The Australian burden of disease study : measuring the loss of health from diseases, injuries and risk factors

This is an overview of the first burden of disease and injury studies carried out in Australia. Methods developed for the World Bank and World Health Organization Global Burden of Disease Study were adapted and applied to Australian population health data. Depression was found to be the top- ranking cause of non-fatal disease burden in Australia, causing 8% of the total years lost due to disability in 1996. Mental disorders overall were responsible for nearly 30% of the non-fatal disease burden. The leading causes of total disease burden (disability-adjusted life years [DALYs]) were ischaemic heart disease and stroke, together causing nearly 18% of the total disease burden. Depression was the fourth leading cause of disease burden, accounting for 3.7% of the total burden. Of the 10 major risk factors to which the disease burden can be attributed, tobacco smoking causes an estimated 10% of the total disease burden in Australia, followed by physical inactivity (7%).

Hepatitis C virus infection in South Australian prisoners : seroprevalence, seroconversion, and risk factors

Objectives : To determine entry antibody seroprevalence and seroconversion to hepatitis C virus (HCV) and associated risk factors in newly incarcerated prisoners.

Methods : Males and females entering South Australian prisons completed risk factor surveys and were offered HCV-antibody testing. Participants completed additional surveys and, if HCV-negative at last test, underwent further antibody tests at 3-monthly intervals for up to 15 months. Data were analyzed using univariate and multivariate techniques.

Results : HCV seroprevalence among 662 prison entrants was estimated at 42%. Previous injecting history was highly prevalent at entry (64%) and both community and prison injecting independently predicted entry HCV status. Tattooing was not an important risk factor. While community exposure could not be ruled out, three seroconversions were noted in 148 initially HCV-seronegative individuals occurring in a median 121 days – 4.6 per 100 person-years. Prison injecting was infrequently reported, but HCV-seropositive participants were significantly more likely to commence IDU in prison than seronegative participants (p = 0.035).

Conclusions : Entry HCV seroprevalence in South Australian prisoners is extremely high and may have contributed to a ‘ceiling effect’, minimizing the observable seroconversion rate. Greater frequency of injecting among those already infected with HCV represents a significant threat to other prisoners and prison staff.

Prevalence of vitamin D insufficiency and risk factors for type 2 diabetes and cardiovascular disease among African migrant and refugee adults in Melbourne

Migration to industrialised countries poses a “double whammy” for type 2 diabetes among sub-Saharan African migrant and refugee adults. This population group has been found to be at an increased risk of obesity and type 2 diabetes, which may be further aggravated by inadequate vitamin D status. Thus, this study aimed to describe the demographics of vitamin D insufficiency, obesity, and risk factors for type 2 diabetes among sub-Saharan African migrants and refugees aged 20 years or older living in Melbourne, Australia (n=49). Data were obtained by a questionnaire, medical assessment, and fasting blood samples. The mean serum 25-hydroxyvitamin D level was 27.3 nmol/L (95% CI: 22.2, 32.4 nmol/L); with 25-hydroxyvitamin D levels <50 nmol/L occurring in 88% of participants. Participants displayed a cluster of risk factors for type 2 diabetes and cardiovascular disease: 62% were overweight or obese, 47% had insulin resistance (HOMA-IR ≥2), 25% had low density lipoprotein cholesterol levels ≥3.5 mmol/L, 24.5% had high density lipoprotein cholesterol levels ≤1.03 mmol/L, 34.6% had borderline or high levels of total cholesterol (≥5.2 mmol/L), 18.2% had borderline or high levels of triglyceride (≥1.7 mmol/L), and 16% had hypertension (systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg). These findings suggest that sub-Saharan African migrants and refugees may be at risk of type 2 diabetes and atherosclerosis-related diseases such as ischemic heart disease, stroke, and peripheral vascular disease. Well-designed vitamin D interventions that incorporate lifestyle changes are urgently needed in this sub-population.

Socioeconomic status and risk factors for obesity and metabolic disorders in a population-based sample of adult females

Objectives : The association between lower socioeconomic status (SES), obesity, lifestyle choices and adverse health consequences are well documented, however to date the relationship between these variables and area-based SES (equivalised for advantage and disadvantage) has not been examined simultaneously in one population or with more than tertiary divisions of SES. We set out to examine the risk factors for obesity and metabolic disorders in the same population across quintiles of area-based SES.

Methods : We performed a descriptive cross-sectional study using existing data from a population-based random selection of women aged 20–92 years (n = 1110) recruited from the Barwon Statistical Division, South Eastern Australia.

Results : All measures of adiposity were inversely associated with SES, and remained significant after adjusting for age. Lifestyle choices associated with adiposity and poorer health, including smoking, larger serving sizes of foods, and reduced physical activity, were significantly associated with individuals from lower SES groups.

Conclusions : Greater measures of adiposity and less healthy lifestyle choices were observed in individuals from lower SES. Significant differences in body composition were identified between quintiles 1 and 5, whereas subjects in the mid quintiles had relatively similar measures. The inverse relationship between SES, obesity and less healthy lifestyle underscores the possibility that these associations may be causal and should be investigated further.

The prevalence and risk factors of epiretinal membranes: the Melbourne collaborative cohort study

Purpose
To determine the prevalence of epiretinal membranes (ERMs) in Melbourne, Australia and its risk factors in this population.

Methods
The Melbourne Collaborative Cohort Study is a prospective study investigating the role of diet and life style in the causation of common chronic diseases. Eighty-six percent of participants were of Northern European origin born in Australia or United Kingdom and 14% were migrants from Greece or Italy (Southern European origin). Nonmydriatic digital retinal photography was implemented at Melbourne Collaborative Cohort Study follow-up. The ERMs were recorded as cellophane macular reflex without retinal folds or preretinal macular fibrosis (PMF) with retinal folds.

Results
A total of 22,406 participants had retinal photography, 95% (n = 21,241) were eligible for ERM grading. The ERM prevalence were 8.9% (1,882); cellophane macular reflex, 4.9% (1,047); and preretinal macular fibrosis, 3.9% (835). After adjustment for age, sex, level of education, smoking status, level of cholesterol, body mass index, waist-to-hip ratio, waist measurement, blood pressure, diabetes, and stroke, increasing age and Southern European ethnicity was significantly associated with ERMs. Overall, in Southern Europeans, ERMs odd ratio was 1.97 (95% confidence intervals, 1.67–2.31), P < 0.001; preretinal macular fibrosis was 1.82 (95% confidence intervals, 1.43–2.31), P < 0.001; and cellophane macular reflex was 1.93 (1.57–2.38), P < 0.001.

Conclusion
In an older Australian population, the prevalence of ERMs was 8.9% and was almost two times higher in participants of Southern European origin than Northern European origin.

The associations of vegetable consumption with food mavenism, personal values, food knowledge and demographic factors

Background: Poor dietary choices, in particular low consumption of fruits and vegetables are associated with the prevalence of diet related diseases. Ways to increase consumption are urgently required. This paper examines the associations of demographic, psychographic and food knowledge variables with reported vegetable consumption. Methods: An online questionnaire was administered in late 2012 to a national sample 2146 Australians who were selected to represent the Australian population in terms of age, sex, education and location of residence. It was divided into sections which assessed food knowledge, food involvement, food mavenism, personal values and personality factors, demographic characteristics and reported consumption of 13 vegetables and the total number of servings of vegetables per day. Principal components analyses of the individual vegetable consumption ratings derived three forms of vegetable consumption scores. These and total serving per day were used as dependent variables in a structural equation model to identify pathways between them and their likely antecedents. Major findings: Three types of vegetable consumption were formed:. Salad vegetables (onion, tomato and lettuce);. Dinner vegetables (carrot, peas and beans); and 'Green' vegetables (cabbage, spinach broccoli and cauliflower). Food mavenism, food knowledge, food involvement and equality-universalist values mediated the relationships between demographics and conscientiousness and the vegetable consumption variables. Conclusions: The three types of vegetable consumption and total servings per day were associated with different antecedent pathways. The mediating roles of food mavenism, food knowledge, food involvement and equality-universalist values may present opportunities for health promotion and the horticultural industry to increase population vegetable intake. Further research is required to test these associations via experimental and longitudinal studies and qualitative investigation of the meaning and place of the three forms of vegetable consumption in people's daily lives is recommended.

Are married couples happier in their relationships than cohabiting couples? Intimacy and relationship factors

This study was designed to examine the relationship between dyadic adjustment and intimacy, and to determine how this varies for different types of relationships between males and females, and for relationships of different duration. Eighty-seven heterosexual couples (10 dating, 21 living together, 56 married) participated in the study. The results demonstrated that there was a strong interrelationship between intimacy and dyadic adjustment for both males and females. Those in relationships of longer duration and married couples experienced higher levels of intimacy and relationship satisfaction than other couples. There was a general trend for married couples and those who were living together to have a higher level of agreement on their levels of intimacy and relationship adjustment than couples who were dating. The implication of these findings for obtaining a better understanding of the lifecycle of relationships is discussed.

Individual and organisational factors influencing academics` decisions to pursue the scholarship and teaching of ICT

This paper focuses on Information and Communication Technology (ICT) academics' perceptions of factors that promote and inhibit their pursuit of scholarship in their teaching work. It identifies critical factors that influence academics' attitudes, orientations and behaviours in respect to the scholarship of teaching, and from these builds a framework for understanding the interaction between these factors. We have named this framework the Scholarship of Teaching Support Framework.

During 2001 and 2002 a national project investigated teaching and learning initiatives in the major discipline of lCT in Australia's universities. As part of this project a mini-conference program was devised to elicit academics' perceptions of the factors influencing their teaching work and their participation in scholarly activities around this work. In total 83 ICT teachers from 29 universities participated in the mini-conference program. Attendees included staff members from a range of academic levels.

In discussions of aspects of the scholarship of teaching at the mini-conference participants referred to both attributes and responses of both university teachers and the university institutions. We have categorized these factors into those that relate to the individual academic (Individual domain) and those that relate to the tertiary institutional system (Organisational domain). Many contributions highlighted the interaction between these two domains.

Within the Individual domain, two key factors described by participants as affecting the pursuit of the scholarship of teaching were teachers' motivation towards, and their capabilities in, scholarly activities surrounding their teaching. Within the organizational domain two influential factors also emerged. These were the organizational support provided through allocation of resources and symbolic support reflected in an institution's systems, policies and processes.

Our findings indicate that both the Individual and Organizational domains contribute to university teachers' decisions to pursue (or not to pursue) the scholarship of teaching.

These two domains were seen by participants to interact within university environments to influence whether a particular environment is supportive or unsupportive in terms of the pursuit of the scholarship of teaching. Factors both from and within the individual and the organizational domains were seen to interact with each other forming a web of interrelated factors that appear to influence individuals' decisions to pursue, or not to pursue, the scholarship of teaching. From this complexity four theoretical extremes emerged providing the dimensions and components of the Scholarship of Teaching Support Framework.

We argue that responsive and innovative approaches to university teaching are best supported by academics undertaking scholarly activities around their teaching work, yet this article presents a picture of a university work environment where scholarly activities that focus on teaching and learning are seen as generally unsupported and unrewarded. This perception was identified as commonalities across a university system. Although some exceptions were noted, participants generally agreed that the organisational domain of Australian universities was largely unsupportive of the pursuit of the scholarship of teaching. Similarly, in general, university ICT teachers were not thought to have the backgrounds and capabilities necessary for pursuing the scholarship of teaching, such as familiarity with literature on teaching and learning and skills in educational evaluation. However, despite perceived inhibitors in universities' organisational culture and allocation of resources, and a perceived lack in individuals' skills, participants agreed that scholarly activities and innovation in university teaching and learning do take place, These are largely driven by the intrinsic motivation of individuals. It was recognised that further work is necessary to explore how motivation can be engendered and encouraged.

The Scholarship of Teaching Support Framework is a useful tool for examining how conducive a given university teaching context is to the scholarship of teaching and, therefore, can be used for review purposes within both research and policy contexts. Such tools will become increasingly important as policy changes begin to affect practices in how university teaching work is managed, supported and encouraged.

Regulation of metabolic transcriptional co-activators and transcription factors with acute exercise

Endurance exercise improves insulin sensitivity and increases fat oxidation, which are partly facilitated by the induction of metabolic transcription factors. Next to exercise, increased levels of FFA's also increase the gene expression of transcription factors, hence making it difficult to discern the effects from contractile signals produced during exercise, from those produced by increased circulatory FFA's. We aimed to investigate, in human skeletal muscle, whether acute exercise affects gene expression of metabolic transcriptional co-activators and transcription factors, including PGC-1α, PRC, PPARα, β/δ, and γ and RXR, SREBP-1c and FKHR, and to discern the effect of exercise per se from those of elevated levels of FFA. Two hours of endurance exercise was performed either in the fasted state, or following carbohydrate ingestion prior to and during exercise, thereby blunting the fasting-induced increase in FA availability and oxidation. Of the genes measured, PGC-1α and PRC mRNA increased immediately after, while PPARβ/δ and FKHR mRNA increased 1–4 h after exercise, irrespective of the increases in FFA's. Our results suggest that the induction in vivo of metabolic transcription factors implicated in mitochondrial biogenesis are under the control of inherent signals, (PGC-1α, PRC), while those implicated in substrate selection are under the control of associated signals (PPARβ/δ, FKHR) stimulated from the contracting skeletal muscle that are independent of circulating FFA levels.

GLBT workplace experience : the impact of social practices, oranisational context and personal factors on turnover decisions

‘Gay Rights’ have recently become a major issue in many Australian employers with the enactment of new legislation. Thus, research on employment issues for GLBT (gay/ lesbian/ bisexual/ transgendered) members of the work has attracted considerable attention from academic and researchers in recent years. However, there is still little research relating to sexual orientation in the management literature. This paper develops a model exploring the impact of potential personal and contextual factors (legal system, industry and organisational) on turnover decisions of GLBT members of the workforce. This paper also suggests a number of potential topics and methodological issues for future research.