National indicators of health literacy: ability to understand health information and to engage actively with healthcare providers - a population-based survey among Danish adults

Health literacy is a multidimensional concept covering a range of cognitive and social skills necessary for participation in health care. Knowledge of health literacy levels in general populations and how health literacy levels impacts on social health inequity is lacking. The primary aim of this study was to perform a population-based assessment of dimensions of health literacy related to understanding health information and to engaging with healthcare providers. Secondly, the aim was to examine associations between socio-economic characteristics with these dimensions of health literacy.

Making robust policy decisions using global biodiversity indicators

In order to influence global policy effectively, conservation scientists need to be able to provide robust predictions of the impact of alternative policies on biodiversity and measure progress towards goals using reliable indicators. We present a framework for using biodiversity indicators predictively to inform policy choices at a global level. The approach is illustrated with two case studies in which we project forwards the impacts of feasible policies on trends in biodiversity and in relevant indicators. The policies are based on targets agreed at the Convention on Biological Diversity (CBD) meeting in Nagoya in October 2010. The first case study compares protected area policies for African mammals, assessed using the Red List Index; the second example uses the Living Planet Index to assess the impact of a complete halt, versus a reduction, in bottom trawling. In the protected areas example, we find that the indicator can aid in decision-making because it is able to differentiate between the impacts of the different policies. In the bottom trawling example, the indicator exhibits some counter-intuitive behaviour, due to over-representation of some taxonomic and functional groups in the indicator, and contrasting impacts of the policies on different groups caused by trophic interactions. Our results support the need for further research on how to use predictive models and indicators to credibly track trends and inform policy. To be useful and relevant, scientists must make testable predictions about the impact of global policy on biodiversity to ensure that targets such as those set at Nagoya catalyse effective and measurable change.

Global biodiversity indicators reflect the modeled impacts of protected area policy change

Global biodiversity indicators can be used to measure the status and trends of biodiversity relating to Convention on Biological Diversity (CBD) targets. Whether such indicators can support decision makers by distinguishing among policy options remains poorly evaluated. We tested the ability of two CBD indicators, the Living Planet Index and the Red List Index, to reflect projected changes in mammalian populations in sub-Saharan Africa in response to potential policies related to CBD targets for protected areas (PAs). We compared policy scenarios to expand the PA network, improve management effectiveness of the existing network, and combinations of the two, against business as usual. Both indicators showed that more effective management would provide greater benefits to biodiversity than expanding PAs alone. The indicators were able to communicate outcomes of modeled scenarios in a simple quantitative manner, but behaved differently. This work highlights both the considerable potential of indicators in supporting decisions, and the need to understand how indicators will respond as biodiversity changes.

The why, what, and how of global biodiversity indicators beyond the 2010 target

The 2010 biodiversity target agreed by signatories to the Convention on Biological Diversity directed the attention of conservation professionals toward the development of indicators with which to measure changes in biological diversity at the global scale. We considered why global biodiversity indicators are needed, what characteristics successful global indicators have, and how existing indicators perform. Because monitoring could absorb a large proportion of funds available for conservation, we believe indicators should be linked explicitly to monitoring objectives and decisions about which monitoring schemes deserve funding should be informed by predictions of the value of such schemes to decision making. We suggest that raising awareness among the public and policy makers, auditing management actions, and informing policy choices are the most important global monitoring objectives. Using four well-developed indicators of biological diversity (extent of forests, coverage of protected areas, Living Planet Index, Red List Index) as examples, we analyzed the characteristics needed for indicators to meet these objectives. We recommend that conservation professionals improve on existing indicators by eliminating spatial biases in data availability, fill gaps in information about ecosystems other than forests, and improve understanding of the way indicators respond to policy changes. Monitoring is not an end in itself, and we believe it is vital that the ultimate objectives of global monitoring of biological diversity inform development of new indicators.

Use of indicators to assess the sustainability of housing developments in Australia

Most new housing in Australia is occurring on greenfield sites on the edges of the capital cities. These housing developments are often criticised for their social and environmental unsustainability. These unsustainable suburbs are a legacy for future generations. They will create dire social and environmental problems if a serious economic downturn was to occur or a resource shortage e.g. oil was to make accessibility impossible. Coupled to these threats is that of the social ‘undesirability’ of isolated suburbs where only those on low incomes made their home. Most of those on higher incomes seek established suburbs which have ‘character’, social amenities and ease of access. Typically, these are in older suburbs close to city centres. This paper describes a methodology that has been developed to analyse past and future housing developments. The results of the analysis can provide a guide to improving the sustainability of these suburbs. The methodology uses several criteria to reflect the fact that no single criterion is adequate to describe or analyse the sustainability of a housing development. Sustainability should embrace social and environmental perspectives, so a multi-criteria analysis is appropriate. The theoretical framework for this methodology has been described elsewhere. However, in this previous work only five criteria were considered: energy use, resource use, neighbourhood character, neighbourhood connectedness and social diversity. In each case, high and low sustainability practice has been identified so that ranking is possible. This paper initially summarizes the way in which these previous five criteria are assessed but then adds a sixth criterion (social connectedness) because of a perceived gap in the previous assessment. The results of an analysis of three suburbs reported in the previous work are updated. They score poorly in terms of social connectedness underlining the need to ‘repair’ these suburbs in order to improve their overall sustainability.

Migratory implications for coronary heart disease risk prevention in Asian Indians: Evidence from the leading health indicators.

OBJECTIVEctives of this descriptive comparative study were to (1) review data obtained from the World Health Organisation Statistical Information System (WHOSIS) database relating to the prevalence of risk factors for coronary heart disease (CHD) among Indians and Australians and (2) compare these data with published epidemiological studies of CHD riskfactors in adult migrant Asian Indians to provide a comprehensive and comparable assessment of risk factors relating to CHD and the mortality attributable to these risk factors. Design: ThDESIGNdy was undertaken using a database search and integrative review methodology. Data were obtained for comparison of CHD risk factors between Indians and Australians using the WHOSIS database. For the integrative review the MEDLINE, CINAHL, EMBASE, and Cochrane databases were searched using the keywords 'Migrants', 'Asian Indian', 'India', 'Migration', 'Immigration', 'Risk factors', and coronary heart disease. Two reviewers independently assessed the eligibility of the studies for inclusion in the review, the methodological quality and extracted details of eligible studies. Results from the integrative review on CHD risk factors in Asian Indians are presented in a narrative format, along with results from the WHOSIS database. Results: TRESULTSadjusted mortality for CHD was four times higher in migrant Asian Indians when compared to both the native population of the host country and migrants from other countries. Similarly when compared to migrants from other countries migrant Asian Indians had the highest prevalence of overweight individuals. Prevalence rates for hypercholesterolemia were up to 18.5 % among mgrant Asian Indians and migrant Asian Indian women had a higher prevalence of hypertriglyceridaemia compared to Caucasian females. Migrant Asian Indians also had a higher incidence of hypertension and upto 71 % of migrnt Asian Indian men did not meet current guidelines for participation in physical activity. Ethnic-specific prevalence of diabetes ranged from 6-7% among the normal weight to 19-33% among the obese migrant Asian Indians compared with non-Hispanic whites. ConclusionCONCLUSIONAsian Indians have an increased risk of CHD. Culturally sensitive strategies that recognise the effects of migration and extend beyond the health sector should be developed to target lifestyle changes in this high risk population.

Conceptualising and measuring spatial indicators of employment through a liveability lens

Employment is a well-known social determinant of health and wellbeing and important for the liveability of a region. Yet, spatial data are rarely used to understand barriers and facilitators of accessing employment within a city. Therefore it remains challenging to plan cities that provide equitable opportunities for urban job seekers. This paper sought to: (1) identify urban planning and neighbourhood spatial attributes that facilitate access to employment; (2) conceptualise how neighbourhood attributes that facilitate accessible urban employment may be related to health and wellbeing behaviours and outcomes; and (3) isolate potentially important neighbourhood-level spatial measures that policy-makers and planners could use to assess urban employment accessibility. A conceptual framework was developed through a social determinants of health lens, where more upstream (e.g., neighbourhood attributes) and more downstream (e.g., behaviours, intermediate outcomes) determinants of urban employment were identified in relation to long-term health and social outcomes of interest. Six potential neighbourhood spatial measures of employment were identified. These were classified into measures of: access to employment (n = 4), local employment (n = 1), and neighbourhood employment level (n = 1). The spatial measures proposed rely on routinely collected administrative datasets existing within Australia (i.e., census data); therefore can be replicated over time and data are available nationally. Together, this research identified a suite of potential (and readily available) spatial measures that can be used to assess selected neighbourhood attributes as they relate to urban employment access. Such spatial measures can be used to inform future planning decisions that integrate policies across multiple sectors, thereby improving employment accessibility in an urban context.

Active video games and health indicators in children and youth: a systematic review

BACKGROUND: Active video games (AVGs) have gained interest as a way to increase physical activity in children and youth. The effect of AVGs on acute energy expenditure (EE) has previously been reported; however, the influence of AVGs on other health-related lifestyle indicators remains unclear.

OBJECTIVE: This systematic review aimed to explain the relationship between AVGs and nine health and behavioural indicators in the pediatric population (aged 0-17 years). DATA SOURCES: Online databases (MEDLINE, EMBASE, psycINFO, SPORTDiscus and Cochrane Central Database) and personal libraries were searched and content experts were consulted for additional material.

DATA SELECTION: Included articles were required to have a measure of AVG and at least one relevant health or behaviour indicator: EE (both habitual and acute), adherence and appeal (i.e., participation and enjoyment), opportunity cost (both time and financial considerations, and adverse events), adiposity, cardiometabolic health, energy intake, adaptation (effects of continued play), learning and rehabilitation, and video game evolution (i.e., sustainability of AVG technology).

RESULTS: 51 unique studies, represented in 52 articles were included in the review. Data were available from 1992 participants, aged 3-17 years, from 8 countries, and published from 2006-2012. Overall, AVGs are associated with acute increases in EE, but effects on habitual physical activity are not clear. Further, AVGs show promise when used for learning and rehabilitation within special populations. Evidence related to other indicators was limited and inconclusive.

CONCLUSIONS: Controlled studies show that AVGs acutely increase light- to moderate-intensity physical activity; however, the findings about if or how AVG lead to increases in habitual physical activity or decreases in sedentary behaviour are less clear. Although AVGs may elicit some health benefits in special populations, there is not sufficient evidence to recommend AVGs as a means of increasing daily physical activity.

Relationships between intuitive eating and health indicators : literature review

OBJECTIVE: To review the peer-reviewed literature on relationships between intuitive eating and health indicators and suggest areas of inquiry for future research. We define the fundamental principles of intuitive eating as: (i) eating when hungry; (ii) stopping eating when no longer hungry/full; and (iii) no restrictions on types of food eaten unless for medical reasons. DESIGN: We include articles cited by PubMed, PsycInfo and Science Direct published in peer-reviewed journals or theses that include 'intuitive eating' or related concepts in the title or abstract and that test relationships between intuitive eating and physical or mental health indicators. RESULTS: We found twenty-six articles that met our criteria: seventeen cross-sectional survey studies and nine clinical studies, eight of which were randomised controlled trials. The cross-sectional surveys indicate that intuitive eating is negatively associated with BMI, positively associated with various psychological health indicators, and possibly positively associated with improved dietary intake and/or eating behaviours, but not associated with higher levels of physical activity. From the clinical studies, we conclude that the implementation of intuitive eating results in weight maintenance but perhaps not weight loss, improved psychological health, possibly improved physical health indicators other than BMI (e.g. blood pressure; cholesterol levels) and dietary intake and/or eating behaviours, but probably not higher levels of physical activity. CONCLUSIONS: Research on intuitive eating has increased in recent years. Extant research demonstrates substantial and consistent associations between intuitive eating and both lower BMI and better psychological health. Additional research can add to the breadth and depth of these findings. The article concludes with several suggestions for future research.

Applying stock indicators for assessment of a recreational surf clam (Donax deltoides) fishery in Victoria, Australia

The aim of this study was to apply indicators for monitoring the impacts of harvest in a recreational surf clam fishery. We investigated trends in abundance, biomass and size structure and proportion of sexual maturity for the pipi (Donax deltoides) in Venus Bay, Australia. The surf clam stock was sampled during the peak harvesting season in the Australian summer (November to February) at four sites exposed to varying degrees of recreational harvest. Sampling was based on three transects at each site; with 0.027 m3 (0.3 m × 0.3 m × 0.3 m) quadrats stratified within transects by tidal position. Restricted maximum likelihood mixed model analyses were used to examine fixed effect combinations after including a priori random effect for transect within site. Results demonstrated that relative abundance varied significantly (P = 0.0090) among sampling months but not among sites. Relative abundance declined across the peak summer harvest season. The proportion of maturity varied significantly (P = 0.00026) among sites whereas relative biomass varied significantly (P = 0.0043) among months by sites. Relative biomass and the proportion of maturity were considerably higher at the site exposed to minimal harvest compared to other sites. This study demonstrates that a suite of indictors including biomass, size–frequency and proportion of maturity are likely to provide a more accurate assessment of stock status in recreationally fished surf clam populations, than relative abundance. This highlights the need to develop methods to estimate relative biomass in surf clam populations that are not exploited commercially.