Cross-national compartability of burden of disease estimates:the European disability weights project

Objective: To investigate the sources of cross-national variation in disability-adjusted life-years (DALYs) in the European Disability
Weights Project.

Methods: Disability weights for 15 disease stages were derived empirically in five countries by means of a standardized procedure and the cross-national differences in visual analogue scale (VAS) scores were analysed. For each country the burden of dementia in women, used as an illustrative example, was estimated in DALYs. An analysis was performed of the relative effects of cross-national variations in demography, epidemiology and disability weights on DALY estimates.

Findings: Cross-national comparison of VAS scores showed almost identical ranking orders. After standardization for population size and age structure of the populations, the DALY rates per 100 000 women ranged from 1050 in France to 1404 in the Netherlands. Because of uncertainties in the epidemiological data, the extent to which these differences reflected true variation between countries was difficult to estimate. The use of European rather than country-specific disability weights did not lead to a significant change in the burden of disease estimates for dementia.

Conclusions: Sound epidemiological data are the first requirement for burden of disease estimation and relevant between-countries comparisons. DALY estimates for dementia were relatively insensitive to differences in disability weights between European countries.

Life-change events and participation in physical activity : a systematic review

Physical inactivity and related diseases are of global public health concern. In many developing countries, levels of health promoting physical activity (PA) are falling despite government initiatives. Previous work has identified that periods of transition across a life course, or ‘life-change events’ have implications for drop out from PA. As yet, there has been little work to understand the life course as a whole and to furnish a complete list of possible life changes that might affect participation in PA. Our paper presents a review of the published literature in which life events have been studied in relation to their effect on participation in PA. A literature search was conducted for papers published between 1977 and April 2007 and referenced in Pubmed. Papers were reviewed if they; reported the effect of a life-change event; had PA as an outcome; reported results in English; and reported results from observational studies. The references for studies identified during this first phase were searched for further papers. Eighty-seven papers were identified as potentially relevant on the basis of title, of which 19 papers met the inclusion criteria on the basis of full text. Five life changes were identified; change in employment status; change in residence; change in physical status; change in relationships; and change in family structure. It was noted that few longitudinal studies examined PA both before and after a life event. A list of possible life events which might effect participation in PA is presented. This paper represents a first step towards a detailed programme of work on life-change events and PA.

Vigilant pleasure as autoethnography : the life of the tea mind as critical history

I examine tea as cultural practice by exploring how it is implicated in the formation of individual subjectivities and national identity. While using the experience of learning and consuming tea lore as a foreigner as my explicit point of entry, I analyse how tea transmission practices are represented in Japanese films. My readings of these films are supported by a survey of the historical applications of tea as part of a project of national invention. Against tea's self-representation as purely cultural, I draw attention to this ideological silencing of its economic and political effects by claiming that institutionalised tea pedagogy has been a major player in a nationally distinctive discourse of transience. My thesis argues that autoethnography can be used to bring into view the ideological foundations of various social practices organised around tea sites and texts. Once ideology is visible autoethnography may mediate the effects of dominant discourses by making a modest form of private resistance possible. As a performance of critical and effective history, I explore the limits of consciously resisting institutionalised power by reflecting on how discourses of tea and social theory intersect in my autoethnographic account of tea experiences. I begin by locating my subjectivity in tea. After outlining how tea is useful to me in psychological, domestic and professional contexts, I survey autoethnographic writing and critical forms of textual analysis. Given that traditions of textual analysis set limits to what can be comprehended, I note that considerations of the role of subjectivity are sometimes absent from several modes of textual analysis. I contend that more delicate forms of textual analysis are possible when multiple forms of subjectivity are explicitly addressed. Subjectivity is emphasised as I move between performances of being a cultural insider of tea subculture and an ethnic and linguistic outsider of daily life in Japan when I examine the connections linking tea anecdotes, film narratives, individual tales and national myths. From the position of tea culture insider and consumer of social theory I examine the relationship between national culture and individual subjectivity. I identify internal contradictions in tea transmission practices and consider how tea pedagogy and its cult of personality are addressed in tea films. The thesis concludes by considering the utility of identities in a global economy and comment on recent theories addressing the ethical self and social practices. It is on this basis that I claim the readings advanced in the earlier chapters map the pleasures and limits of employing autoethnography as a form of private resistance against the dominant discourses of tea, nation, and leisure.

Cost effectiveness of a sugar-sweetened beverage excise tax in the U.S.

INTRODUCTION: Reducing sugar-sweetened beverage consumption through taxation is a promising public health response to the obesity epidemic in the U.S. This study quantifies the expected health and economic benefits of a national sugar-sweetened beverage excise tax of $0.01/ounce over 10 years. METHODS: A cohort model was used to simulate the impact of the tax on BMI. Assuming ongoing implementation and effect maintenance, quality-adjusted life-years gained and disability-adjusted life-years and healthcare costs averted were estimated over the 2015-2025 period for the 2015 U.S. POPULATION: Costs and health gains were discounted at 3% annually. Data were analyzed in 2014. RESULTS: Implementing the tax nationally would cost $51 million in the first year. The tax would reduce sugar-sweetened beverage consumption by 20% and mean BMI by 0.16 (95% uncertainty interval [UI]=0.06, 0.37) units among youth and 0.08 (95% UI=0.03, 0.20) units among adults in the second year for a cost of $3.16 (95% UI=$1.24, $8.14) per BMI unit reduced. From 2015 to 2025, the policy would avert 101,000 disability-adjusted life-years (95% UI=34,800, 249,000); gain 871,000 quality-adjusted life-years (95% UI=342,000, 2,030,000); and result in $23.6 billion (95% UI=$9.33 billion, $54.9 billion) in healthcare cost savings. The tax would generate $12.5 billion in annual revenue (95% UI=$8.92, billion, $14.1 billion). CONCLUSIONS: The proposed tax could substantially reduce BMI and healthcare expenditures and increase healthy life expectancy. Concerns regarding the potentially regressive tax may be addressed by reduced obesity disparities and progressive earmarking of tax revenue for health promotion.

Child obesity prevention in primary health care: the role of practice nurses

Aim

Overweight and obesity affects approximately 20% of Australian pre-schoolers. The general practice nurse (PN) workforce has increased in recent years; however, little is known of PN capacity and potential to provide routine advice for the prevention of child obesity. This mixed methods pilot study aims to explore the current practices, attitudes, confidence and training needs of Australian PNs surrounding child obesity prevention in the general practice setting.

Methods

PNs from three Divisions of General Practice in New South Wales were invited to complete a questionnaire investigating PN roles, attitudes and practices in preventive care with a focus on child obesity. A total of 59 questionnaires were returned (response rate 22%). Semi-structured qualitative interviews were also conducted with a subsample of PNs (n = 10).

Results

Questionnaire respondent demographics were similar to that of national PN data. PNs described preventive work as enjoyable despite some perceived barriers including lack of confidence. Number of years working in general practice did not appear to strongly influence nurses' perceived barriers. Seventy per cent of PNs were interested in being more involved in conducting child health checks in practice, and 85% expressed an interest in taking part in child obesity prevention training.

Conclusions

Findings from this pilot study suggest that PNs are interested in prevention of child obesity despite barriers to practice and low confidence levels. More research is needed to determine the effect of training on PN confidence and behaviours in providing routine healthy life-style messages for the prevention of child obesity.

Measuring health in a vacuum: examining the disability weight of the DALY

The Disability Adjusted Life Year (DALY) is a widely used summary measure of population health combining years of life lost due to mortality and years of healthy life lost due to disability. A feature of the DALY is that, in the assessment of morbidity, each health condition is associated with a disability weight. The disability weight lies on a scale between 0 (indicating the health condition is equivalent to full health) and 1 (indicating the health condition is equivalent to death). The disability weight associated with each health condition is currently fixed across all social, cultural and environmental contexts. Thus blindness in the United Kingdom has the same disability weight as blindness in Niger in spite of structural interventions in the UK that make the disability less severe than in Niger. Although the fixed disability weight is defended on grounds that it supports a strongly egalitarian flavour in the DALY, we argue that the lack of consideration of realistic contexts results in a measure that will underestimate the burden associated with morbidity in disadvantaged populations and overestimate the burden in advantaged populations. There is, consequently, a loss of information on possible non-clinical points of intervention. Disaggregated estimates of the burden of disease such as those in the World Health Report 2000 should be interpreted with caution.

Measuring wellness through interdisciplinary community development: linking the physical, economic and social environment

The aim of this study is to answer the question: Is there evidence that the quality of life of residents in a community that has had community development intervention is different as compared to the quality of life of residents in a nearby community that did not have community development initiatives? This was done by administering community development initiatives in a local area and comparing it to a similar community that did not receive this intervention. The residents of these communities rated the quality of their lives and communities in two purposively selected suburbs in Perth, Western Australia using the Australian Unity Wellbeing Index to measure individual and neighbourhood well-being. The quality of life of residents in both communities is then compared to national averages for quality of life or well-being. Answering this question provides empirical evidence of variation between ratings of quality of life of residents in different communities and highlights the utility of the Wellbeing Index for the evaluation of interdisciplinary community development

ICT alternative for primary care delivery in Indonesia : a proposal

This paper proposes a new research program and presents a current analysis of the potential of health information systems (HIS) to improve primary care delivery in rural Indonesia. A new HIS will be implemented to facilitate patient centred primary care and to support the interactions and collaborations between three types of participants including the patient, their doctors and pharmacist in Malang, Indonesia. A tetradic relationship between the new HIS and three participants (patient, doctors, and pharmacist) is examined through the lens of the actor network theory (ANT) with a view to form a new healthcare service delivery model for primary care providers in Indonesia. Based on this model, a network of primary care providers would share the patient medical records (PMR) and provide collaborative care programs to promote healthy life styles, prevent diseases, and to manage chronic disease care more effectively and efficiently.

Promoting social inclusion of frail older people living in the community

The increasingly diverse needs and wants of Australia's ageing population, like those in many other societies, are drawing attention to aged care as an increasingly important area of broader health and social policy. Active qgeing and a focus on enabling people to remain living in their own homes in the community are two of the key components of this policy shift.

The policy shift towards active ageing recognises and aims to support the desires of older people to remain active members of their communities as they age. Active ageing is 'the process of optimising opportunities for physical, social and mental wellbeing throughout the life-course, in order to extend healthy life expectancy, productivity and quality oflife in older age' (AIPC 2008: 26).

According to the World Health Organization (WHO), the rights, needs, preferences and capacities of older people should be central to active ageing policies, and these should be framed by a life-course approach to ageing (WHO 2002). The development of age-friendly communities, social inclusion and engagement are emerging as key policy issues in the context of an ageing population.

Recent research demonstrates the importance of a sense of belonging in maintaining a sense of identity and increasing the wellbeing of an individual. The sense of belonging that comes about through community engagement also plays a role in successful adjustment to ageing, including prolonging good health and reduced risk of entry into residential aged care.

Bone density and neuromuscular function in older competitive athletes depend on running distance

UNLABELLED: Individuals who are involved in explosive sport types, such as 100-m sprints and long jump, have greater bone density, leg muscle size, jumping height and grip strength than individuals involved in long-distance running. INTRODUCTION: The purpose of this study is to examine the relationship between different types of physical activity with bone, lean mass and neuromuscular performance in older individuals. METHODS: We examined short- (n = 50), middle- (n = 19) and long-distance (n = 109) athletes at the 15th European Masters Championships in Poznań, Poland. Dual X-ray absorptiometry was used to measure areal bone mineral density (aBMD) and lean tissue mass. Maximal countermovement jump, multiple one-leg hopping and maximal grip force tests were performed. RESULTS: Short-distance athletes showed significantly higher aBMD at the legs, hip, lumbar spine and trunk compared to long-distance athletes (p ≤ 0.0012). Countermovement jump performance, hop force, grip force, leg lean mass and arm lean mass were greater in short-distance athletes (p ≤ 0.027). A similar pattern was seen in middle-distance athletes who typically showed higher aBMD and better neuromuscular performance than long-distance athletes, but lower in magnitude than short-distance athletes. In all athletes, aBMD was the same or higher than the expected age-adjusted population mean at the lumbar spine, hip and whole body. This effect was greater in the short- and middle-distance athletes. CONCLUSIONS: The stepwise relation between short-, middle- and long-distance athletes on bone suggests that the higher-impact loading protocols in short-distance disciplines are more effective in promoting aBMD. The regional effect on bone, with the differences between the groups being most marked at load-bearing regions (legs, hip, spine and trunk) rather than non-load-bearing regions, is further evidence in support of the idea that bone adaptation to exercise is dependent upon the local loading environment, rather than as part of a systemic effect.

An abominable crime: filicide in the context of parental separation and divorce

The victims of filicide in the context of parental separation and divorce have recently been identified as the largest group among all filicide victims in Australia. Nevertheless, research into this group of victims has been sparse, fragmentary and contradictory, with the consequence that confusion has prevailed. This article critically reflects on the existing research on filicide and argues that it has been insufficiently comprehensive and reliable and, therefore, is not suitable for use as a knowledge base for professional individuals, programmatic and policy interventions, and prevention. The article suggests ways of developing more reliable research for knowledge building and details the data developed so far that underpins their recommendations for a national programme of research.