Tobacco use in South Africans during 1998: The first demographic and health survey

Objective To determine smoking patterns in South Africa, and to identify groups requiring culturally appropriate smoking cessation programmes. Methods A random sample of 13 826 people (415 years), was interviewed to identify tobacco use patterns and respiratory symptoms. Peak expiratory flow rates were measured. Multinomial regression analyses identified sociodemographic factors related to tobacco use, and the latter’s association with respiratory conditions. Results In 1998, 24.6% adults (44.2% of males and 11.0% of females) smoked regularly. Coloured women had a higher rate (39%) than African women (5.4%). About 24% of the regular smokers had attempted to quit, with only 9.9% succeeding. African women (13.2%) used smokeless tobacco more frequently than others. Of the nonsmokers 28% and 19% were exposed to environmental tobacco smoke in their homes and workplaces, respectively. The regression analysis showed that the demographic characteristics of light smokers (1–14 tobacco equivalents per day) and heavy smokers (>=15 tobacco equivalents per day) differed. Light smoking occurred significantly more frequently in the poorest, least educated and urban people. The relative risk for light smoking was 18 in Coloured women compared with African women. Heavy smoking occurred most frequently in the highest educated group. A dose–response was observed between the amount smoked and the presence of respiratory diseases. Conclusions Smoking in South Africa is decreasing and should continue with the recently passed tobacco control legislation. Culturally appropriate tobacco cessation programmes for the identified target groups need to be developed.

Beyond the hospital door : a retrospective, cohort study of associations between birthing in the public or private sector and women’s postpartum care

Background In Australia, maternity care is available through universal coverage and a parallel, competitive private health insurance system. Differences between sectors in antenatal and intrapartum care and associated outcomes are well documented but few studies have investigated differences in postpartum care following hospital discharge and their impact on maternal satisfaction and confidence. Methods Women who birthed in Queensland, Australia from February to May 2010 were mailed a self-report survey 4 months postpartum. Regression analysis was used to determine associations between sector of birth and postpartum care, and whether postpartum care experiences explained sector differences in postpartum well-being (satisfaction, parenting confidence and feeling depressed). Results Women who birthed in the public sector had higher odds of health professional contact in the first 10 days post-discharge and satisfaction with the amount of postpartum care. After adjusting for demographic and postpartum contact variables, sector of birth no longer had an impact on satisfaction (AOR 0.95, 99% CI 0.78-1.31), but any form of health professional contact did. Women who had a care provider’s 24 hour contact details had higher odds of being satisfied (AOR 3.64, 95% CI 3.00-4.42) and confident (AOR 1.34, 95% CI 1.08- 1.65). Conclusion Women who birthed in the public sector appeared more satisfied because they had higher odds of receiving contact from a health professional within 10 days post-discharge. All women should have an opportunity to speak to and/or see a doctor, midwife or nurse in the first 10 days at home, and the details of a person they can contact 24 hours a day.

Latent class analysis reveals distinct subgroups of patients based on symptom occurrence and demographic and clinical characteristics

Context Cancer patients experience a broad range of physical and psychological symptoms as a result of their disease and its treatment. On average, these patients report ten unrelieved and co-occurring symptoms. Objectives To determine if subgroups of oncology outpatients receiving active treatment (n=582) could be identified based on their distinct experience with thirteen commonly occurring symptoms; to determine whether these subgroups differed on select demographic, and clinical characteristics; and to determine if these subgroups differed on quality of life (QOL) outcomes. Methods Demographic, clinical, and symptom data from one Australian and two U.S. studies were combined. Latent class analysis (LCA) was used to identify patient subgroups with distinct symptom experiences based on self-report data on symptom occurrence using the Memorial Symptom Assessment Scale (MSAS). Results Four distinct latent classes were identified (i.e., All Low (28.0%), Moderate Physical and Lower Psych (26.3%), Moderate Physical and Higher Psych (25.4%), All High (20.3%)). Age, gender, education, cancer diagnosis, and presence of metastatic disease differentiated among the latent classes. Patients in the All High class had the worst QOL scores. Conclusion Findings from this study confirm the large amount of interindividual variability in the symptom experience of oncology patients. The identification of demographic and clinical characteristics that place patients are risk for a higher symptom burden can be used to guide more aggressive and individualized symptom management interventions.

Segmenting Australian high school students : two-step cluster analysis preliminary results

A one size fits all approach dominates alcohol programs in school settings (Botvin et al., 2007), which may limit program effectiveness (Snyder et al., 2004). Programs tailored to the meet the needs and wants of adolescent groups may be more effective. Limited attention has been directed towards employing a full segmentation process. Where segmentation has been examined, the focus has remained on socio-demographic characteristics and more recently psychographic variables (Mathijssen et al., 2012). The current study aimed to identify whether the addition of behaviour could be used to identify segments. Variables included attitudes towards binge drinking (α = 0.86), behavioral intentions’ (α = 0.97), perceived behavioral control (PBC), injunctive norms (α = 0.94); descriptive norms (α = 0.87), knowledge and reported behaviour. Data was collected from five schools, n = 625 (32.96% girls). Two-Step cluster analysis produced a sample (n = 625) with a silhouette measure of cohesion and separation of 0.4. The intention measure and whether students reported previously consuming alcohol were the most distinguishing characteristics - predictor importance scores of (1.0). A four segment solution emerged. The first segment (“Male abstainers” – 37.2%) featured the highest knowledge score (M: 5.9) along with the lowest-risk drinking attitudes and intentions to drink excessively. Segment 2 (“At risk drinkers” - 11.2%) were characterised by their high-risk attitudes and high-risk drinking intentions. Injunctive (M: 4.1) and descriptive norms (M: 4.9) may indicate a social environment where drinking is the norm. Segment 3 (”Female abstainers” – 25.9%) represents young girls, who have the lowest-risk attitudes and low intentions to drink excessively. The fourth and final segment (boys = 67.4%) (“Moderate drinkers” – 25.7%) all report previously drinking alcohol yet their attitudes and intentions towards excessive alcohol consumption are lower than other segments. Segmentation focuses on identifying groups of individuals who feature similar characteristics. The current study illustrates the importance of including reported behaviour in addition to psychographic and demographic characteristics to identify unique groups to inform intervention planning and design. Key messages The principle of segmentation has received limited attention in the context of school-based alcohol education programs. This research identified four segments amongst 14-16 year high school students, each of which can be targeted with a unique, tailored program to meet the needs and wants of the target audience.

Socio-environmental drivers and suicide in Australia: Bayesian spatial analysis

Background The impact of socio-environmental factors on suicide has been examined in many studies. Few of them, however, have explored these associations from a spatial perspective, especially in assessing the association between meteorological factors and suicide. This study examined the association of meteorological and socio-demographic factors with suicide across small areas over different time periods. Methods Suicide, population and socio-demographic data (e.g., population of Aboriginal and Torres Strait Islanders (ATSI), and unemployment rate (UNE) at the Local Government Area (LGA) level were obtained from the Australian Bureau of Statistics for the period of 1986 to 2005. Information on meteorological factors (rainfall, temperature and humidity) was supplied by Australian Bureau of Meteorology. A Bayesian Conditional Autoregressive (CAR) Model was applied to explore the association of socio-demographic and meteorological factors with suicide across LGAs. Results In Model I (socio-demographic factors), proportion of ATSI and UNE were positively associated with suicide from 1996 to 2000 (Relative Risk (RR)ATSI = 1.0107, 95% Credible Interval (CI): 1.0062-1.0151; RRUNE = 1.0187, 95% CI: 1.0060-1.0315), and from 2001 to 2005 (RRATSI = 1.0126, 95% CI: 1.0076-1.0176; RRUNE = 1.0198, 95% CI: 1.0041-1.0354). Socio-Economic Index for Area (SEIFA) and IND, however, had negative associations with suicide between 1986 and 1990 (RRSEIFA = 0.9983, 95% CI: 0.9971-0.9995; RRATSI = 0.9914, 95% CI: 0.9848-0.9980). Model II (meteorological factors): a 1°C higher yearly mean temperature across LGAs increased the suicide rate by an average by 2.27% (95% CI: 0.73%, 3.82%) in 1996–2000, and 3.24% (95% CI: 1.26%, 5.21%) in 2001–2005. The associations between socio-demographic factors and suicide in Model III (socio-demographic and meteorological factors) were similar to those in Model I; but, there is no substantive association between climate and suicide in Model III. Conclusions Proportion of Aboriginal and Torres Strait Islanders, unemployment and temperature appeared to be statistically associated with of suicide incidence across LGAs among all selected variables, especially in recent years. The results indicated that socio-demographic factors played more important roles than meteorological factors in the spatial pattern of suicide incidence.

Copula-based spatial modelling of geometallurgical variables

The most important aspect of modelling a geological variable, such as metal grade, is the spatial correlation. Spatial correlation describes the relationship between realisations of a geological variable sampled at different locations. Any method for spatially modelling such a variable should be capable of accurately estimating the true spatial correlation. Conventional kriged models are the most commonly used in mining for estimating grade or other variables at unsampled locations, and these models use the variogram or covariance function to model the spatial correlations in the process of estimation. However, this usage assumes the relationships of the observations of the variable of interest at nearby locations are only influenced by the vector distance between the locations. This means that these models assume linear spatial correlation of grade. In reality, the relationship with an observation of grade at a nearby location may be influenced by both distance between the locations and the value of the observations (ie non-linear spatial correlation, such as may exist for variables of interest in geometallurgy). Hence this may lead to inaccurate estimation of the ore reserve if a kriged model is used for estimating grade of unsampled locations when nonlinear spatial correlation is present. Copula-based methods, which are widely used in financial and actuarial modelling to quantify the non-linear dependence structures, may offer a solution. This method was introduced by Bárdossy and Li (2008) to geostatistical modelling to quantify the non-linear spatial dependence structure in a groundwater quality measurement network. Their copula-based spatial modelling is applied in this research paper to estimate the grade of 3D blocks. Furthermore, real-world mining data is used to validate this model. These copula-based grade estimates are compared with the results of conventional ordinary and lognormal kriging to present the reliability of this method.

Differential segmentation responses to an alcohol social marketing program

Objective This study seeks establish whether meaningful subgroups exist within a 14-16 year old adolescent population and if these segments respond differently to the Game On: Know Alcohol (GOKA) intervention, a school-based alcohol social marketing program. Methodology This study is part of a larger cluster randomized controlled evaluation of the Game On: Know Alcohol (GOKA) program implemented in 14 schools in 2013/2014. TwoStep cluster analysis was conducted to segment 2114 high school adolescents (14-16 years old) on the basis of 22 demographic, behavioral and psychographic variables. Program effects on knowledge, attitudes, behavioral intentions, social norms, expectancies and refusal self-efficacy of identified segments was subsequently examined. Results Three segments were identified: (1) Abstainers (2) Bingers (3) Moderate Drinkers. Program effects varied significantly across segments. The strongest positive change effects post participation were observed for the Bingers, while mixed effects were evident for Moderate Drinkers and Abstainers. Conclusions These findings provide preliminary empirical evidence supporting application of social marketing segmentation in alcohol education programs. Development of targeted programs that meet the unique needs of each of the three identified segments is indicated to extend the social marketing footprint in alcohol education.

Comparison of kinematic variables obtained by inertial sensors among stroke survivors and healthy older adults in the Functional Reach Test: cross-sectional study

Background Balance dysfunction is one of the most common problems in people who suffer stroke. To parameterize functional tests standardized by inertial sensors have been promoted in applied medicine. The aim of this study was to compare the kinematic variables of the Functional Reach Test (FRT) obtained by two inertial sensors placed on the trunk and lumbar region between stroke survivors (SS) and healthy older adults (HOA) and to analyze the reliability of the kinematic measurements obtained. Methods Cross-sectional study. Five SS and five HOA over 65. A descriptive analysis of the average range as well as all kinematic variables recorded was developed. The intrasubject and intersubject reliability of the measured variables was directly calculated. Results In the same intervals, the angular displacement was greater in the HOA group; however, they were completed at similar times for both groups, and HOA conducted the test at a higher speed and greater acceleration in each of the intervals. The SS values were higher than HOA values in the maximum and minimum acceleration in the trunk and in the lumbar region. Conclusions The SS show less functional reach, a narrower, slower and less accelerated movement during the FRT execution, but with higher peaks of acceleration and speed when they are compared with HOA.

Functional and psychosocial outcomes 1 year after mild stroke

Background Mild stroke survivors are generally discharged from acute care within a few days of the stroke event, often without rehabilitation follow-up. We aimed to examine the recovery trajectory for male patients and their wife-caregivers during the 12 months postdischarge. Methods A descriptive study was undertaken to examine functional outcomes, quality of life (QOL), depression, caregiver strain, and marital function in a prospective cohort of male survivors of mild stroke and their wife-caregivers during the 12 months postdischarge. Data from each point in time were summarized and repeated measures analyses undertaken. Logistic regression was used to determine which baseline demographic and biopsychosocial variables influenced or predicted marital functioning 1 year postdischarge. Results A total of 38 male patients (mean age 63.4 years) and their wife-caregivers (mean age 58.5 years) were examined. The median discharge National Institutes of Health Stroke Scale score was 1.5, modified Rankin Scale score was 1.0, Barthel Index was 100.0, and Stroke Impact Scale-16v2 score was 78.5. The patients' modified Rankin Scale (function) and QOL scores improved significantly over time (F (2) = 4.583, P = .017; and F (6) = 5.632, P < .001, respectively). However, the wife-caregiver QOL scores did not change. Multivariate analysis revealed overall worsening of depression for both the patient and wife-caregivers (F (6, 32) = 3.087, P = .017) and marital function (F (6, 32) = 3.961, P = .004), although the wife-caregivers' perceptions of caregiver strain improved (F (6, 32) = 3.923, P = .007). None of the measured variables were associated with marital functioning 1 year postdischarge. Conclusions Despite improvement in patients' functional status, other patient and wife-caregiver psychosocial outcomes during the 12 months postdischarge may be negatively affected. Thus, attention needs to focus on recovery beyond functional outcomes.

Correlation between architectural variables and torque in the erector spinae muscle during maximal isometric contraction

This study analysed whether a significant relationship exists between the torque and muscle thickness and pennation angle of the erector spinae muscle during a maximal isometric lumbar extension with the lumbar spine in neutral position. This was a cross-sectional study in which 46 healthy adults performed three repetitions for 5 s of maximal isometric lumbar extension with rests of 90 s. During the lumbar extensions, bilateral ultrasound images of the erector spinae muscle (to measure pennation angle and muscle thickness) and torque were acquired. Reliability test analysis calculating the internal consistency (Cronbach's alpha) of the measure, correlation between pennation angle, muscle thickness and torque extensions were examined. Through a linear regression the contribution of each independent variable (muscle thickness and pennation angle) to the variation of the dependent variable (torque) was calculated. The results of the reliability test were: 0.976–0.979 (pennation angle), 0.980–0.980 (muscle thickness) and 0.994 (torque). The results show that pennation angle and muscle thickness were significantly related to each other with a range between 0.295 and 0.762. In addition, multiple regression analysis showed that the two variables considered in this study explained 68% of the variance in the torque. Pennation angle and muscle thickness have a moderate impact on the variance exerted on the torque during a maximal isometric lumbar extension with the lumbar spine in neutral position.

Pedestrian Crashes in Ethiopia: Identification of contributing factors through modelling of exposure and road environment variables

Pedestrian safety is a critical issue in Ethiopia. Reports show that 50 to 60% of traffic fatality victims in the country are pedestrians. The primary aim of this research was to examine the possible causes of and contributing factors to crashes with pedestrians in Ethiopia, and improve pedestrian safety by recommending possible countermeasures. The secondary aim was to develop appropriate pedestrian crash models for two-way two-lane rural roads and roundabouts in the capital city of Ethiopia. This research uses quantitative methods throughout the process of the investigation. The research has applied various statistical methods. The results of this research support the idea that geometric and operational features have significant influence on pedestrian safety and crashes. Accordingly, policies and strategies are needed to safeguard pedestrians in Ethiopia.

The impact of a self-development coaching programme on medical and dental students’ psychological health and academic performance: A randomised controlled trial

Background Psychological distress is well-documented worldwide among medical and dental students. Few studies have assessed the impact of self-development coaching programs on the students’ psychological health. The aim of the study was to evaluate the effect of a self-development coaching programme on the psychological health and academic performance of preclinical medical and dental students at Umm Al-Qura University, Saudi Arabia. Methods Four-hundred and twenty-two participants (n = 422, 20–22 years) fulfilled the study requirements and were invited into a parallel-randomised controlled trial that was partially blinded. Participants were stratified by faculty, gender, and academic year, and then randomised. A total of 156 students participated in the intervention group (IG) and 163 students participated in the control group (CG). The IG received the selfdevelopment programme, involving skills and strategies aimed to improve students’ psychological health and academic performance, through a two-day workshop. Meanwhile, the CG attended an active placebo programme focussing on theoretical information that was delivered through a five-hour workshop. Both programmes were conducted by the same presenter during Week 1 of the second semester of the 2012–2013 academic year. Data were gathered immediately before (T1), one week after (T2) and five weeks (T3) after the intervention. Psychological health was measured using the Depression Anxiety Stress Scale (DASS-21), the General Self-Efficacy (GSE), and the Satisfaction With Life Scale (SWLS). Academic performance was measured using students’ academic weighted grades (WG). Student cognitive and emotional perceptions of the intervention were measured using the Credibility/Expectancy Questionnaire (CEQ). Results Data from 317 students, who completed the follow ups, were analysed across the three time periods (IG, n = 155; CG, n = 162). The baseline variables and demographic data of the IG and CG were not significantly different. The IG showed short-term significant reductions in depression and anxiety in compared to CG from T1 to T2. The short-term changes in stress, GSE and SWLS of the IG were not significantly different from those of the CG. While both groups showed a significant change on most of the psychological variables from T1 to T3, no significant differences were found between the groups in this period. In addition, no significant difference was found in WG between the IG and CG after the intervention. No harms relevant to the intervention were reported. Conclusion The investigated self-development coaching programme showed only a short-term improvement on depression and anxiety compared with an active control. There was no effect of the intervention on academic performance.

Predictors of physical activity in colorectal cancer survivors after participation in a telephone-delivered multiple health behavior change intervention

Purpose: Physical activity improves the health outcomes of colorectal cancer (CRC) survivors, yet few are exercising at levels known to yield health benefits. Baseline demographic, clinical, behavioral, and psychosocial predictors of physical activity at 12 months were investigated in CRC survivors. Methods: Participants were CRC survivors (n = 410) who completed a 12-month multiple health behavior change intervention trial (CanChange). The outcome variable was 12 month sufficient physical activity (≥150 min of moderate–vigorous physical activity/week). Baseline predictors included demographics and clinical variables, health behaviors, and psychosocial variables. Results: Multivariate linear regression revealed that baseline sufficient physical activity (p < 0.001), unemployment (p = 0.004), private health insurance (p = 0.040), higher cancer-specific quality of life (p = 0.031) and higher post-traumatic growth (p = 0.008) were independent predictors of sufficient physical activity at 12 months. The model explained 28.6 % of the variance. Conclusions: Assessment of demographics, health behaviors, and psychosocial functioning following a diagnosis of CRC may help to develop effective physical activity programs.

Burnout and work engagement in occupational therapists

Introduction Work engagement, characterized by vigour, dedication, and absorption, is often perceived as the opposite of burnout. Occupational therapists with burnout feel exhausted and disengaged from their work. This study aims to investigate demographic and work-related psychosocial factors associated with burnout and work engagement. Method A cross-sectional postal survey of 951 occupational therapists was conducted. Findings Two models representing factors associated with burnout (F(15,871) = 28.01, p < .001) and work engagement (F(10,852) = 16.15, p < .001) accounted for 32.54% and 15.93% of the variance respectively. Burnout and work engagement were inversely associated (χ2(n = 941) = 55.16, p < .001). Conclusion Factors associated with burnout and work engagement were identified. The variables associated with burnout included: low psychological detachment from work during out-of-work hours, low income satisfaction, perceived work overload, difficulty saying ‘no’, < 10 years' experience, low frequency of having a ‘belly laugh’, and not having children. High levels of work engagement were reported by therapists with the following: low psychological detachment from work, high income satisfaction, postgraduate qualifications, > 40 hours work/week, high frequency of having a ‘belly laugh’, and having children. Understanding the factors associated with burnout and work engagement provides prerequisite information to inform strategies aimed at building healthy workforces.

Signs of driver sleepiness and risky sleepy driving behaviours: the associations with demographic, work and sleep-related factors

Driving while sleepy is regarded as a substantial crash risk factor. Reducing the risk of sleep-related crashes predominately rests with the driver’s awareness of experiencing signs that are common when sleepy; such as yawning, frequent eye blinks, and difficulty keeping eyes open. However the relationship between the signs of sleepiness and risky sleepy driving behaviours is largely unknown. The current study sought to examine the relationships between drivers’ experiences of the signs of sleepiness, risky sleepy driving behaviours, and the associations with demographic, work and sleep-related factors. In total 1,608 participants completed a questionnaire administered via a telephone interview that assessed their experiences and behaviours of driving while sleepy. The results revealed a number of demographic, work and sleep-related factors were associated with experiencing signs of sleepiness when driving. Signs of sleepiness were also found to mediate the relationship between continuing to drive while sleepy and having a sleep-related close call event. A subgroup analysis based on age (under 30 and 30 years or older) found younger drivers were more likely to continue to drive when sleepy despite experiencing more signs of sleepiness. The results suggest participants had considerable experience with the signs of sleepiness and driving while sleepy. Actions to be taken from this research include informing the content of driver education campaigns regarding the importance of the signs of sleepiness. Working together to educate all drivers about the dangerousness of driving when experiencing signs of sleepiness is an important road safety outcome.