Socioeconomic inequalities in cardiovascular mortality and the role of childhood socioeconomic conditions and adulthood risk factors : a prospective cohort study with 17-years of follow up

Background The mechanisms underlying socioeconomic inequalities in mortality from cardiovascular diseases (CVD) are largely unknown. We studied the contribution of childhood socioeconomic conditions and adulthood risk factors to inequalities in CVD mortality in adulthood. Methods The prospective GLOBE study was carried out in the Netherlands, with baseline data from 1991, and linked with the cause of death register in 2007. At baseline, participants reported on adulthood socioeconomic position (SEP) (own educational level), childhood socioeconomic conditions (occupational level of respondent’s father), and a broad range of adulthood risk factors (health behaviours, material circumstances, psychosocial factors). This present study is based on 5,395 men and 6,306 women, and the data were analysed using Cox regression models and hazard ratios (HR). Results A low adulthood SEP was associated with increased CVD mortality for men (HR 1.84; 95% CI: 1.41-2.39) and women (HR 1.80; 95%CI: 1.04-3.10). Those with poorer childhood socioeconomic conditions were more likely to die from CVD in adulthood, but this reached statistical significance only among men with the poorest childhood socioeconomic circumstances. About half of the investigated adulthood risk factors showed significant associations with CVD mortality among both men and women, namely renting a house, experiencing financial problems, smoking, physical activity and marital status. Alcohol consumption and BMI showed a U-shaped relationship with CVD mortality among women, with the risk being significantly greater for both abstainers and heavy drinkers, and among women who were underweight or obese. Among men, being single or divorced and using sleep/anxiety drugs increased the risk of CVD mortality. In explanatory models, the largest contributor to adulthood CVD inequalities were material conditions for men (42%; 95% CI: −73 to −20) and behavioural factors for women (55%; 95% CI: -191 to −28). Simultaneous adjustment for adulthood risk factors and childhood socioeconomic conditions attenuated the HR for the lowest adulthood SEP to 1.34 (95% CI: 0.99-1.82) for men and 1.19 (95% CI: 0.65-2.15) for women. Conclusions Adulthood material, behavioural and psychosocial factors played a major role in the explanation of adulthood SEP inequalities in CVD mortality. Childhood socioeconomic circumstances made a modest contribution, mainly via their association with adulthood risk factors. Policies and interventions to reduce health inequalities are likely to be most effective when considering the influence of socioeconomic circumstances across the entire life course and in particular, poor material conditions and unhealthy behaviours in adulthood.

Working with refugee survivors of torture and trauma : an opportunity for vicarious posttraumatic growth

Clinical work with people who have survived trauma carries a risk of vicarious traumatisation for the service provider, but also the potential for vicarious posttraumatic growth. Despite growing interest in this area, the effects of working with survivors of refugee-related trauma have remained relatively unexplored. The aim of the current study was to examine the lived experiences of people working on a daily basis with survivors of torture and trauma who had sought refuge in Australia. Seventeen clinical, administrative, and managerial staff from a not-for-profit organisation participated in a semi-structured interview that was later analysed using interpretive phenomenological analysis. Analysis of the data demonstrated that the entire sample reported symptoms of vicarious trauma (e.g., strong emotional reactions, intrusive images, shattering of existing beliefs) as well as vicarious posttraumatic growth (e.g., forming new relationships, increased self-understanding, greater appreciation of life). Moreover, effortful meaning making processes appeared to facilitate such positive changes. Reduction in the risks associated with this work, enhancement of clinician well-being, and improvement of therapeutic outcomes is a shared responsibility of the organisation and clinician. Without negating the distress of trauma work, clinicians are encouraged to more deeply consider the unique positive outcomes that supporting survivors can provide.

Ventilation distribution in rats : Part I - The effect of gas composition as measured with electrical impedance tomography

The measurement of ventilation distribution is currently performed using inhaled tracer gases for multiple breath inhalation studies or imaging techniques to quantify spatial gas distribution. Most tracer gases used for these studies have properties different from that of air. The effect of gas density on regional ventilation distribution has not been studied. This study aimed to measure the effect of gas density on regional ventilation distribution. Methods Ventilation distribution was measured in seven rats using electrical impedance tomography (EIT) in supine, prone, left and right lateral positions while being mechanically ventilated with either air, heliox (30% oxygen, 70% helium) or sulfur hexafluoride (20% SF6, 20% oxygen, 60% air). The effect of gas density on regional ventilation distribution was assessed. Results Gas density did not impact on regional ventilation distribution. The non-dependent lung was better ventilated in all four body positions. Gas density had no further impact on regional filling characteristics. The filling characteristics followed an anatomical pattern with the anterior and left lung showing a greater impedance change during the initial phase of the inspiration. Conclusion It was shown that gas density did not impact on convection dependent ventilation distribution in rats measured with EIT.

The cost of being perfect : perfectionism and suicide ideation in university students

Objective: The aim of the study was to assess the relationship between dimensions of perfectionism and suicide ideation in a tertiary student population in Australia. Method: The methodology involved 405 students completing the General Health Questionnaire (GHQ-28) which includes a subset of questions which can be used to assess suicide ideation, and the Multidimensional Perfectionism Scale. Results: The presence of suicide ideation was associated with higher scores on total perfectionism and two perfectionism dimensions, and total GHQ scores. There were significant differences between participants with high levels of perfectionism and participants with moderate to low levels of perfectionism on a measure of suicide ideation. Neither gender nor age were associated with differences in the scores, with results indicating high levels of perfectionism may indicate a vulnerability to suicide ideation. Conclusions: Perfectionism is a valued attribute in high-achieving populations. The question needs to be asked, however, at what cost? The findings indicate that high levels of perfectionism may be associated with an increased vulnerability to suicide ideation. Future research is needed to gain a better understanding of the complex interrelationship between personality and temperament, environmental factors and self-destructive behaviour.

The cost of being ethical : evidence from Islamic equity funds

This paper examines the relationship between financial performance and ethical screening intensity of a special class of ethical funds that is rooted in Islamic values – Islamic equity funds (IEFs). These faith-based ethical funds screen investments on compliance with Islamic values where conventional interest expense (riba), gambling (maysir), excessive uncertainty (gharar), and non-ethical (non-halal) products are prohibited. We test whether these extra screens affect the financial performance of IEFs relative to non-Islamic funds. Based on a large survivorship-free international sample of 387 Islamic funds, our results show that IEFs on average underperform conventional funds by 40 basis points per month, or 4.8% per year (supporting the underperformance hypothesis). While Islamic funds do not generally perform better during crisis periods, they outperformed conventional funds during the recent sub-prime crisis (supporting the outperformance hypothesis). Using holdings-based measures for ethical screening intensity, results show IEFs that apply more intensive screening perform worse, suggesting that there is a cost to being ethical.

Gender and the capacity of women with NIDDM to implement medical advice

This qualitative study of women with non-insulin dependent diabetes mellitus (NIDDM) examined constructions of their diabetes management and socio-familial relationships as potential sources of support. Semi-structured interview data was collected from 16 women. The transcripts were analysed with the aim of examining the ways in which Sender relations structured women's accounts of health-related behaviours. Women talked about themselves as wives, mothers, being pregnant and parenting, and friends of other women in ways that demonstrated how caring for others impeded their capacity to care for themselves. Meeting the food preferences of husbands and dietary requirements of diabetic husbands were dominant themes in women's accounts of marriage, and in various ways women justified their husbands' lack of support. Furthermore, the care of others during pregnancy and parenting was also an obstacle to women caring for themselves. An awareness of the gender politics inherent within social and family contexts is crucial to improving the effectiveness of medical advice for diabetes management.

Ureaplasma species multiple banded antigen (MBA) variation is associated with the severity of chorioamnionitis in late preterm placentas

Background: Intra-amniotic infection accounts for 30% of all preterm births (PTB), with the human Ureaplasma species being the most frequently identified microorganism from the placentas of women who deliver preterm. The highest prevalence of PTB occurs late preterm (32-36 weeks) but no studies have investigated the role of infectious aetiologies associated with late preterm birth. Method: Placentas from women with late PTB were dissected aseptically and samples of chorioamnion tissue and membrane swabs were collected. These were tested for Ureaplasma spp. and aerobic/anaerobic bacteria by culture and real-time PCR. Western blot was used to assess MBA variation in ureaplasma clinical isolates. The presence of microorganisms was correlated with histological chorioamnionitis. Results: Ureaplasma spp. were isolated from 33/466 (7%) of placentas by culture or PCR. The presence of ureaplasmas, but not other microorganisms, was associated with histological chorioamnionitis (21/33 ureaplasma-positive vs. 8/42 other bacteria; p= 0.001). Ureaplasma clinical isolates demonstrating no MBA variation were associated with histological chorioamnionitis. By contrast, ureaplasmas displaying MBA variation were isolated from placentas with no significant histological chorioamnionitis (p= 0.001). Conclusion: Ureaplasma spp. within placentas delivered late preterm (7%) is associated with histological chorioamnionitis (p = 0.001). Decreased inflammation within chorioamnion was observed when the clinical ureaplasma isolates demonstrated variation of their surface-exposed lipoproteins (MBA). This variation may be a mechanism by which ureaplasmas modulate and evade the host immune response. So whilst ureaplasmas are present intra-amniotically they are not suspected because of the normal macroscopic appearance of the placentas and the amniotic fluid.

Cultural impact on e-service use in Saudi Arabia : the need for interaction with other humans

This paper reports the results of a mixed method approach to answer: To what extent do cultural values impact on e-service use in Saudi Arabia, and if so how? This paper will firstly, introduce the importance of culture and define the aspects of Saudi culture with focus on our scope: the fear of a lack of Interaction with other Humans. It will then describe the method used and present the qualitative and quantitative findings related to the need for Interactions with other Humans. Much of the written literature about human interaction aims at Information Systems design or design improvement. Yet, this is different to what is being investigated in this study. One of the factors this study will consider is the perceived lack of interaction with other humans or the anxiety people may feel in missing the physical interaction with other people by fully moving business interaction to the virtual world. The review of the literature indicates that the impact of such factor on Information and Communication Technologies (ICT) use has not been studied. This research aims to cover this gap by investigating to what extent the fear of a lack of Interaction with other Humans, as one of Saudi Arabia’s cultural values, impacts on e-service use in Saudi Arabia. The tested hypothesis was found consistent with its predicted outcome: the fear of a lack of Interaction with other Humans is a negative predictor of intention to use e-services in Saudi Arabia. It is evidenced that consideration of the impact of the cultural values will mainly contribute to the enhancement of ICTs implementation and use.

‘Working with the team’ : an exploratory study of improved type 2 diabetes management in a new model of integrated primary/secondary care

This study aimed to explore how a new model of integrated primary/secondary care for type 2 diabetes management, the Brisbane South Complex Diabetes Service (BSCDS), related to improved diabetes management in a selected group of patients. We used a qualitative research design to obtain detailed accounts from the BSCDS via semi-structured interviews with 10 patients. The interviews were fully transcribed and systematically coded using a form of thematic analysis. Participants’ responses were grouped in relation to: (1) Patient-centred care; (2) Effective multiprofessional teamwork; and (3) Empowering patients. The key features of this integrated primary/secondary care model were accessibility and its delivery within a positive health care environment, clear and supportive interpersonal communication between patients and health care providers, and patients seeing themselves as being part of the team-based care. The BSCDS delivered patient-centred care and achieved patient engagement in ways that may have contributed to improved type 2 diabetes management in these participants.

People with ID as active participants in nursing research : a literature review.

Aim: The movement from a medical model of disability to a more social model implies an imperative to include the views of people with ID in research regarding their care. Contemporary quality processes in improving care require consumer involvement at many levels and in doing so have shown better outcomes. A New Zealand research study is being undertaken utilizing focus groups with people with ID to understand their experiences during a psychiatric inpatient admission. The primary focus of this presentation will concern the literature review, undertaken as part of the study, of research in which people with ID have participated. Method: The literature review was conducted using a variety of electronic databases and search terms to identify studies with people with ID as active participants. Results: Only a few studies have been undertaken with people with ID as participants. While these studies demonstrate numerous benefits in including the voice of the person with ID this still remains absent from much of the research discourse. Conclusion: It is accepted and indeed advocated that people with ID have the same rights as others in regard to choosing whether or not they wish to participate in research. High response rates in the few identified studies indicated that people with ID are eager to be consulted. It is recommended that the unique needs of people with ID be taken into account in the research evidence base for future services.

A longitudinal study of grieving in family caregivers of people with dementia

A longitudinal study of grieving in family caregivers of people with dementia Recent research into dementia has identified the long term impact that the role of care giving for a relative with dementia has on family members This is largely due to the cognitive decline that characterises dementia and the losses that can be directly attributed to this. These losses include loss of memories, relationships and intimacy, and are often ambiguous so that the grief that accompanies them is commonly not recognised or acknowledged. The role and impact of pre-death or anticipatory grief has not previously been widely considered as a factor influencing health and well-being of family caregivers. Studies of grief in caregivers of a relative with dementia have concluded that grief is one of the greatest barriers to care giving and is a primary determinant of caregiver well-being. The accumulation of losses, in conjunction with experiences unique to dementia care giving, place family caregivers at risk of complicated grief. This occurs when integration of the death does not take place following bereavement and has been associated with a range of negative health outcomes. The aim of this research was to determine the influence of grief, in addition to other factors representing both positive and negative aspects of the role, on the health related quality of life of family caregivers of people with dementia, prior to and following the death of their relative with dementia. An exploratory research project underpinned by a conceptual framework of caregivers’ adaptation in the context of subjective appraisal of the strains and gains in their role was undertaken. The research comprised three studies. Study 1 was a scoping study that involved a series of semi-structured interviews with thirteen participants who were family caregivers of people with severe dementia or whose relative with dementia had died in the previous twelve months. The results of this study in conjunction with factors identified in the literature informed data collection for the further studies. Study 2 was a cross sectional survey of fifty caregivers recruited when their relative was in the moderate to severe stage of dementia. This study provided the baseline data for Study 3, a prospective cohort follow up study. Study 3 consisted of seventeen participants followed up at two time points after the death of their relative with dementia: six weeks and then six months following the death of the relative with dementia. The scoping study indicated that differences in appraisal of the care giving role and encounters with health professionals were related to levels of grief of caregivers prior to and following the death of the relative with dementia. This was supported in the baseline and follow up studies. In the baseline study, after adjusting for all variables in multivariate regression models, subjective appraisal of burden was found to make a significant contribution (p<.05) to mental health related quality of life. The two dependent variables, anticipatory grief and mental health related quality of life, were significantly (p<.01) correlated at a bivariate level. In the follow up study, linear mixed modelling and multiple regression analysis of data found that subjective appraisal of burden and resilience were significantly associated (p<.05 and p<.01, respectively) with mental health related quality of life over time. In addition, bereavement and complicated grief were significantly associated (p<.05) with mental health following the death of the relative. In this study social support and satisfaction with end of life care were found to be statistically associated (p<.05) with physical health related quality of life over time. The strong relationship between grief of caregivers and their health related quality of life over the entire care giving trajectory and period following the death of their relative highlights the urgent need for further research and interventions in this area. Overall results indicate that addressing the risk and protective factors including subjective appraisal of their care giving role, resilience, social support and satisfaction with end of life care of their relative, has the potential to both ameliorate negative health outcomes and to promote improved health for these caregivers. This research provides important information for development of targeted and appropriate interventions that aim to promote resilience and reduce the personal burden on caregivers of people with dementia.

Taka 'i fonua mahu : being Tongan; second generation Tongan migrants

Taka ‘i fonua mahu is a Tongan proverb, which means: "Going about or living in a fruitful land". This thesis analyses the experiences and impacts on migration on being Tongan, particularly Tongan youth in an adopted fruitful land, South East Queensland. The thesis argues that being Tongan in Tonga, has new meaning in the diaspora because of remittances, job prospects, educational opportunity, adapting to a multicultural society, and social justice. These issues are revealed by comparisons made with the experiences of the first generation Tongan migrants, and second generation Tongan migrants, as well as those in New Zealand and America. It argues that the Church, the family and kainga (extended family) impact on the anga fakatonga (Tongan way) and the essence of community as experienced by the first and second generation Tongan migrants. The framework for this analysis is a study of transnationalism, and being Tongan as it is maintained and changed in the diaspora.

Are we missing opportunities? Understanding health behaviours associated with overweight in pregnancy

While maternal obesity, excess pregnancy weight gain and lifestyle behaviours are associated with future overweight for both mothers and babies, there is limited research on how best to intervene. An evidence base that identifies behavioural influences is crucial to the development of effective interventions. This thesis aims to gain an understanding of maternal behavioural outcomes of healthy eating, physical activity and gestational weight gain (GWG), the psychosocial influences on these and to examine differences according to pre-pregnancy weight status. The New Beginnings Healthy Mothers and Babies Study was a prospective observational study using the PRECEDE-PROCEED model of health promotion planning as a framework. A consecutive sample of 715 women was recruited. Height and weight were measured and women completed questionnaires at approximately 16 and 36 weeks gestation. This thesis presents three chapters of original research across four study domains. While healthy eating was widely regarded as important during pregnancy and had become more so, there was more variability in attitudes towards physical activity. Ninety-two percent of participants achieved the maximum knowledge score relating to the influence of nutrition on pregnancy. However, 8% and 36% respectively knew how many serves of fruit and vegetables should be consumed daily. Six percent of participants met the recommendations for fruit consumption, 4% achieved the recommended vegetable intake and 44% achieved sufficient physical activity. There were few differences between healthy and overweight women for measures of physical activity and healthy eating. Many predisposing, reinforcing and enabling factors with a positive influence on health behaviours were lower in women commencing pregnancy overweight and those factors with a negative influence on health behaviours were higher when compared to healthy weight women. Some of these antecedents to health behaviours that were different according to prepregnancy weight status were associated with diet quality and physical activity. While self efficacy was consistently associated with diet quality and physical activity for both weight groups, other associations between specific predisposing, reinforcing and enabling factors differed with behaviour and weight status group. These results highlight the complexity of supporting behaviour change in a one-size-fits-all approach. Sixty-four percent of participants gained weight outside of recommendations. Compared to healthy weight women, those women who were already overweight at the beginning of pregnancy were more likely to gain too much weight (30% vs 56%, p<0.001). Only 35% of participants reported their correct recommended weight gain. Excess GWG was associated with few predisposing factors, however, these were not consistent between prepregnancy weight status groups. Less than 50% of women reported sometimes/usually/always receiving advice from health professionals relating to healthy eating, physical activity or GWG. These results indicate that there are opportunities to improve the advice and support provided by health care professionals in the antenatal period. Evidence from this PhD research suggests that there is a need for effective prevention and management of excess weight in pregnancy. Effective management of this problem is likely to require a multidisciplinary approach with multi-level strategies. Importantly, the strategies may need to be tailored according to pre-pregnancy weight status. Collectively, the evidence derived from this thesis suggests that opportunities to support healthy lifestyles and prevent future overweight are being missed during pregnancy.

Mathematical modelling of tumour growth and interaction with host tissue and the immune system

In this thesis, three mathematical models describing the growth of solid tumour incorporating the host tissue and the immune system response are developed and investigated. The initial model describes the dynamics of the growing tumour and immune response before being extended in the second model by introducing a time-varying dendritic cell-based treatment strategy. Finally, in the third model, we present a mathematical model of a growing tumour using a hybrid cellular automata. These models can provide information to pre-experimental work to assist in designing more effective and efficient laboratory experiments related to tumour growth and interactions with the immune system and immunotherapy.

Pseudo-marginal algorithms with multiple CPUs

The emergence of pseudo-marginal algorithms has led to improved computational efficiency for dealing with complex Bayesian models with latent variables. Here an unbiased estimator of the likelihood replaces the true likelihood in order to produce a Bayesian algorithm that remains on the marginal space of the model parameter (with latent variables integrated out), with a target distribution that is still the correct posterior distribution. Very efficient proposal distributions can be developed on the marginal space relative to the joint space of model parameter and latent variables. Thus psuedo-marginal algorithms tend to have substantially better mixing properties. However, for pseudo-marginal approaches to perform well, the likelihood has to be estimated rather precisely. This can be difficult to achieve in complex applications. In this paper we propose to take advantage of multiple central processing units (CPUs), that are readily available on most standard desktop computers. Here the likelihood is estimated independently on the multiple CPUs, with the ultimate estimate of the likelihood being the average of the estimates obtained from the multiple CPUs. The estimate remains unbiased, but the variability is reduced. We compare and contrast two different technologies that allow the implementation of this idea, both of which require a negligible amount of extra programming effort. The superior performance of this idea over the standard approach is demonstrated on simulated data from a stochastic volatility model.