Estimates of global and regional potential health gains from reducing multiple major risk factors

Background Estimates of the disease burden due to multiple risk factors can show the potential gain from combined preventive measures. But few such investigations have been attempted, and none on a global scale. Our aim was to estimate the potential health benefits from removal of multiple major risk factors. Methods We assessed the burden of disease and injury attributable to the joint effects of 20 selected leading risk factors in 14 epidemiological subregions of the world. We estimated population attributable fractions, defined as the proportional reduction in disease or mortality that would occur if exposure to a risk factor were reduced to an alternative level, from data for risk factor prevalence and hazard size. For every disease, we estimated joint population attributable fractions, for multiple risk factors, by age and sex, from the direct contributions of individual risk factors. To obtain the direct hazards, we reviewed publications and re-analysed cohort data to account for that part of hazard that is mediated through other risks. Results Globally, an estimated 47% of premature deaths and 39% of total disease burden in 2000 resulted from the joint effects of the risk factors considered. These risks caused a substantial proportion of important diseases, including diarrhoea (92%-94%), lower respiratory infections (55-62%), lung cancer (72%), chronic obstructive pulmonary disease (60%), ischaemic heart disease (83-89%), and stroke (70-76%). Removal of these risks would have increased global healthy life expectancy by 9.3 years (17%) ranging from 4.4 years (6%) in the developed countries of the western Pacific to 16.1 years (43%) in parts of sub-Saharan Africa. Interpretation Removal of major risk factors would not only increase healthy life expectancy in every region, but also reduce some of the differences between regions, The potential for disease prevention and health gain from tackling major known risks simultaneously would be substantial.

Relations between companion animals and self-reported health in older women: Cause, effect or artifact

A large longitudinal dataset on women's health in Australia provided the basis of analysis of potential positive health effects of living with a companion animal. Age, living arrangements, and housing all strongly related to both living with companion animals and health. Methodological problems in using data from observational studies to disentangle a potential association in the presence of substantial effects of demographic characteristics are highlighted. Our findings may help to explain some inconsistencies and contradictions in the literature about the health benefits of companion animals, as well as offer suggestions for ways to more forward in future investigations of human-pet relationships.

Walking towards health in a university community: Preliminary analyses of baseline data

Research has shown that accumulating 10 000 steps/day provides a range of significant clinical health benefits. However, opportunities for daily walking are constrained by a number of barriers, including employment in sedentary occupations.

Provitamin A carotenoid content of different cultivars of edible pandanus fruit

As part of an overall study to identify vitamin A-rich foods, a study was carried out in the Federated States of Micronesia (FSM) to provide information on production, acquisition, consumption and cultural acceptability of edible pandanus cultivars, Pandanus teetorius, and to identify their carotenoid content. Samples of five pandanus cultivars were collected and analyzed for alpha- and beta-carotene by HPLC. The results showed that the two cultivars with yellow fruit coloration contained low levels of carotenoids, while the orange fruits, which were also well liked as a food in the community, contained higher levels at maxima of 190 mug/100 g and 393 mug/100 g for alpha- and beta-carotene, respectively. Common patterns of intake when the fruit is available show that pandanus can provide a large proportion of estimated requirements of retinol equivalents. Local people were generally unaware that pandanus had health benefits, although the food was very popular. Nevertheless, key informants report that production had greatly decreased in recent years. To reverse this trend, those acceptable cultivars high in carotenoid content should be promoted both for their general enjoyment and their health benefits. (C) 2003 Elsevier Science Ltd. All rights reserved.

Pacific pandanus fruit: an ethnographic approach to understanding an overlooked source of provitamin A carotenoids

Commonly recommended plant sources of provitamin A, such as dark green leafy vegetables, are not acceptable in many population groups. The objective of this study was to identify other indigenous foods that may be effectively promoted to alleviate vitamin A deficiency (VAD) and to gather information relevant to identification, production, acquisition, and consumption of foods relevant to a food-based VAD prevention strategy in the Federated States of Micronesia. An ethnographic study on edible pandanus cultivars, involving key informant interviews and observation was carried out. Analyses revealed a great range in carotenoid content. Several orange-coloured pandanus cultivars, all highly acceptable, contained high levels of carotenoid, almost meeting daily requirements in usual consumption patterns, whereas light yellow-coloured cultivars contained low levels. Availability has decreased substantially in recent years due to increased consumption of imported foods and general neglect of indigenous foods. High-carotenoid pandanus should be promoted for general enjoyment and health benefits.

Measurement and prediction of energy expenditure in males during household and garden tasks

Participation in at least 30 min of moderate intensity activity on most days is assumed to confer health benefits. This study accordingly determined whether the more vigorous household and garden tasks (sweeping, window cleaning, vacuuming and lawn mowing) are performed by middle-aged men at a moderate intensity of 3-6 metabolic equivalents (METs) in the laboratory and at home. Measured energy expenditure during self-perceived moderate-paced walking was used as a marker of exercise intensity. Energy expenditure was also predicted via indirect methods. Thirty-six males [Xmacr (SD): 40.0 (3.3) years; 179.5 (6.9) cm; 83.4 (14.0) kg] were measured for resting metabolic rate (RMR) and oxygen consumption (V.O-2) during the five activities using the Douglas bag method. Heart rate , respiratory frequency, CSA (Computer Science Applications) movement counts, Borg scale ratings of perceived exertion and Quetelet's index were also recorded as potential predictors of exercise intensity. Except for vacuuming in the laboratory, which was not significantly different from 3.0 METs (P=0.98), the MET means in the laboratory and home were all significantly greater than 3.0 (Pless than or equal to0.006). The sweeping and vacuuming MET means were significantly higher (P

Measurement properties of the CHAMPS physical activity questionnaire in a sample of older Australians

Background: The effective evaluation of physical activity interventions for older adults requires measurement instruments with acceptable psychometric properties that are sufficiently sensitive to detect changes in this population. Aim: To assess the measurement properties (reliability and validity) of the Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire in a sample of older Australians. Methods: CHAMPS data were collected from 167 older adults (mean age 79.1 S.D. 6.3 years) and validated with tests of physical ability and the SF-12 measures of physical and mental health. Responses from a sub-sample of 43 older adults were used to assess 1-week test-retest reliability. Results: Approximately 25% of participants needed assistance to complete the CHAMPS questionnaire. There were low but significant correlations between the CHAMPS scores and the physical performance measures (rho=0.14-0.32) and the physical health scale of the SF-12 (rho=0.12-0.24). Reliability coefficients were highest for moderate-intensity (ICC=0.81-0.88) and lowest for vigorous-intensity physical activity (ICC=0.34-0.45). Agreement between test-retest estimates of sufficient physical activity for health benefits (>= 150 min and >= 5 sessions per week) was high (percent agreement = 88% and Cohen's kappa = 0.68). Conclusion: These findings suggest that the CHAMPS questionnaire has acceptable measurement properties, and is therefore suitable for use among older Australian adults, as long as adequate assistance is provided during administration. (c) 2006 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Trends for in situ and invasive melanoma in Queensland, Australia, 1982-2002

Objectives Queensland, the north-eastern state of Australia, has the highest incidence of melanoma in the world. Control measures started earlier here than probably anywhere else in the world; early detection programmes started in the 1960s and primary prevention in the 1980s. Data from the population-based Queensland Cancer Registry therefore provide an internationally unique data source with which to assess trends for in situ and invasive melanomas and to consider the implications for early detection and primary prevention. Methods We used Poisson regression to estimate the annual percentage change in rates across 21 years of incidence data for in situ and invasive lesions, stratified by age and sex. Joinpoint analyses were used to assess whether there had been a statistically significant change in the trends. Results In situ melanomas increased by 10.4% (95% CI: 10.1%, 11.1%) per year among males and 8.4% (7.9%, 8.9%) per year among females. The incidence of invasive lesions also increased, but not as quickly; males 2.6% (2.4%, 2.8%), females 1.2% (0.9%, 1.5%). Valid data on thickness was only available for 1991 to 2002 and for this period thin-invasive lesions were increasing faster than thick-invasive lesions (for example, among males: thin 3.8%, thick 2.0%). We found some suggestive evidence of lower proportionate increase for the most recent years for both in-situ and invasive lesions, but this did not achieve statistical significance. Among people younger than 35 years, the incidence of invasive melanoma was stable and there was a suggestion of a birth cohort effect from about 1958. Mortality rates were stable across all ages, and there was a suggestion of decreasing rates among young women, although this did not achieve statistical significance. Conclusion Age-standardised incidence is continuing to increase and this, in combination with a shift to proportionately more in situ lesions, suggests that the stabilisation of mortality rates is due, in large part, to earlier detection. For primary prevention, after a substantial period of sustained effort in Queensland, there is some suggestive, but not definitive, evidence that progress is being made. Incidence rates are stabilising in those younger than 35 years and the proportionate increase for both in situ and invasive lesions appears to be lower for the most recent period compared with previous periods. However, even taking the most favourable view of these trends, primary prevention is unlikely to lead to decreases in the overall incidence rate of melanoma for at least another 20 years. Consequently, the challenge for primary prevention programmes will be to maintain momentum over the long term. If this can be achieved, the eventual public-health benefits are likely to be substantial.

Carotenoid content of pandanus fruit cultivars and other foods of the Republic of Kiribati

Background: Kiribati, a remote atoll island country of the Pacific, has serious problems of vitamin A deficiency (VAD). Thus, it is important to identify locally grown acceptable foods that might be promoted to alleviate this problem. Pandanus fruit (Pandanus tectorius) is a well-liked indigenous Kiribati food with many cultivars that have orange/yellow flesh, indicative of carotenoid content. Few have been previously analysed. Aim: This study was conducted to identify cultivars of pandanus and other foods that could be promoted to alleviate VAD in Kiribati. Method: Ethnography was used to select foods and assess acceptability factors. Pandanus and other foods were analysed for beta- and alpha-carotene, beta-cryptoxanthin, lutein, zeaxanthin, lycopene and total carotenoids using high-performance liquid chromatography. Results: Of the nine pandanus cultivars investigated there was a great range of provitamin A carotenoid levels (from 62 to 19 086 mu g beta-carotene/100 g), generally with higher levels in those more deeply coloured. Seven pandanus cultivars, one giant swamp taro (Cyrtosperma chamissonis) cultivar and native fig (Ficus tinctoria) had significant provitamin A carotenoid content, meeting all or half of estimated daily vitamin A requirements within normal consumption patterns. Analyses in different laboratories confirmed high carotenoid levels in pandanus but showed that there are still questions as to how high the levels might be, owing to variation arising from different handling/preparation/analytical techniques. Conclusions: These carotenoid-rich acceptable foods should be promoted for alleviating VAD in Kiribati and possibly other Pacific contexts where these foods are important. Further research in the Pacific is needed to identify additional indigenous foods with potential health benefits.

Critical health psychology - Who benefits?

This commentary deals with two issues raised by Hepworth (this issue). Concerning definitions, it argues that critical health psychology needs to be more explicit in defining itself as politically left-wing, and that its central defining characteristic should be that it is research and practice which aims primarily to benefit the participants, regardless of any specific method or epistemology. Concerning the value of critical health psychology, it argues that work which has improved health on a global scale and which aims to reduce inequities is being done, but not by critical psychologists, and suggests a need for more action and less rhetoric.