A longitudinal study of the impact of chronic psychological stress on health-related quality of life and clinical biomarkers : protocol for the Australian Healthy Aging of Women Study

BACKGROUND: Despite advancements in our understanding of the importance of stress reduction in achieving good health, we still only have limited insight into the impact of stress on cellular function. Recent studies have suggested that exposure to prolonged psychological stress may alter an individual's physiological responses, and contribute to morbidity and mortality. This paper presents an overview of the study protocol we are using to examine the impact of life stressors on lifestyle factors, health-related quality of life and novel and established biomarkers of stress in midlife and older Australian women.The primary aim of this study is to explore the links between chronic psychological stress on both subjective and objective health markers in midlife and older Australian women. The study examines the extent to which exposure frightening, upsetting or stressful events such as natural disasters, illness or death of a relative, miscarriage and relationship conflict is correlated with a variety of objective and subjective health markers.Methods/design: This study is embedded within the longitudinal Healthy Aging of Women's study which has collected data from midlife and older Australian women at 5 yearly intervals since 2001, and uses the Allostastic model of women's health by Groer and colleagues in 2010. The current study expands the focus of the HOW study and will assess the impact of life stressors on quality of life and clinical biomarkers in midlife and older Australian women to explain the impact of chronic psychological stress in women. DISCUSSION: The proposed study hypothesizes that women are at increased risk of exposure to multiple or repeated stressors, some being unique to women, and the frequency and chronicity of stressors increases women's risk of adverse health outcomes. This study aims to further our understanding of the relationships between stressful life experiences, perceived quality of life, stress biomarkers, chronic illness, and health status in women.

Sustainability of a successful health and nutrition program in a remote Aboriginal community

OBJECTIVE: To assess the long term effect of a nutrition program in a remote Aboriginal community (Minjilang). DESIGN: Evaluation of nutritional outcomes over the three years before and the three years after a health and nutrition program that ran from June 1989 to June 1990. Turnover of food items at the community store was used as a measure of dietary intake at Minjilang and a comparison community. SETTING: A community of about 150 Aboriginal people live at Minjilang on Croker Island, 240 km north-east of Darwin. A similar community of about 300 people on another island was used as the comparison. RESULTS: The program produced lasting improvements in dietary intake of most target foods (including fruit, vegetables and wholegrain bread) and nutrients (including folate, ascorbic acid and thiamine). Sugar intake fell in both communities before the program, but the additional decrease in sugar consumption during the program at Minjilang "rebounded" in the next year. Dietary improvements in the comparison community were delayed and smaller than at Minjilang. CONCLUSIONS: The success of the program at Minjilang was linked to an ongoing process of social change, which in turn provided a stimulus for dietary improvement in the comparison community. When Aboriginal people themselves control and maintain ownership of community-based intervention programs, nutritional improvements can be initiated and sustained.

Survival tucker : improved diet and health indicators in an Aboriginal community

The poor nutritional status of Aboriginal Australians is a serious and complex public health concern. We describe an unusually successful health and nutrition project initiated by the people of Minjilang, which was developed, implemented and evaluated with the community. Apparent community dietary intake, assessed by the ‘store-turnover’ method, and biochemical, anthropometric and haematological indicators of health and nutritional status were measured before intervention and at three-monthly intervals during the intervention year. Following intervention, there was a significant decrease in dietary intake of sugar and saturated fat, an increase in micronutrient density, corresponding improvements in biochemical indices (for example, a 12 per cent decrease in mean serum cholesterol, increases in serum and red cell folate, serum vitamin B6 and plasma ascorbic acid), decrease in mean systolic and diastolic blood pressures, a normalisation of body mass index, and a normalisation of haematologic indices. The success of this project demonstrates that Aboriginal communities can bring about improvements in their generally poor nutritional status, and that the store-turnover method provides a valid, inexpensive and noninvasive method for evaluating the resultant changes in community diet. Although the project was undoubtedly effective in the short term, further work is in progress to assess individual strategies with respect to sustainability, cost-effectiveness and generalisability.

The effects of a woman-focused, woman-held resource on preventive health behaviors during pregnancy : the pregnancy pocketbook

We evaluated the effectiveness of a woman-held pregnancy record ('The Pregnancy Pocketbook') on improving health behaviors important for maternal and infant health. The Pregnancy Pocketbook was developed as a woman-focused preventive approach to pregnancy health based on antenatal management guidelines, behavior-change evidence, and formative research with the target population and health service providers. The Pregnancy Pocketbook was evaluated using a quasi-experimental, two-group design; one clinic cohort received the Pregnancy Pocketbook (n = 163); the other received Usual Care (n = 141). Smoking, fruit and vegetable intake, and physical activity were assessed at baseline (service-entry) and 12-weeks. Approximately two-thirds of women in the Pregnancy Pocketbook clinic recalled receiving the resource. A small, but significantly greater proportion of women at the Pregnancy Pocketbook site (7.6%) than the UC site (2.1%) quit smoking. No significant effect was observed of the Pregnancy Pocketbook on fruit and vegetable intake or physical activity. Few women completed sections that required health professional assistance. The Pregnancy Pocketbook produced small, but significant effects on smoking cessation, despite findings that indicate minimal interaction about the resource between health staff and the women in their care. A refocus of antenatal care toward primary prevention is required to provide essential health information and behavior change tools more consistently for improved maternal and infant health outcomes.

Predictors of initiating and maintaining active commuting to work using transport and public health perspectives in Australia

Objective To identify predictors for initiating and maintaining active commuting (AC) to work following the 2003 Australia's Walk to Work Day (WTWD) campaign. Methods Pre- and post-campaign telephone surveys of a cohort of working age (18–65years) adults (n = 1100, 55% response rate). Two dependent campaign outcomes were assessed: initiating or maintaining AC (i.e., walk/cycle and public transport) on a single day (WTWD), and increasing or maintaining health-enhancing active commuting (HEAC) level (≥ 30min/day) in a usual week following WTWD campaign. Results A significant population-level increase in HEAC (3.9%) was observed (McNemar's χ2 = 6.53, p = 0.01) with 136 (19.0%) achieving HEAC at post campaign. High confidence in incorporating walking into commute, being active pre-campaign and younger age (< 46years) were positively associated with both outcomes. The utility of AC for avoiding parking hassles (AOR = 2.1, 95% CI: 1.2–3.6), for less expense (AOR = 1.8, 95% CI: 1.1–3.1), for increasing one's health (AOR = 2.5, 95% CI: 1.1–5.6) and for clean air (AOR = 2.2, 95% CI: 1.0–4.4) predicted HEAC outcome whereas avoiding the stress of driving (AOR = 2.6, 95% CI: 1.4–5.0) and the hassle of parking predicted the single-day AC. Conclusions Transportation interventions targeting parking and costs could be further enhanced by emphasizing health benefits of AC. AC was less likely to occur among inactive employees.

Screening for risk of later mental health problems : a longitudinal study

Purpose: This is one of the first studies to report that the Achenbach internalising scales were much more effective at identifying those with current comorbid depression and anxiety, rather than individual mood disorder. Introduction: The Achenbach behaviour checklists (YSR,YASR) are widely used, low cost screening tools used to assess problem behaviour. Several studies report good association between the checklists and psychiatric diagnoses; although with varying degrees of agreement. Most are cross-sectional studies involving adolescents referred to mental health services; few are in large community-based studies. This study examined the usefulness of the Achenbach internalising scales in the primary screening (both predictive and concurrent)for depression and anxiety. Methods: The sample was 2400 young adults from an Australian population-based prospective birth cohort study. The association between the empirical anxiety and depression scales were individually assessed against DSM-IV depression and anxiety diagnoses. Odds ratios and diagnostic efficiency tests report the findings. Results: Adolescents with internalising symptoms were twice (OR 2.3, 95%CI 1.7 to 3.1) as likely to be diagnosed with later DSM-IV depression. YASR internalising scale predicted DSM-IV mood disorders (depression OR = 6.9, 95% CI 5.0–9.5; anxiety OR = 5.1, 95% CI 3.8–6.7) in the previous 12 months. The internalising scales were much more effective at identifying those with comorbid depression and anxiety. Conclusions: Adolescence and early adulthood are key risk periods for the onset of anxiety and depression. This study found that young people with internalising behaviour problems were more likely to have comorbid depression and anxiety DSM-IV disorder.

Physiotherapists have accurate expectations of their patients’ future health-related quality of life after first assessment in a subacute rehabilitation setting

BACKGROUND Expectations held by health professionals and their patients are likely to affect treatment choices in subacute inpatient rehabilitation settings for older adults. There is a scarcity of empirical evidence evaluating whether health professionals expectations of the quality of their patients' future health states are accurate. METHODS A prospective longitudinal cohort investigation was implemented to examine agreement (kappa coefficients, exact agreement, limits-of-agreement, and intraclass-correlation coefficients) between physiotherapists' (n = 23) prediction of patients' discharge health-related quality of life (reported on the EQ-5D-3L) and the actual health-related quality of life self-reported by patients (n = 272) at their discharge assessment (using the EQ-5D-3L). The mini-mental state examination was used as an indicator of patients' cognitive ability. RESULTS Overall, 232 (85%) patients had all assessment data completed and were included in analysis. Kappa coefficients (exact agreement) ranged between 0.37-0.57 (58%-83%) across EQ-5D-3L domains in the lower cognition group and 0.53-0.68 (81%-85%) in the better cognition group. CONCLUSIONS Physiotherapists in this subacute rehabilitation setting predicted their patients' discharge health-related quality of life with substantial accuracy. Physiotherapists are likely able to provide their patients with sound information regarding potential recovery and health-related quality of life on discharge. The prediction accuracy was higher among patients with better cognition than patients with poorer cognition.

Managing health risks of extreme weather events : need for a systematic approach

The Climate Commission recently outlined the trend of major extreme weather events in different regions of Australia, including heatwaves, floods, droughts, bushfires, cyclones and storms. These events already impose an enormous health and financial burden onto society and are projected to occur more frequently and intensely. Unless we act now, further financial losses and increasing health burdens seem inevitable. We seek to highlight the major areas for interdisciplinary investigation, identify barriers and formulate response strategies.

Improved rural health through a collaborative model of care – qualitative findings

INTRODUCTION Health disparity between urban and rural regions in Australia is well-documented. In the Wheatbelt catchments of Western Australia there is higher incidence and rate of avoidable hospitalisation for chronic diseases. Structured care approach to chronic illnesses is not new but the focus has been on single disease state. A recent ARC Discovery Project on general practice nurse-led chronic disease management of diabetes, hypertension and stable ischaemic heart disease reported improved communication and better medical administration.[1] In our study we investigated the sustainability of such a multi-morbidities general practice –led collaborative model of care in rural Australia. METHODS A QUAN(qual) design was utilised. Eight pairs of rural general practices were matched. Inclusion criteria used were >18 years and capable of giving informed consent, at least one identified risk factor or diagnosed with chronic conditions. Patients were excluded if deemed medically unsuitable. A comprehensive care plan was formulated by the respective general practice nurse in consultation with the treating General Practitioner (GP) and patient based on the individual’s readiness to change, and was informed by available local resource. A case management approach was utilised. Shediaz-Rizkallah and Lee’s conceptual framework on sustainability informed our evaluation.[2] Our primary outcome on measures of sustainability was reduction in avoidable hospitalisation. Secondary outcomes were patients and practitioners acceptance and satisfaction, and changes to pre-determined interim clinical and process outcomes. RESULTS The qualitative interviews highlighted the community preference for a ‘sustainable’ local hospital in addition to general practice. Costs, ease of access, low prioritisation of self chronic care, workforce turnover and perception of losing another local resource if underutilised influenced the respondents’ decision to present at local hospital for avoidable chronic diseases regardless. CONCLUSIONS Despite the pragmatic nature of rural general practice in Australia, the sustainability of chronic multi-morbidities management in general practice require efficient integration of primary-secondary health care and consideration of other social determinants of health. What this study adds: What is already known on this subject: Structured approach to chronic disease management is not new and has been shown to be effective for reducing hospitalisation. However, the focus has been on single disease state. What does this study add: Sustainability of collaborative model of multi-morbidities care require better primary-secondary integration and consideration of social determinants of health.

SettleMEN : health and settlement among men from refugee backgrounds living in South East Queensland

Between 2008 and 2010, the SettleMEN study followed a cohort of 233 recently arrived men from refugee backgrounds living in urban and regional areas of South East Queensland with the aim of documenting their health and settlement experiences. This report presents the key findings of the study.

We have a lot to learn yet : a postcolonial lens in health promotion

Health promotion progresses a social justice and empowerment agenda and thus emphasises working with people to increase their control over their health. Certainly, Australia has experienced much success in this endeavour and is internationally recognised as a leader. However, health promotion has failed Indigenous Australians; a fact that is echoed in the health outcomes that ironically provide us with the “moral imperative” to act. Further investigation has also revealed health promotion’s foundation in colonial imaginings. Thus, this paper calls for the culture of health promotion to be examined as a risk factor for poor Indigenous health. To complement this call, this paper presents findings of an ethnographic study of Indigenous health promotion practice, undertaken from a postcolonial and critical whiteness framework. These findings provide a narrative of strength and innovative approaches, highlighting the value of Indigenous knowledge. These findings also contradict the biomedical tendency to construct culture as illness-producing. More broadly, this study’s findings entail important lessons for health promotion to consider, if it is to move beyond the rhetoric, to truly increase people’s control over their health.