95 resultados para Aged, 80 and over
Resumo:
Aim: Recent analyses suggest the decline in coronary heart disease (CHD) mortality rates is slowing in younger age groups in countries such as the UK and US. We aimed to assess recent mortality rate trends in all circulatory disease and its subtypes in Australia.
Methods: Annual all circulatory, CHD, and cerebrovascular disease mortality rates between 1980 and 2005 for Australia were analysed. Data were stratified by sex and ten-year age group (age 35 to 85+). The annual rate of change and significant changes in trends were identified using joinpoint Poisson regression.
Results: Age standardised all circulatory disease mortality rates continue to decline in Australia, falling from 441 per 100,000 in 1980 to 145 per 100,000 in 2005 for males and from 264 per 100,000 to 96 per 100,000 for females. The rate of decline from both CHD and cerebrovascular disease appears to be stable or accelerating for individuals aged 55 years and over. However, the decline in young men and women aged 35-54 years is slowing for CHD and cerebrovascular disease mortality alike (except cerebrovascular disease mortality in males aged 35-44). For females aged 35-44 and 45-54 there has been no change in the cerebrovascular mortality rate since 1993 and 1999, respectively.
Conclusions: In Australia, whilst in older adults the decline in cardiovascular mortality rates is generally accelerating, in younger adults it appears to be slowing. It will be important to identify the causes of these trends.
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Deakin University and the University of Tasmania were commissioned by Parks Victoria (PV) to create two updated habitat maps for areas within the Corner Inlet and Nooramunga Marine and Coastal Park and Ramsar area. The team obtained a ground-truth data set using in situ video and still photographs. This dataset was used to develop and assess predictive models of benthic marine habitat distributions incorporating data from both ALOS (Advanced Land Observation Satellite) imagery atmospherically corrected by CSIRO and LiDAR (Light Detection and Ranging) bathymetry. This report describes the results of the mapping effort as well as the methodology used to produce these habitat maps.
Overall accuracies of habitat classifications were good, returning overall accuracies >73 % and kappa values > 0.62 for both study localities. Habitats predicted with highest accuracies included Zosteraceae in Nooramunga (91 %), reef in Corner Inlet (80 %), and bare sediment (no-visible macrobiota/no-visible seagrass classes; both > 76 %). The majority of classification errors were due to the misclassification of areas of sparse seagrass as bare sediment. For the Corner Inlet study locality the no-visible macrobiota (10,698 ha), Posidonia (4,608 ha) and Zosteraceae (4,229 ha) habitat classes covered the most area. In Nooramunga no-visible seagrass (5,538 ha), Zosteraceae (4,060 ha) and wet saltmarsh (1,562 ha) habitat classes were most dominant.
In addition to the commissioned work preliminary change detection analyses were undertaken as part of this project. These analyses indicated shifts in habitat extents in both study localities since the late 1990s/2000. In particular, a post-classification analysis highlighted that there were considerable increases in seagrass habitat (primarily Zosteraceae) throughout the littoral zones and river/creek mouths of both study localities. Further, the numerous channel systems remained stable and were free of seagrass at both times. A substantial net loss of Posidonia in the Corner Inlet locality is likely but requires further investigation due to potential misclassifications between habitats in both the 1998 map (Roob et al. 1998) and the current mapping. While the unsupervised Independent Components Analysis (ICA) change detection technique indicated some changes in habitat extent and distribution, considerable areas of habitat change observed in the post-classification approach are questionable, and may reflect misclassifications rather than real change. A particular example of this is an apparent large decrease in Zosteraceae and increase in Posidonia being related to the classification of Posidonia beds as Zosteraceae in the 1998 mapping. Despite this, we believe that changes indicated by both the ICA and post-classification approaches have a high likelihood of being ‘actual’ change. A pattern of gains and losses of Zosteraceae in the region north of Stockyard channel is an example of this. Further analyses and refinements of approaches in change detection analyses such as would improve confidence in the location and extent of habitat changes over this time period.
This work has been successful in providing new baseline maps using a repeatable method meaning that any future changes in intertidal and shallow water marine habitats may be assessed in a consistent way with quantitative error assessments. In wider use, these maps should also allow improved conservation planning, advance fisheries and catchment management, and progress infrastructure planning to limit impacts on the Inlet environment.
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Background
Little is known about patterns of sedentary behavior (SB) and physical activity among preschoolers. Therefore, in this observational study patterns of SB and moderate-to-vigorous physical activity (MVPA) were examined in detail throughout the week in preschool-aged boys and girls.
Methods
A sample of 703 Melbourne preschool children (387 boys; 4.6 ± 0.7 y) were included in data analysis. SB and MVPA data were collected using accelerometry over an eight-day period. Percentage of time per hour in SB and in MVPA between 08:00 h and 20:00 h was calculated. Multi-level logistic regression models were created to examine the hour-by-hour variability in SB and MVPA for boys and girls across weekdays and weekend days. Odds ratios (OR) were calculated to interpret differences in hour-by-hour SB and MVPA levels between boys and girls, and between weekdays and weekend days.
Results
The highest SB levels co-occurred with the lowest MVPA levels from the morning till the early afternoon on weekdays, and during the morning and around midday on weekends. Besides, participation in SB was the lowest and participation in MVPA was the highest from the mid afternoon till the evening on weekdays and weekend days. The variability across the hours in SB and, especially, in MVPA was rather small throughout weekdays and weekends. These patterns were found in both boys and girls. During some hours, girls were found to be more likely than boys to demonstrate higher SB levels (OR from 1.08 to 1.16; all p < 0.05) and lower MVPA levels (OR from 0.75 to 0.88; all p < 0.05), but differences were small. During weekends, hour-by-hour SB levels were more likely to be lower (OR from 0.74 to 0.98; all p < 0.05) and hour-by-hour MVPA levels were more likely to be higher (OR from 1.15 to 1.50; all p < 0.05), than during weekdays, in boys and girls.
Conclusion
Entire weekdays, especially from the morning till the early afternoon, and entire weekend days are opportunities to reduce SB and to promote MVPA in preschool-aged boys and girls. Particularly weekdays hold the greatest promise for improving SB and MVPA. No particular time of the week was found where one sex should be targeted.
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This study is the first multi-year examination of the relative influence of the four main variables said to influence sponsorship recall. Sponsor recall data were collected from season ticket holders (STHs) of 10 professional sports teams, over periods ranging from 3 to 5 years per team. Across those teams and over that time, 309 sponsor–team relationships were examined, and sponsor recall data from over 117,000 individual STHs were collected. Sponsorship length and level were shown to have the strongest impact on recall, followed by relatedness and prominence. These variables affected both the recall of current sponsors and the decay rates of residual recall following the end of a sponsorship. The average rates of sponsor recall growth and decline have been derived from these data, giving managers a tool by which to benchmark sport sponsorship recall performance.
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Summary
In 2007, Medicare Australia revised reimbursement guidelines for dual energy X-ray absorptiometry (DXA) for Australians aged ≥70 years; we examined whether these changes increased DXA referrals in older adults. Proportions of DXA referrals doubled for men and tripled for women from 2003 to 2010; however, rates of utilization remained low.
Introduction
On April 1, 2007 Medicare Australia revised reimbursement guidelines for DXA for Australians aged ≥70 year; changes that were intended to increase the proportion of older adults being tested. We examined whether changes to reimbursement increased DXA referrals in older adults, and whether any sex differences in referrals were observed in the Barwon Statistical Division.
Methods
Proportions of DXA referrals 2003–2010 based on the population at risk ascertained from Australian Census data and annual referral rates and rate ratios stratified by sex, year of DXA, and 5-year age groups. Persons aged ≥70 years referred to the major public health service provider for DXA clinical purposes (n = 6,096; 21 % men).
Results
DXA referrals. Proportions of DXA referrals for men doubled from 0.8 % (2003) to 1.8 % (2010) and tripled from 2.0 to 6.3 % for women (all p < 0.001). For 2003–2006, referral ratios of men/women ranged between 1:1.9 and 1:3.0 and for 2007–2010 were 1:2.3 to 1:3.4. Referral ratios <2007:≥2007 were 1:1.7 for men aged 70–79 years (p < 0.001), 1:1.2 for men aged 80–84 years (p = 0.06), and 1:1.3 for men 85+ years (p = 0.16). For women, the ratios <2007:≥2007 were 1:2.1 (70–79 years), 1.1.5 (80–84 years), and 1:1.4 (85+ years) (all p < 0.001).
Conclusions
DXA referral ratios were 1:1.6 (men) and 1:1.8 (women) for 2007–2010 vs. 2003–2006; proportions of referrals doubled for men and tripled for women from 2003 to 2010. Overall, rates of DXA utilization remained low. Policy changes may have had minimal influence on referral; thus, ongoing evaluation over time is warranted.
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Background
Renal access coordinators contribute specifically to dialysis access care for people with chronic and end stage renal disease. Since the introduction of renal access coordinators into Australia in the early 2000s, there have been anecdotal examples of associated improvements in patient outcomes and service delivery; however scant published quantitative evidence exists. Thus, the impact of the implementation of renal access coordinators has not undergone a rigorous review to date.
Objective
The objective of this systematic review was to critically appraise and synthesize the best available evidence related to the impact of renal access coordinators on dialysis patient outcomes and associated service delivery.
INCLUSION CRITERIA
Types of participants
This review considered studies that included renal access coordinators (noting variations of the titles) and adult hemodialysis patients (aged 18 years and over).
Types of intervention(s)
This review considered studies that evaluated the effectiveness of the renal access coordinator. This role typically consists of clinical and administration duties such as providing pre dialysis access coordination, access surveillance patient education and nurse education.
Types of studies
The types of studies considered within this review included experimental and epidemiological study designs. Thus randomized controlled trials (RCT), non-randomized controlled trials, and quasi-experimental, before and after studies, prospective and retrospective cohort studies were considered as were case control studies, analytical cross sectional studies and descriptive cross sectional studies.
Types of outcomes
Patient outcomes considered included: days to first vascular access complication (such as stenosis or thrombosis) and/or primary intervention (such as angioplasty or surgical intervention); percentage of central line insertions (negative); rate of arteriovenous fistula (AVF)/arteriovenous graft (AVG)/central venous catheter (CVC) at start of dialysis (incidence); prevalent rate of AVF/AVG/CVC; time to occlusion of AVF and time from referral to surgery. Service outcomes included: knowledge/up skilling of renal nurses; cannulation skills, ultrasound skills, knowledge of anatomy and physiology and other access related knowledge.
Search strategy
The search strategy aimed to locate published and unpublished studies, utilizing a three-step searching approach. Studies published in English from 1990 to October 2013 were considered for inclusion in this review.
Methodological quality
The studies were assessed by two independent reviewers using the appropriate standardized critical appraisal instruments from the Joanna Briggs Institute.
Data collection
Data were extracted from papers included in the review using the standardised data extraction tool from the Joanna Briggs Institute, namely JBI Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI).
Data synthesis
This review aimed to conduct meta-analyses of the findings: however, because of the limitations of the data found, this was not possible and so the findings are presented in a narrative format.
Results
Five studies were identified for inclusion in the review. No RCTs were found, therefore four of the five studies were pre-post intervention cohort studies and one was a prospective quality assurance report. Data were heterogeneous and thus did not allow for meta-analysis. All studies included multidisciplinary teams with variable emphasis on the renal access coordinator role. The pre post intervention cohort studies measured incident and/or prevalent AVF, AVG and CVC rates in the hemodialysis population and the quality assurance report measured the difference in patency rates between AVF and AVG. All discussed the role of central coordination as a contributor to the success of vascular access care.
Conclusions
This review found insufficient data to make firm conclusions about the impact that renal access coordinators have on patient outcomes. The results of this review suggest an association between renal access coordinators and improved patient outcomes. These improved patient outcomes were apparent in an increase in incident and prevalent AVFs, and a decrease in the incidence and prevalence of CVCs. Both associations are correlated with a reduction in infection rates, length of hospital stay and healthcare costs.
Resumo:
To determine the prevalence and nature of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) in patients aged 65 years and over.
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Staple entanglement in mohair fleeces occurs when adhesions form between longer and faster growing fibres and shorter and slower growing fibres. This results in accentuated crimp of the longer fibres and an "apparently" reduced staple length. The appearance in the fleece of Angora goats of staple entanglements can lead to the downgrading of the mohair to poorer style and shorter length grades, resulting in up to 60% price reductions. This study examined how staple entanglement score (SES) is related to lifetime factors of Angora goats, and how this relationship can be explained by variations in animal size and fleece attributes. SES was scored using a five-point scale: 5, long free fibres easily separated as no adhesions; 4, some adhesions between fibres; 3, some effort to separate fibres as many adhesions; 2, many adhesions, staple fibres entangled, shortening of staple; 1, very entangled and shortened staple. Measurements were made over 9 shearing periods on a population of Angora castrated males (wethers) goats representing the current range and diversity of genetic origins in Australia, including South African, Texan and interbred admixtures of these and Australian sources. Data on genetic origin, sire, dam, date of birth, dam age, birth weight, birth parity, weaning weight, live weight, fleece growth and fleece attributes were recorded. Two restricted maximum likelihood (REML) models were developed to relate SES with age, animal lifetime factors, fleece quality attributes and live weight. One model allowed fleece quality and live weight traits in the model and the other excluded these traits. Staple entanglement was almost eliminated in mohair harvested from goats shorn every 3. months but was common in mohair from goats shorn twice or once per year. SES was less in goats of Texan genetic background, and was generally less in winter grown mohair. SES was higher for mohair with low fibre curvature (FC, 10°/mm) and a high clean washing yield (CWY, 90%) compared with mohair with low FC and lower CWY (80%), and compared with all mohair with high FC (18°/mm). The response of SES to shearing regime, genetic background, shearing season, age of goat and a response to dam age were almost identical whether or not an adjustment was made for CWY and FC. There was a moderate amount of variability due to sires and individuals. We can conclude that a large part of these effects observed, namely breed, dam age, sire, and a component of the FC and CWY effects, are genetic. Mohair producers can manage the genetic effects by careful selection of sires, especially avoiding those with low CWY or high FC, and avoiding sires with higher levels of staple entanglement or that have produced progeny with higher levels of staple entanglement. Also, unidentified environmental effects are affecting staple entanglement, although a lack of a live weight change effect on entanglement indicates that this effect might not be due to nutrition. © 2013 Elsevier B.V.
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Purpose: Adults with moderate or severe cerebral palsy often require significant lifetime support from family and formal services. The aim of this study was to use a life course approach to explore how previous life experiences impact on the later life relationships of people with moderate to severe cerebral palsy aged 40 years and over and their non-disabled siblings. Method: Twelve adults with moderate to severe cerebral palsy and 16 of their non-disabled siblings were interviewed twice to explore their relationships. Constructivist grounded theory method was used to analyse the data. Results: Four themes were identified as important in understanding these later life sibling relationships: sharing childhood experiences, contact in adulthood, diminishing parental role and increasing support needs. Conclusions: The life course approach indicated that siblings' growing up together was important for the development and maintenance of emotional closeness later in life. Emotional closeness and familial obligation were important factors in motivating siblings with and without cerebral palsy to maintain or re-establish contact with each other in adulthood. Maintenance of sibling relationships in later life is dependent on health, proximity and the ability to keep in contact with each other.Implications for RehabilitationAs adults with severe cerebral palsy live longer, their relationships with non-disabled siblings often take on increased importance and particularly as their parents may be no longer able to provide support.Service providers have a role in helping ageing siblings with and without disability to maintain and build their relationships, for example, by supporting geographically distant siblings to keep in touch.Service providers have a role in supporting the person with a disability and their siblings to make plans for the future. © 2014 Informa UK Ltd.
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BACKGROUND: There has been a significant growth in the energy drink (ED) market in Australia and around the world; however, most research investigating the popularity of ED and alcohol and energy drink (AED) use has focused on specific subpopulations such as university students. The aim of this study was to estimate the prevalence, consumption patterns, and sociodemographic correlates of ED and combined AED use among a representative Australian population sample. METHODS: A computer-assisted telephone interview survey (n = 2,000) was undertaken in March-April 2013 of persons aged 18 years and over. Half of the interviews were obtained through randomly generated landline telephone numbers and half through mobile phones. Approximately half of the sample was female (55.5%; n = 1,110) and the mean age of participants was 45.9 (range 18 to 95, SD 20.0). RESULTS: Less than 1 in 6 Australians reported ED use (13.4%, n = 268) and 4.6% (n = 91) reported AED use in the past 3 months. Majority of ED and AED users consumed these beverages monthly or less. ED and AED users are more likely to be aged 18 to 24 years, live in a metropolitan area, and be moderate risk or problem gamblers. AED consumers are more likely to report moderate levels of psychological distress. CONCLUSIONS: Our findings in relation to problem gambling and psychological distress are novel and require further targeted investigation. Health promotion strategies directed toward reducing ED and AED use should focus on young people living in metropolitan areas and potentially be disseminated through locations where gambling takes place.
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OBJECTIVE: To evaluate the impact of the National Perinatal Depression Initiative on access to Medicare services for women at risk of perinatal mental illness. METHOD: Retrospective cohort study using difference-in-difference analytical methods to quantify the impact of the National Perinatal Depression Initiative policies on Medicare Benefits Schedule mental health usage by Australian women giving birth between 2006 and 2010. A random sample of women of reproductive age enrolled in Medicare who had not given birth where used as controls. The main outcome measures were the proportions of women giving birth each month who accessed a Medicare Benefits Schedule mental health items during the perinatal period (pregnancy through to the end of the first postnatal year) before and after the introduction of the National Perinatal Depression Initiative. RESULTS: The proportion of women giving birth who accessed at least one mental health item during the perinatal period increased from 88 to 141 per 1000 between 2007 and 2010. The difference-in-difference analysis showed that while there was an overall increase in Medicare Benefits Schedule mental health item access as a result of the National Perinatal Depression Initiative, this did not reach statistical significance. However, the National Perinatal Depression Initiative was found to significantly increase access in subpopulations of women, particularly those aged under 25 and over 34 years living in major cities. CONCLUSION: In the 2 years following its introduction, the National Perinatal Depression Initiative was found to have increased access to Medicare funded mental health services in particular groups of women. However, an overall increase across all groups did not reach statistical significance. Further studies are needed to assess the impact of the National Perinatal Depression Initiative on women during childbearing years, including access to tertiary care, the cost-effectiveness of the initiative, and mental health outcomes. It is recommended that new mental health policy initiatives incorporate a planned strategic approach to evaluation, which includes sufficient follow-up to assess the impact of public health strategies.
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We adapted/developed and examined the test–retest reliability and internal consistency of eight parent-report measures of home and neighborhood environmental correlates of physical activity appropriate for Chinese preschool-aged children and their parents/primary caregivers living in densely populated urban environments. This study consisted of a qualitative (cognitive interviews) and a quantitative (test–retest reliability) component. Chinese versions of the measures were pilot-tested on 20 parents of Hong Kong preschool-aged children using cognitive interviews. Measures were then administered to 61 parents twice, 1 week apart. Test–retest reliability and internal consistency were computed. Except for two items, the test–retest reliability of items and scale summary scores ranged from moderate to excellent. The internal consistency of the measures exceeded recommended minimal values (Cronbach’s α >.70). The parent-report measures examined in this study are potentially appropriate for use in investigations of environmental correlates of the physical activity of Chinese preschool-aged children living in densely populated urban environments. However, their predictive validity with respect to Chinese preschool-aged children’s physical activity needs to be assessed in future studies.
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AIM: To establish 1) the socioeconomic and cultural profile and 2) correlates of quality of life (QOL) of Maori in advanced age. METHOD: A cross sectional survey of a population based cohort of Maori aged 80-90 years, participants in LiLACS NZ, in the Rotorua and Bay of Plenty region of New Zealand. Socioeconomic and cultural engagement characteristics were established by personal interview and QOL was assessed by the SF-12. RESULTS: In total 421 (56%) participated and 267 (63%) completed the comprehensive interview. Maori lived with high deprivation areas and had received a poor education in the public system. Home ownership was high (81%), 64% had more than 3 children still living and social support was present for practical tasks and emotional support in 82%. A need for more practical help was reported by 21%. Fifty-two percent of the participants used te reo Maori me nga tikanga (Maori language and culture) daily. One in five had experienced discrimination and one in five reported colonisation affecting their life today. Greater frequency of visits to marae/sacred gathering places was associated with higher physical health-related QOL. Unmet need for practical help was associated with lower physical health-related QOL. Lower mental health-related QOL was associated with having experienced discrimination. CONCLUSION: Greater language and cultural engagement is associated with higher QOL for older Maori and unmet social needs and discrimination are associated with lower QOL.
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PURPOSE: Nutrition is a key determinant of chronic disease in later life. A systematic review was conducted of studies examining dietary patterns and quality of life, physical function, cognitive function and mental health among older adults. METHODS: Literature searches in MEDLINE complete, Academic Search Complete, CINAHL Complete, Ageline, Global health, PsycINFO, SCOPUS and EMBASE and hand searching from 1980 up to December 2014 yielded 1236 results. Inclusion criteria included dietary pattern assessment via dietary indices or statistical approaches, a sample of community-dwelling adults aged 45 years and over at baseline and a cross-sectional or longitudinal study design. Exclusion criteria included a single 24-h recall of diet, evaluation of single foods or nutrients, clinical or institutionalised samples and intervention studies. Risk of bias was assessed using the six-item Effective Public Health Practice Project's Quality Assessment Tool for Quantitative Studies. RESULTS: There were 34 articles (11 cross-sectional and 23 longitudinal) included with 23 studies examining dietary indices and 13 studies using empirical analysis. Most studies examined mental health (n = 10) or cognitive function (n = 18), with fewer studies examining quality of life (n = 6) and physical function (n = 8). Although dietary pattern and outcome assessment methods varied, most studies reported positive associations between a healthier diet and better health outcomes. CONCLUSION: Overall, the number of studies using dietary patterns to investigate diet and successful ageing is small, and further investigation in longitudinal studies is needed, particularly for quality-of-life outcomes. This review provides support for the importance of a healthy diet for the ageing population globally.
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To predict current and future body mass index (BMI) and prevalence of overweight and obesity in Australian children and adults based on sex, age and year of birth (cohort). These predictions are needed for population health planning and evaluation. Data were drawn from 11 cross-sectional national or state population surveys conducted in Australia between 1969 and 2004. These included representative population samples of children (n= 27,635) and adults (n= 43,447) aged 5 years or older with measured height and weight data. Multiple linear regression analyses of measured log-transformed BMI data were conducted to determine the independent effects of age and year of birth (cohort) on ln(BMI) for males and females, respectively. Regression coefficients for cohort obtained from these analyses were applied to the National Nutrition Survey 1995 data set to predict mean BMI and prevalence of overweight (BMI 25-29.99 kg/m(2)) and obesity (BMI ≥ 30 kg/m(2)) in 2005, 2015 and 2025. Based on past trends, BMI is predicted to continue to increase for both males and females and across the age span. This would result in increases in the prevalence of overweight and obesity of between 0.4 and 0.8% per year, such that by 2025 around one-third of 5-19 year olds will be overweight or obese as will 83% of males and 75% of females aged 20 years and over. The increases in prevalence and mean BMI predicted in this study will have significant impacts on disease burden, healthcare costs and need for prevention and treatment programmes.
