Differences in mail and telephone responses to self-rated health: use of multiple imputation in correcting for response bias

Objectives: To estimate differences in self-rated health by mode of administration and to assess the value of multiple imputation to make self-rated health comparable for telephone and mail. Methods: In 1996, Survey 1 of the Australian Longitudinal Study on Women's Health was answered by mail. In 1998, 706 and 11,595 mid-age women answered Survey 2 by telephone and mail respectively. Self-rated health was measured by the physical and mental health scores of the SF-36. Mean change in SF-36 scores between Surveys 1 and 2 were compared for telephone and mail respondents to Survey 2, before and after adjustment for socio-demographic and health characteristics. Missing values and SF-36 scores for telephone respondents at Survey 2 were imputed from SF-36 mail responses and telephone and mail responses to socio-demographic and health questions. Results: At Survey 2, self-rated health improved for telephone respondents but not mail respondents. After adjustment, mean changes in physical health and mental health scores remained higher (0.4 and 1.6 respectively) for telephone respondents compared with mail respondents (-1.2 and 0.1 respectively). Multiple imputation yielded adjusted changes in SF-36 scores that were similar for telephone and mail respondents. Conclusions and Implications: The effect of mode of administration on the change in mental health is important given that a difference of two points in SF-36 scores is accepted as clinically meaningful. Health evaluators should be aware of and adjust for the effects of mode of administration on self-rated health. Multiple imputation is one method that may be used to adjust SF-36 scores for mode of administration bias.

The evolution of the Global Burden of Disease framework for disease, injury and risk factor quantification: Developing the evidence base for national, regional and global public health action

Reliable, comparable information about the main causes of disease and injury in populations, and how these are changing, is a critical input for debates about priorities in the health sector. Traditional sources of information about the descriptive epidemiology of diseases, injuries and risk factors are generally incomplete, fragmented and of uncertain reliability and comparability. Lack of a standardized measurement framework to permit comparisons across diseases and injuries, as well as risk factors, and failure to systematically evaluate data quality have impeded comparative analyses of the true public health importance of various conditions and risk factors. As a consequence the impact of major conditions and hazards on population health has been poorly appreciated, often leading to a lack of public health investment. Global disease and risk factor quantification improved dramatically in the early 1990s with the completion of the first Global Burden of Disease Study. For the first time, the comparative importance of over 100 diseases and injuries, and ten major risk factors, for global and regional health status could be assessed using a common metric (Disability-Adjusted Life Years) which simultaneously accounted for both premature mortality and the prevalence, duration and severity of the non-fatal consequences of disease and injury. As a consequence, mental health conditions and injuries, for which non-fatal outcomes are of particular significance, were identified as being among the leading causes of disease/injury burden worldwide, with clear implications for policy, particularly prevention. A major achievement of the Study was the complete global descriptive epidemiology, including incidence, prevalence and mortality, by age, sex and Region, of over 100 diseases and injuries. National applications, further methodological research and an increase in data availability have led to improved national, regional and global estimates for 2000, but substantial uncertainty around the disease burden caused by major conditions, including, HIV, remains. The rapid implementation of cost-effective data collection systems in developing countries is a key priority if global public policy to promote health is to be more effectively informed.

Risk reduction: Recontexualizing health as a physical education curriculum

While there is sufficient evidence to suggest that physical activity is inversely related to lifestyle diseases, researchers are far from being certain that this evidence extends to children. Nevertheless, the school physical education curriculum has been targeted as an institutional agency that could have a significant impact on health during childhood and later during adulthood if individuals could be habituated to assume a physically active lifestyle. The purpose of this article is to examine the recontextualization of biomedical knowledge into an ideology of healthism in which health is conceived as a controllable certainty and used as a pedagogical construction to transform school physical education. Using a Foucauldian perspective, we explore how the atomized biomedical model of chemical and physical relationships is constructed, reproduced, and perpetuated to service and empower the discourse and the practices of researchers and scholars. In this process the sociological or cultural aspects of public health are marginalized or ignored. As a result of this examination, alternative approaches are proposed that engage the limitations of the biomedical model and openly consider the insights that are available from the social sciences regarding what participation in physical activity means to individuals.

Conceptions of health held by Aboriginal, Torres Strait Islander and Papua New Guinea health care students

Health is considered to be a fundamental human right. Concurrently health is assumed to be a global social goal (Bloom, 1987) yet many third-world countries and some sub-populations within developed countries do not enjoy a healthy existence. The research reported in this paper examined the conceptions of health, conceptions of illness and health practices for a group of Aboriginal, Torres Strait Islander, and Papua New Guinea university students studying health science courses. Results found three conceptions of health and three conceptions of illness that showed these students held traditional/cultural and Western beliefs about health and health practices. These findings may contribute to the development of health care courses that are more specific to how these students understand health. This may also serve to improve the educational status of Aboriginal and Torres Strait Islander people and potentially improve the health status within these communities (author abstract)

Medicinal herbal extracts - renal friend or foe? Part one: The toxicities of medicinal herbs

In recent years, an increasing percentage of people from industrialized countries have been using complementary and alternative medicines (CAM). This, combined with numerous warnings regarding the potential toxicity of these therapies, suggests the need for practitioners to keep abreast of the reported incidence of renal toxicity caused by the ingestion of medicinal herbs. The goal of the present two-part series, on the toxic or beneficial effects of medicinal herbs on renal health, is to provide practitioners with a summary of the most recent information as well as the means by which evidence for benefit or toxicity has been found. In this first article, we explore in vivo evidence of toxicity. Included are nephrotoxicity from aristolochic acid and other components within herbs, herb-drug interactions resulting in adverse renal effects, and renal toxicity from contaminants within the extracts. The review aims to provide a guide to encourage future toxicity studies and rigorous clinical trials.

Role of oxidative stress in age-associated chronic kidney pathologies

The kidneys exhibit age-associated deterioration in function via a loss of 20% to 25% kidney mass, particularly from the renal cortex and increased fibrosis. Oxidative stress has been found to mediate age-associated renal cell injury and cell death, particularly apoptosis. Oxidative stress results from an imbalance between the levels of free radicals generated during aerobic metabolism, inflammation, and infection and the safe breakdown of these species by endogenous and exogenous scavengers. Other factors may influence these pathologies. For example, growth hormone and caloric restriction have been shown to influence life span, although neither method of prolonging life is likely to find general acceptance in humans. Some genetic knockout models offer promise; for example, knockout of the p66 isoform of the Shc gene in mice increases life span by 30%, but appetite, size, and fertility are retained. Whether the increase in life span is via increased kidney health is not yet clear, but decreasing the age-related renal pathologies will no doubt aid in increasing life span and health in general. This review looks at the role and modulation of factors that influence life span, in particular modulation of oxidative stress, with particular relevance to age-related renal pathologies. (C) 2005 by the National Kidney Foundation, Inc.

Impact of ethnicity upon body composition assessment in Sri Lankan Australian children

Objectives: Obesity is a disease with excess body fat where health is adversely affected. Therefore it is prudent to make the diagnosis of obesity based on the measure of percentage body fat. Body composition of a group of Australian children of Sri Lankan origin were studied to evaluate the applicability of some bedside techniques in the measurement of percentage body fat. Methods: Height (H) and weight (W) was measured and BMI (W/H-2) calculated. Bioelectrical impedance analysis (BIA) was measured using tetra polar technique with an 800 mu A current of 50 Hz frequency. Total body water was used as a reference method and was determined by deuterium dilution and fat free mass and hence fat mass (FM) derived using age and gender specific constants. Percentage FM was estimated using four predictive equations, which used BIA and anthropometric measurements. Results: Twenty-seven boys and 15 girls were studied with mean ages being 9.1 years and 9.6 years, respectively. Girls had a significantly higher FM compared to boys. The mean percentage FM of boys (22.9 +/- 8.7%) was higher than the limit for obesity and for girls (29.0 +/- 6.0%) it was just below the cut-off. BMI was comparatively low. All but BIA equation in boys under estimated the percentage FM. The impedance index and weight showed a strong association with total body water (r(2)= 0.96, P < 0.001). Except for BIA in boys all other techniques under diagnosed obesity. Conclusions: Sri Lankan Australian children appear to have a high percentage of fat with a low BMI and some of the available indirect techniques are not helpful in the assessment of body composition. Therefore ethnic and/or population specific predictive equations have to be developed for the assessment of body composition, especially in a multicultural society using indirect methods such as BIA or anthropometry.

Physical activity and the occupations of children: Perspectives of parents and children

There is concern that children’s health is being compromised by a decline in physical activity occurring as a result of the changing nature of the occupations of childhood. This article reports the findings of in-depth interviews conducted with six children and their parents when the children were between 7 and 8 years and then again when they were between 9 and 10 years. This longitudinal perspective highlighted features associated with children remaining engaged in physical occupations. Factors found to contribute to continued involvement in exercise and sports were: the initial introduction to the activity being pleasurable; same-sex parents or older siblings being directly involved; and the skills required by the occupations being commensurate with children’s developmental level. These findings help inform occupational scientists about the nature of recreational and leisure occupations, and how they are introduced and framed within the context of children’s occupational roles.

Evidence-based approaches to dissemination and diffusion of physical activity interventions

With the increasing availability of effective, evidence-based physical activity interventions, widespread diffusion is needed. We examine conceptual foundations for research on dissemination and diffusion of physical activity interventions; describe two school-based program examples; review examples of dissemination and diffusion research on other health behaviors; and examine policies that may accelerate the diffusion process. Lack of dissemination and diffusion evaluation research and policy advocacy is one of the factors limiting the impact of evidence-based physical activity interventions on public health. There is the need to collaborate with policy experts from other fields to improve the interdisciplinary science base for dissemination and diffusion. The promise of widespread adoption of evidence-based physical activity interventions to improve public health is sufficient to justify devotion of substantial resources to the relevant research on dissemination and diffusion.

Is discrepancy between actual and preferred work activities a factor in work-related stress for mental health occupational therapists and social workers

In the Western developed nations, the changing pattern of mental health care provision has necessitated mental health staff adopting new approaches to service delivery across a diverse and expanding range of service settings. The impact of changed service delivery on Australian mental health professionals is an area that has not been well studied. The aim of the study was to identify the current clinical work activities performed by occupational therapists and social workers and whether there was a discrepancy between the actual and preferred work activities. The study also aimed to identify whether any discrepancy between their actual and preferred clinical work activities was associated with higher levels of stress. A cross-sectional survey of 304 (response rate 76.6%) occupational therapists and social workers in Australian mental health services was conducted. A work activities scale developed specifically for this study and the Mental Health Professionals Stress Scale were used to measure actual and preferred work activities and stress respectively. Both groups experienced a discrepancy between their actual and preferred work activities, with the occupational therapists and the social workers mostly wanting to undertake a diverse range of activities to a significantly greater extent than they currently were. As predicted, stress was associated with the discrepancy between the kind of work that the participants wanted to do and the kind of work that their job actually entailed. Health workers require assistance to adapt to their new work roles and to achieve a balance between generic and discipline-specific competencies. This has implications for education and professional training.

The sense of belonging to a neighbourhood: can it be measured and is it related to health and well being in older women?

This study investigates the sense of belonging to a neighbourhood among 9445 women aged 73-78 years participating in the Australian Longitudinal Study on Women's Health. Thirteen items designed to measure sense of neighbourhood were included in the survey of the older women in 1999. Survey data provided a range of measures of demographic, social and health-related factors to assess scale construct validity. Factor analysis showed that seven of the items loaded on one factor that had good face validity and construct validity as a measure of the sense of neighbourhood. Two of the remaining items related to neighbourhood safety and comprised a factor. A better sense of neighbourhood was associated with better physical and mental health, lower stress, better social support and being physically active. Women who had lived longer at their present address had a better sense of belonging to their neighbourhood, as did women living in non-urban areas and who were better able to manage on their income. Feeling safe in the neighbourhood was least likely in urban areas, increased in rural townships, and was most likely in rural and remote areas. Older women living alone felt less safe, as did women who were less able to manage on their income. This study has identified two sets of items that form valid measures of aspects of the social environment of older women, namely the sense of neighbourhood and feelings of safety. These findings make a contribution to our understanding of the relationship between feelings of belonging to a neighbourhood and health in older women. (C) 2004 Elsevier Ltd. All rights reserved.