased risks of all-cause mortality (HR 1.58, 95% CI 1.44 to 1.74, p<0.0001) and CVD mortality (HR 1.60, 95% CI 1.36 to 1.88, p<0.0001). Adjustment for confounders did not abrogate these associations. Neither exposure was associated with recurrent MIs. Conclusions: Non-achievement of lipid and adherence targets are associated with increased risks of all-cause and CVD mortality. Further work is required to optimise their use to improve outcomes in clinical practice

Variation in cardiovascular disease care: an Australian cohort study on sex differences in receipt of coronary procedures

Objectives The aim of this study was to quantify sex differences in diagnostic and revascularisation coronary procedures within 1 year of hospitalisation for acute myocardial infarction (AMI) or angina. Design This is a prospective cohort study. Baseline questionnaire (January 2006–April 2009) data from the Sax Institute’s 45 and Up Study were linked to hospitalisation and mortality data (to 30 June 2016) in a time-to-event analysis, treating death as a censoring event. Setting This was conducted in New South Wales, Australia. Participants The study included participants aged ≥45 years with no history of ischaemic heart disease (IHD) who were admitted to hospital with a primary diagnosis of AMI (n=4580) or a primary diagnosis of angina or chronic IHD with secondary diagnosis of angina (n=4457). Outcome measures The outcome of this study was coronary angiography and coronary revascularisation with percutaneous coronary intervention or coronary artery bypass graft (PCI/CABG) within 1 year of index admission. Cox regression models compared coronary procedure rates in men and women, adjusting sequentially for age, sociodemographic variables and health characteristics. Results Among patients with AMI, 71.6% of men (crude rate 3.45/person-year) and 64.7% of women (2.62/person-year) received angiography; 57.8% of men (1.73/person-year) and 37.4% of women (0.77/person-year) received PCI/CABG. Adjusted HRs for men versus women were 1.00 (0.92–1.08) for angiography and 1.51 (1.38–1.67) for PCI/CABG. In the angina group, 67.3% of men (crude rate 2.36/person-year) and 54.9% of women (1.32/person-year) received angiography; 44.6% of men (0.90/person-year) and 19.5% of women (0.26/person-year) received PCI/CABG. Adjusted HRs were 1.24 (1.14–1.34) and 2.44 (2.16–2.75), respectively. Conclusions Men are more likely than women to receive coronary procedures, particularly revascularisation. This difference is most evident among people with angina, where clinical guidelines are less prescriptive than for AMI.This research was supported by a NSW CVRN Women and Heart Disease grant from the National Heart Foundation of Australia (101692). EB is supported by the National Health and Medical Research Council of Australia (1042717

Socioeconomic variation in absolute cardiovascular disease risk and treatment in the Australian population

Cardiovascular disease (CVD), preventable through appropriate management of absolute CVD risk, disproportionately affects socioeconomically disadvantaged individuals. The aim of this study was to estimate absolute and relative socioeconomic inequalities in absolute CVD risk and treatment in the Australian population using cross-sectional representative data on 4,751 people aged 45-74 from the 2011-12 Australian Health Survey. Poisson regression was used to calculate prevalence differences (PD) and ratios (PR) for prior CVD, high 5-year absolute risk of a primary CVD event and guideline-recommended medication use, in relation to socioeconomic position (SEP, measured by education). After adjusting for age and sex, the prevalence of high absolute risk of a primary CVD event among those of low, intermediate and high SEP was 12.6%, 10.9% and 7.7% (PD, low vs. high=5.0 [95% CI: 2.3, 7.7], PR=1.6 [1.2, 2.2]) and for prior CVD was 10.7%, 9.1% and 6.7% (PD=4.0 [1.4, 6.6], PR=1.6 [1.1, 2.2]). The proportions using preventive medication use among those with high primary risk were 21.3%, 19.5% and 29.4% for low, intermediate and high SEP and for prior CVD, were 37.8%, 35.7% and 17.7% (PD=20.1 [9.7, 30.5], PR=2.1 [1.3, 3.5]). Proportions at high primary risk and not using medications among those of low, intermediate and high SEP were 10.6%, 8.8% and 4.7% and with prior CVD not using medications were 8.5%, 6.3% and 4.1%. Findings indicate substantial potential to prevent CVD and reduce inequalities through appropriate management of high absolute risk in the population.This work was supported by a National Health and Medical Research Council of Australia (NHMRC) Partnership Project (reference 1092674) and the NHMRC Centre for Research Excellence in Medicines and Ageing (reference 1060407). Emily Banks is supported by the NHMRC (reference 1042717)

Cultural and Contextual Adaptation of a Childhood Obesity Preventive Intervention Program

This article describes the adaptation of a parent-focused evidence-based childhood obesity intervention program for implementation by county-based Extension educators in coordination with school district personnel in rural Pennsylvania. The Lifestyle Positive Parenting Program was designed and evaluated in Australia in clinical settings. Several minor and more serious adaptations, such as featured recipes and content of follow-up telephone calls, were made so that the program would be more appropriate for and appealing to target families. Conceptual issues regarding the adaptation of evidence-based programs are reviewed