160 resultados para cross-national study
Resumo:
Aims and objectives: To examine the impact and obstacles that individual Institutional Research Ethics Committee (IRECs) had on a large-scale national multi-centre clinical audit called the National Benchmarks and Evidence-based National Clinical guidelines for Heart failure management programmes Study.
Background: Multi-centre research is commonplace in the health care system. However, IRECs continue to fail to differentiate between research and quality audit projects.
Methods: The National Benchmarks and Evidence-based National Clinical guidelines for Heart failure management programmes study used an investigator-developed questionnaire concerning a clinical audit for heart failure programmes throughout Australia. Ethical guidelines developed by the National governing body of health and medical research in Australia classified the National Benchmarks and Evidence-based National Clinical guidelines for Heart failure management programmes Study as a low risk clinical audit not requiring ethical approval by IREC.
Results: Fifteen of 27 IRECs stipulated that the research proposal undergo full ethical review. None of the IRECs acknowledged: national quality assurance guidelines and recommendations nor ethics approval from other IRECs. Twelve of the 15 IRECs used different ethics application forms. Variability in the type of amendments was prolific. Lack of uniformity in ethical review processes resulted in a six- to eight-month delay in commencing the national study.
Conclusions: Development of a national ethics application form with full ethical review by the first IREC and compulsory expedited review by subsequent IRECs would resolve issues raised in this paper. IRECs must change their ethics approval processes to one that enhances facilitation of multi-centre research which is now normative process for health services.
Relevance to clinical practice: The findings of this study highlight inconsistent ethical requirements between different IRECs. Also highlighted are the obstacles and delays that IRECs create when undertaking multi-centre clinical audits. However, in our clinical practice it is vital that clinical audits are undertaken for evaluation purposes. The findings of this study raise awareness of inconsistent ethical processes and highlight the need for expedient ethical review for clinical audits.
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Background : The emergency contraceptive pill (ECP) has the potential to assist in reducing unintended pregnancy and abortion rates. Since its rescheduling to pharmacy availability without prescription in Australia in January 2004, there is little information about Australian women's knowledge, attitudes and use of the ECP. The aim of this study was to measure the knowledge about the ECP and sociodemographic patterns of and barriers to use of the ECP.
Study Design : A cross-sectional study, using a computer-assisted telephone interview (CATI) survey conducted with a national random sample of 632 Australian women aged 16–35 years.
Results : Most women had heard of the ECP (95%) and 26% had used it. The majority of women agreed with pharmacy availability of the ECP (72%); however, only 48% were aware that it was available from pharmacies without a prescription. About a third (32%) believed the ECP to be an abortion pill. The most common reason for not using the ECP was that women did not think they were at risk of getting pregnant (57%). Logistic regression showed that women aged 20–29 years (OR 2.58; CI: 1.29–5.19) and 30–35 years (OR 3.16; CI: 1.47–6.80) were more likely to have used the ECP than those aged 16–19 years. Women with poor knowledge of the ECP were significantly less likely to have used it than those with very good knowledge (OR 0.28; CI: 0.09–0.77). Those in a de facto relationship (OR 2.21; CI: 1.27–3.85), in a relationship but not living with the partner (OR 2.46; 95% CI 1.31–4.63) or single women (OR 2.40; CI: 1.33–4.34) were more likely to have used the ECP than married women.
Conclusions : Women in Australia have a high level of awareness of the ECP, but more information and education about how to use it and where to obtain it are still needed.
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Summary The association of long-termsport-specific exercise loading with cross-sectional geometry of the weight-bearing tibia was evaluated among 204 female athletes representing five different exercise loadings and 50 referents. All exercises involving ground impacts (e.g., endurance running, ball games, jumping) were associated with thicker cortex at the distal and diaphyseal sites of the tibia and also with large diaphyseal cross-section, whereas the high-magnitude (powerlifting) and non-impact (swimming) exercises were not. Introduction Bones adapt to the specific loading to which they are habitually subjected. In this cross-sectional study, the association of long-term sport-specific exercise loading with the geometry of the weight-bearing tibia was evaluated among premenopausal female athletes representing 11 different sports.
Methods A total of 204 athletes were divided into five exercise loading groups, and the respective peripheral quantitative computed tomographic data were compared to data obtained from 50 physically active, non-athletic referents. Analysis of covariance was used to estimate the between-group differences.
Results At the distal tibia, the high-impact, odd-impact, and repetitive low-impact exercise loading groups had ~30% to 50% (p<0.05) greater cortical area (CoA) than the referents. At the tibial shaft, these three impact groups had ~15% to 20% (p<0.05) greater total area (ToA) and ~15% to 30% (p<0.05) greater CoA. By contrast, both the high-magnitude and repetitive non-impact groups had similar ToA and CoA values to the reference group at both tibial sites.
Conclusions High-impact, odd-impact, and repetitive lowimpact exercise loadings were associated with thicker cortex at the distal tibia. At the tibial shaft, impact loading was not only associated with thicker cortex, but also a larger cross-sectional area. High-magnitude exercise loading did not show such associations at either site but was comparable to repetitive non-impact loading and reference data. Collectively, the relevance of high strain rate together with moderate-to-high strain magnitude as major determinants of osteogenic loading of the weight-bearing tibia is implicated.
Resumo:
Purpose
To compare the levels of risk and protective factors and the predictive influence of these factors on alcohol, tobacco, and cannabis use over a 12-month follow-up period in Washington State in the United States and in Victoria, Australia.
Method
The study involved a longitudinal school-based survey of students drawn as a two-stage cluster sample recruited through schools, and administered in the years 2002 and 2003 in both states. The study used statewide representative samples of students in the seventh and ninth grades (n = 3,876) in Washington State and Victoria.
Results
Washington State students, relative to Victorian students, had higher rates of cannabis use but lower rates of alcohol and tobacco use at time 1. Levels of risk and protective factors showed few but important differences that contribute to the explanation of differences in substance use; Washington State students, relative to Victorian students, reported higher religiosity (odds ratio, .96 vs. .79) and availability of handguns (odds ratio, 1.23 vs. 1.18), but less favorable peer, community, and parental attitudes to substance use. The associations with substance use at follow-up are generally comparable, but in many instances were weaker in Washington State.
Conclusions
Levels of risk and protective factors and their associations with substance use at follow-up were mostly similar in the two states. Further high-quality longitudinal studies to establish invariance in the relations between risk and protective factors and substance use in adolescence across diverse countries are warranted.
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Background
Lifestyle behaviours, such as healthy diet, physical activity and sedentary behaviour, are key elements of healthy ageing and important modifiable risk factors in the prevention of chronic diseases. Little is known about the relationship between these behaviours in older adults. The purpose of this study was to explore the relationship between fruit and vegetable (F&V) intake, leisure-time physical activity (LTPA) and sitting time (ST), and their association with self-rated health in older adults.
Methods
This cross-sectional study comprised 3,644 older adults (48% men) aged 55-65 years, who participated in the Wellbeing, Eating and Exercise for a Long Life ("WELL") study. Respondents completed a postal survey about their health and their eating and physical activity behaviours in 2010 (38% response rate). Spearman's coefficient (rho) was used to evaluate the relationship between F&V intake, LTPA and ST. Their individual and shared associations with self-rated health were examined using ordinal logistic regression models, stratified by sex and adjusted for confounders (BMI, smoking, long-term illness and socio-demographic characteristics).
Results
The correlations between F&V intake, LTPA and ST were low. F&V intake and LTPA were positively associated with self-rated health. Each additional serving of F&V or MET-hour of LTPA were associated with approximately 10% higher likelihood of reporting health as good or better among women and men. The association between ST and self-rated health was not significant in the multivariate analysis. A significant interaction was found (ST*F&V intake). The effect of F&V intake on self-rated health increased with increasing ST in women, whereas the effect decreased with increasing ST in men.
Conclusion
This study contributes to the scarce literature related to lifestyle behaviours and their association with health indicators among older adults. The findings suggest that a modest increase in F&V intake, or LTPA could have a marked effect on the health of older adults. Further research is needed to fully understand the correlates and determinants of lifestyle behaviours, particularly sitting time, in this age group.
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Objective To examine the association between individual- and neighborhood-level disadvantage and self-reported arthritis.
Methods We used data from a population-based cross-sectional study conducted in 2007 among 10,757 men and women ages 40–65 years, selected from 200 neighborhoods in Brisbane, Queensland, Australia using a stratified 2-stage cluster design. Data were collected using a mail survey (68.5% response). Neighborhood disadvantage was measured using a census-based composite index, and individual disadvantage was measured using self-reported education, household income, and occupation. Arthritis was indicated by self-report. Data were analyzed using multilevel modeling.
Results The overall rate of self-reported arthritis was 23% (95% confidence interval [95% CI] 22–24). After adjustment for sociodemographic factors, arthritis prevalence was greatest for women (odds ratio [OR] 1.5, 95% CI 1.4–1.7) and in those ages 60–65 years (OR 4.4, 95% CI 3.7–5.2), those with a diploma/associate diploma (OR 1.3, 95% CI 1.1–1.6), those who were permanently unable to work (OR 4.0, 95% CI 3.1–5.3), and those with a household income <$25,999 (OR 2.1, 95% CI 1.7–2.6). Independent of individual-level factors, residents of the most disadvantaged neighborhoods were 42% (OR 1.4, 95% CI 1.2–1.7) more likely than those in the least disadvantaged neighborhoods to self-report arthritis. Cross-level interactions between neighborhood disadvantage and education, occupation, and household income were not significant.
Conclusion Arthritis prevalence is greater in more socially disadvantaged neighborhoods. These are the first multilevel data to examine the relationship between individual- and neighborhood-level disadvantage upon arthritis and have important implications for policy, health promotion, and other intervention strategies designed to reduce the rates of arthritis, indicating that intervention efforts may need to focus on both people and places.
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Background: Chronic diseases and impairments are prevalent among older Americans. However, prevalence data for Alaska Native (AN) elders are limited, with estimates usually extrapolated from national studies in which AN elders may not be well-represented. The aim of this study was to describe the prevalence of selected chronic diseases, impairments, and measured medical risk factors among a large community sample of AN elders.
Methods: Design, setting, and participants. A community-based cross-sectional study of baseline information from 656 AN elders aged 55 years or over who participated in the Alaska Education and Research Towards Health (EARTH) Study, March 2004 to August 2006. Measurements. Self-reported lifetime prevalence of 17 doctor-diagnosed chronic diseases, and point prevalence of vision, hearing, oral, and general health impairment were estimated from data collected using audio computer-assisted self-administered questionnaires. In addition, height, weight, blood pressure, fasting blood lipids, and fasting blood glucose levels were measured.
Results: The four most prevalent chronic diseases among AN elders were high blood pressure (55%), arthritis (49%), high cholesterol (42%), and adult bone fracture/break (35%). The median number of chronic diseases reported was three (inter-quartile range, 2 to 5). The prevalence of self-reported vision impairment was 15%, hearing impairment 18%, and having had all natural teeth removed 25%. Almost 50% were obese. High blood pressure (systolic ≥ 140 mm Hg and/or diastolic ≥ 90 mm Hg) was measured in 23%, high low density lipoprotein (LDL) cholesterol (≥ 130 mg/dL) in 39%, and high fasting plasma glucose (> 125 mg/dL) in 9%. Obesity was more prevalent among women than men. There were also significant regional differences in rates of obesity and high LDL cholesterol.
Conclusion: These data may be useful in public health programs and health services planning.
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Identifying specific aspects of peer social norms that influence adolescent substance use may assist international prevention efforts. This study examines two aggregated measures of social norms in the school setting and their predictive association with substance (alcohol, tobacco and marijuana) use 2 years later in a large cross-national population-based cohort of adolescents. The primary hypothesis is that in Grade 7 both "injunctive" school norms (where students associate substance use with "coolness") and "descriptive" norms (where student substance use is common) will predict Grade 9 substance use. Data come from the International Youth Development Study, including 2,248 students (51.2% female) in the US and Australia attending 121 schools in Grade 7. Independent variables included injunctive norms (aggregating measures of school-wide coolness ratings of each substance use) and descriptive norms (aggregating the prevalence of school substance use) in Grade 7. Dependent variables included binge drinking and current use of alcohol, tobacco and marijuana in Grade 9. Associations between each type of school-wide social norm and substance use behaviors in Grade 9 were tested using multilevel logistic regression, adjusting for covariates. In unadjusted models, both injunctive and descriptive norms each significantly predicted subsequent substance use. In fully adjusted models, injunctive norms were no longer significantly associated with Grade 9 use, but descriptive norms remained significantly associated with tobacco and marijuana use in the expected direction. The findings identify descriptive social norms in the school context as a particularly important area to address in adolescent substance use prevention efforts.
Resumo:
The effect of early adolescent alcohol use on antisocial behavior was examined at one- and two-year follow-up in Washington, United States and Victoria, Australia. Each state used the same methods to survey statewide representative samples of students (N = 1,858, 52% female) in 2002 (Grade 7 [G7]), 2003 (Grade 8 [G8]), and 2004 (Grade 9 [G9]). Rates of lifetime, current, frequent, and heavy episodic alcohol use were higher in Victoria than Washington State, whereas rates of five antisocial behaviors were generally comparable across states. After controlling for established risk factors, few associations between alcohol use and antisocial behavior remained, except that G7 current use predicted G8 police arrests and stealing and G9 carrying a weapon and stealing; G7 heavy episodic use predicted G8 and G9 police arrests; and G7 lifetime use predicted G9 carrying a weapon. Hence, risk factors other than alcohol were stronger predictors of antisocial behaviors.
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International Association for the Evaluation of Educational Achievement (IEA) cross-national studies (FIMS, SIMS and TIMSS) show that gender differences in mathematical achievements and attitudes have decreased considerably over thirty years (Hanna, 2000), however, mathematics is still historically stereotyped as a male domain with crucial evidence supporting this belief (Forgasz, Leder, & Kloosterman, 2009). Previous research showed that gender differences in mathematics participation,performance and achievement existed widely in the majority of English speaking countries, specifically favouring boys (Forgasz, 1992; Hyde, Fennema, & Lamon, 1990; Tiedemann, 2000). Hyde, Lindberg, Linn, Ellis and Williams (2008) pointed out that the stereotype that females lack mathematical ability persists and is widely held by parents and teachers.Mathematics teaching materials play an important role in mathematics teaching and learning. The contents within mathematical teaching materials are rational, and deliver both explicit and implicit information. The explicit information refers to mathematics knowledge that students can learn from textbooks, while the latter one, also named as hidden curriculum, contains social and cultural messages. Hidden curriculum is a side effect of education. It has deep and long-term influences on students’ construction of math-gender stereotype that impact their future mathematicallearning (Zhang & Zhou, 2008). Therefore, this study will investigate Chinese andAustralian elementary mathematics teaching materials to explore the messages of gender equity and inequity delivered through hidden curriculum including names, images and problem-solving contexts. Based on the findings, practical implications concerning the promotion of equitable gender environments within elementary mathematics teaching materials from a cross-cultural perspective will be discussed.
Associations between the home food environment and obesity-promoting eating behaviors in adolescence
Resumo:
Objective: This study examines relationships between multiple aspects of the home food environment and obesity-promoting characteristics of 12- to 13-year-old adolescents' diets, specifically frequency of consumption of high-energy fluids, sweet snacks, savory snacks, and take-out foods.
Research Methods: This was a cross-sectional study including 347 adolescents 12 to 13 years of age and their parents. Data were collected via self-completed surveys. The adolescents' diets were assessed using a Food Frequency Questionnaire derived from existing age-appropriate National Nutrition Survey data. An extensive range of domains within the home food environment were assessed. Bivariate linear regression analyses were run split by gender. Forced entry multiple linear regression analyses (adjusting for all variables significant in bivariate analyses as well as for maternal education) were also performed, stratified by the sex of the child.
Results: The influence of mothers, either as models for eating behaviors or as the providers of food, was pervasive. Mothers' intake of high-energy fluids (p = 0.003), sweet snacks (p = 0.010), savory snacks (p = 0.008), and take-out food (p = 0.007) was positively associated with boys' intake of all these foods. In addition, mothers' intake of high-energy fluids was positively associated with daughters' consumption of these drinks (p = 0.025). Furthermore, availability of unhealthy foods at home was positively associated with girls' sweet snack (p = 0.001), girls' savory snack (p < 0.001), boys' savory snack (p = 0.002), and, in the bivariate analyses, girls' high-energy fluid consumption (p = 0.002).
Discussion: This study of home food environment influences on adolescent diet highlights the pervasive influence of mothers in determining adolescents' obesity-promoting eating, providing direction for obesity prevention strategies and future research.
Resumo:
This article compares prevalence estimates of substance use and delinquent behavior in Washington State, United States and Victoria, Australia, two states chosen for their different policy environments around problem behavior. Few comparisons of international differences on rates of multiple problem behavior exist, and most are based on methods that are not matched, raising the question of whether findings are based on methodological differences rather than actual rate differences. The International Youth Development Study used standardized methods to recruit and administer an adaptation of the Communities That Care Youth Survey to representative state samples of fifth-, seventh-, and ninth-grade students in each state. Rates of delinquent behavior were generally comparable. However, striking differences in substance use were noted, with Victoria students reporting higher rates of alcohol use, alcohol misuse, smoking, and inhalant use, whereas Washington State students reported higher rates of marijuana use. Implications for conducting international comparisons are discussed.
Resumo:
Objective:
To measure the prevalence of obesity in Australian adults and to examine the associations of obesity with socioeconomic and lifestyle factors.
Design:
AusDiab, a cross-sectional study conducted between May 1999 and December 2000, involved participants from 42 randomly selected districts throughout Australia.
Participants:
Of 20 347 eligible people aged > 25 years who completed a household interview, 11 247 attended the physical examination at local survey sites (response rate, 55%).
Main outcome measures:
Overweight and obesity defined by body mass index (BMI; kg/m2) and waist circumference (cm); sociodemographic factors (including smoking, physical activity and television viewing time).
Results:
The prevalence of overweight and obesity (BMI > 25.0 kg/m2; waist circumference > 80.0 cm [women] or > 94.0 cm [men]) in both sexes was almost 60%, defined by either BMI or waist circumference. The prevalence of obesity was 2.5 times higher than in 1980. Using waist circumference, the prevalence of obesity was higher in women than men (34.1% v 26.8%; P < 0.01). Lower educational status, higher television viewing time and lower physical activity time were each strongly associated with obesity, with television viewing time showing a stronger relationship than physical activity time.
Conclusions:
The prevalence of obesity in Australia has more than doubled in the past 20 years. Strong positive associations between obesity and each of television viewing time and lower physical activity time confirm the influence of sedentary lifestyles on obesity, and underline the potential benefits of reducing sedentary behaviour, as well as increasing physical activity, to curb the obesity epidemic.
Resumo:
Objective To evaluate responses to self-administered brief questions regarding consumption of vegetables and fruit by comparison with blood levels of serum carotenoids and red-cell folate.
Design A cross-sectional study in which participants reported their usual intake of fruit and vegetables in servings per day, and serum levels of five carotenoids (α-carotene, β-carotene, β-cryptoxanthin, lutein/zeaxanthin and lycopene) and red-cell folate were measured. Serum carotenoid levels were determined by high-performance liquid chromatography, and red-cell folate by an automated immunoassay system.
Settings and subjects Between October and December 2000, a sample of 1598 adults aged 25 years and over, from six randomly selected urban centres in Queensland, Australia, were examined as part of a national study conducted to determine the prevalence of diabetes and associated cardiovascular risk factors.
Results Statistically significant (P<0.01) associations with vegetable and fruit intake (categorised into groups: ≤1 serving, 2–3 servings and ≥4 servings per day) were observed for α-carotene, β-carotene, β-cryptoxanthin, lutein/zeaxanthin and red-cell folate. The mean level of these carotenoids and of red-cell folate increased with increasing frequency of reported servings of vegetables and fruit, both before and after adjusting for potential confounding factors. A significant association with lycopene was observed only for vegetable intake before adjusting for confounders.
Conclusions These data indicate that brief questions may be a simple and valuable tool for monitoring vegetable and fruit intake in this population.
Resumo:
Purpose: To examine the effect of school suspensions and arrests (i.e., being taken into police custody) on subsequent adolescent antisocial behavior such as violence and crime, after controlling for established risk and protective factors in Victoria, Australia and Washington State, United States (U.S.). Methods: This article reports on analyses of two points of data collected 1 year apart within a cross-national longitudinal study of the development of antisocial behavior, substance use, and related behaviors in approximately 4000 students aged 12 to 16 years in Victoria, Australia and Washington State, U.S. Students completed a modified version of the Communities That Care self-report survey of behavior, as well as risk and protective factors across five domains (individual, family, peer, school, and community). Multivariate logistic regression analyses investigate the effect of school suspensions and arrests on subsequent antisocial behavior, holding constant individual, family, peer, school, and community level influences such as being female, student belief in the moral order, emotional control, and attachment to mother. Results: At the first assessment, school suspensions and arrests were more commonly reported in Washington, and school suspensions significantly increased the likelihood of antisocial behavior 12 months later, after holding constant established risk and protective factors (adjusted odds ratio [OR] 1.5, 95% confidence interval [CI] 1.1–2.1, p < .05). Predictors of antisocial behavior spanned risk and protective factors across five individual and ecological areas of risk. Risk factors in this study were pre-existing antisocial behavior (OR 3.6, CI 2.7–4.7, p < .001), association with antisocial peers (OR 1.8, CI 1.4–2.4, p < .001), academic failure (OR 1.3, CI 1.1–1.5, p < .01), and perceived availability of drugs in the community (OR 1.3, CI 1.1–1.5, p < .001). Protective factors included being female (OR 0.7, CI 0.5–0.9, p < .01), student belief in the moral order (OR 0.8, CI 0.6–1.0, p < .05), student emotional control (OR 0.7, CI 0.6–0.8, p < .001), and attachment to mother (OR 0.8, CI 0.7–1.0, p < .05). Conclusions: School suspensions may increase the likelihood of future antisocial behavior. Further research is required to both replicate this finding and establish the mechanisms by which school suspensions exert their effects.
