Psychosocial epidemiology of colorectal cancer

The research explored the role played by personality and stress in the development and progress of colorectal cancer. Personality type was related to health outcomes following diagnosis, and to participation in bowel cancer screening. The personality types also differed in terms of their capacity to deal with stress.

Chronic heart failure programs : does more equal less? (BENCH study)

The national multi-centre study (49 programs, 1158 patients) developed a quality score (HF-IS) and the national benchmarks for heart programs. The higher a program scored on the HF-IS the greater the reduction in hospital admissions and mortality. This score has the potential to change national nursing practice and improve health outcomes of patients.

Cost-effectiveness analysis of a two-stage screening intervention for hepatocellular carcinoma in Taiwan

Background/Purpose

Hepatocellular carcinoma (HCC) has been the leading cause of cancer death in Taiwan since the 1980s. A two-stage screening intervention was introduced in 1996 and has been implemented in a limited number of hospitals. The present study assessed the costs and health outcomes associated with the introduction of screening intervention, from the perspective of the Taiwanese government. The cost-effectiveness analysis aimed to assist informed decision making by the health authority in Taiwan.
Methods

A two-phase economic model, 1-year decision analysis and a 60-year Markov simulation, was developed to conceptualize the screening intervention within current practice, and was compared with opportunistic screening alone. Incremental analyses were conducted to compare the incremental costs and outcomes associated with the introduction of the intervention. Sensitivity analyses were performed to investigate the uncertainties that surrounded the model.
Results

The Markov model simulation demonstrated an incremental cost-effectiveness ratio (ICER) of NT$498,000 (US$15,600) per life-year saved, with a 5% discount rate. An ICER of NT$402,000 (US$12,600) per quality-adjusted life-year was achieved by applying utility weights. Sensitivity analysis showed that excess mortality reduction of HCC by screening and HCC incidence rates were the most influential factors on the ICERs. Scenario analysis also indicated that expansion of the HCC screening intervention by focusing on regular monitoring of the high-risk individuals could achieve a more favorable result.
Conclusion

Screening the population of high-risk individuals for HCC with the two-stage screening intervention in Taiwan is considered potentially cost-effective compared with opportunistic screening in the target population of an HCC endemic area.

Dietary patterns, assessed from a weighed food record, and survival among elderly participants from the United Kingdom

Background/Objectives: There is variability in the association between dietary intake and health outcomes across different countries, especially among the elderly. We used the gold standard dietary assessment method, a weighed food record, to examine the association between dietary pattern and mortality in a representative sample of community dwelling participants from Great Britain aged 65 years and older.

Subjects/Methods: Dietary intake was recorded at baseline in 1017 elderly participants (520 men, 497 women, mean age 76.3±7.4 years). Exploratory factor analysis was performed to examine dietary patterns and participants were followed up over an average of 9.2 years for mortality.

Results: The factor analysis revealed four interpretable principal components accounting for approximately 9.8% of the total variance, with similar patterns across sex. A ‘Mediterranean-style’ dietary pattern explained the greatest proportion of the variance (3.7%), followed by ‘health-aware’ (2.2%), ‘traditional’ (2.0%) and ‘sweet and fat’ (1.9%) factors. There were a total of 683 deaths through follow-up. After adjustment for potential confounders, only the Mediterranean-style dietary pattern remained associated with mortality (highest vs lowest tertile; hazard ratio¼0.82, 95% CI, 0.68–1.00). The benefits of the Mediterranean-style diet were only observed among women (hazard ratio¼0.71, 95% CI 0.52–0.96) although in men the traditional diet was a risk factor for mortality (hazard ratio¼1.30, 95% CI 1.00–1.71).

Conclusions: Using a gold standard approach, our results confirm previous evidence that dietary patterns are important in longevity among the elderly.

Simulation models of obesity : a review of the literature and implications for research and policy

Simulation models (SMs) combine information from a variety of sources to provide a useful tool for examining how the effects of obesity unfold over time and impact population health. SMs can aid in the understanding of the complex interaction of the drivers of diet and activity and their relation to health outcomes. As emphasized in a recently released report of the Institute or Medicine, SMs can be especially useful for considering the potential impact of an array of policies that will be required to tackle the obesity problem. The purpose of this paper is to present an overview of existing SMs for obesity. First, a background section introduces the different types of models, explains how models are constructed, shows the utility of SMs and discusses their strengths and weaknesses. Using these typologies, we then briefly review extant obesity SMs. We categorize these models according to their focus: health and economic outcomes, trends in obesity as a function of past trends, physiologically based behavioural models, environmental contributors to obesity and policy interventions. Finally, we suggest directions for future research.

Correlates of sedentary behaviours in preschool children : a review

Background: Sedentary behaviour has been linked with a number of health outcomes. Preschool-aged children spend significant proportions of their day engaged in sedentary behaviours. Research into the correlates of sedentary behaviours in the preschool population is an emerging field, with most research being published since 2002. Reviews on correlates of sedentary behaviours which include preschool children have previously been published; however, none have reported results specific to the preschool population. This paper reviews articles reporting on correlates of sedentary behaviour in preschool children published between 1993 and 2009.
Methods: A literature search was undertaken to identify articles which examined correlates of sedentary behaviours in preschool children. Articles were retrieved and evaluated in 2008 and 2009.
Results: Twenty-nine studies were identified which met the inclusion criteria. From those studies, 63 potential correlates were identified. Television viewing was the most commonly examined sedentary behaviour. Findings from the review suggest that child’s sex was not associated with television viewing and had an indeterminate association with sedentary behaviour as measured by accelerometry. Age, body mass index, parental education and race had an indeterminate association with television viewing, and outdoor playtime had no association with television viewing. The remaining 57 potential correlates had been investigated too infrequently to be able to draw robust conclusions about associations.
Conclusions: The correlates of preschool children’s sedentary behaviours are multi-dimensional and not well established. Further research is required to provide a more comprehensive understanding of the influences on preschool children’s sedentary behaviours to better inform the development of interventions.

Socio-demographic correlates of prolonged television viewing time in Australian men and women : the AusDiab study

Background: Sedentary behaviors, particularly television viewing (TV) time, are associated with adverse health outcomes in adults, independent of physical activity levels. These associations are stronger and more consistent for women than for men. Methods: Multivariate regression models examined the sociodemographic correlates of 2 categories of TV time (≥2 hours/day and ≥4 hours/day); in a large, population-based sample of Australian adults (4950 men, 6001 women; mean age 48.1 years, range 25-91) who participated in the 1999/2000 Australian Diabetes, Obesity, and Lifestyle (AusDiab) study. Results: Some 46% of men and 40% of women watched ≥ 2 hours TV/day; 9% and 6% respectively watched ≥ 4 hours/day. For both men and women, ≥2 hours TV/day was associated with less than tertiary education, living outside of state capital cities, and having no paid employment. For women, mid and older age (45-64 and 65+) were also significant correlates of ≥2 hours TV/day. Similar patterns of association were observed in those viewing ≥4 hours/day. Conclusions: Prolonged TV time is associated with indices of social disadvantage and older age. These findings can inform the understanding of potential contextual influences and guide preventive initiatives.

Nursing and justice as a basic human need

This paper explores the idea that justice is a basic human need akin to those famously depicted in Maslow’s hierarchy of human needs and, as such, warrants recognition as a core element in representative ideas about nursing. Early nurse theorists positioned the principles and practice of nursing as having their origins in ‘universal human needs’. The principle of deriving nursing care from human needs was thought to provide a guide not only for promoting health, but for preventing disease and illness. The nursing profession has had a longstanding commitment to social justice as a core professional value and ideal, obligating nurses to address the social conditions that undermine people’s health.The idea of justice as a universal human need per se and its possible relationship to people’s health outcomes has, however, not been considered. One reason for this is that justice in nursing discourse has more commonly been associated with law and ethics, and the legal and ethical responsibilities of nurses in relation to individualized patient care and, more recently, changing systems of care to improve health and health outcomes. Although this association is not incorrect, it is incomplete.A key aim of this paper is to redress this oversight and to encourage a broader conceptualization of justice as necessary for human survival, health and development, not merely as a professional value, or legal or ethical principle for guiding human conduct.

Lower levels of physical activity in childhood associated with adult depression

Emerging evidence indicates that early life exposures influence adult health outcomes and there is cause to hypothesise a role for physical activity (PA) in childhood as a protective factor in adult depression. This study aimed to investigate the association between self-reported levels of PA in childhood and self-reported depressive illness. Lifetime depression and levels of physical activity (low/high) in childhood (<15 yr) were ascertained by self-report in 2152 adults (20–97 yr) participating in an ongoing epidemiological study in south-eastern Australia. Data were collected between 2000 and 2006. In this sample, 141 women (18.9%) and 169 men (12.0%) reported ever having a depressive episode. Low PA in childhood was associated with an increased risk of reporting depression in adulthood (OR = 1.70, 95%CI = 1.32–2.17, p < 0.001). Adjustment for age, gender and adult PA attenuated the relationship somewhat (OR = 1.35, 95%CI = 1.01–1.78, p = 0.04), however further adjustment for SES or country of birth did not affect this relationship. In this community-based study, lower levels of self-reported PA in childhood were associated with a 35% increase in odds for self-reported depression in adulthood. These results are consistent with the hypothesis that lower levels of PA in childhood may be a risk factor for adult depression.