Analysing Seasonal Health Data

Seasonal patterns have been found in a remarkable range of health conditions, including birth defects, respiratory infections and cardiovascular disease. Accurately estimating the size and timing of seasonal peaks in disease incidence is an aid to understanding the causes and possibly to developing interventions. With global warming increasing the intensity of seasonal weather patterns around the world, a review of the methods for estimating seasonal effects on health is timely. This is the first book on statistical methods for seasonal data written for a health audience. It describes methods for a range of outcomes (including continuous, count and binomial data) and demonstrates appropriate techniques for summarising and modelling these data. It has a practical focus and uses interesting examples to motivate and illustrate the methods. The statistical procedures and example data sets are available in an R package called ‘season’. Adrian Barnett is a senior research fellow at Queensland University of Technology, Australia. Annette Dobson is a Professor of Biostatistics at The University of Queensland, Australia. Both are experienced medical statisticians with a commitment to statistical education and have previously collaborated in research in the methodological developments and applications of biostatistics, especially to time series data. Among other projects, they worked together on revising the well-known textbook "An Introduction to Generalized Linear Models," third edition, Chapman Hall/CRC, 2008. In their new book they share their knowledge of statistical methods for examining seasonal patterns in health.

Stroke education : promising effects on the health beliefs of those at risk

Background: The effect of patient education on reducing stroke has had mixed effects, raising questions about how to achieve optimal benefit. Because past evaluations have typically lacked an appropriate theoretical base, the design of past research may have missed important effects. --------- Method: This study used a social cognitive framework to identify variables that might change in response to education. A mixed design was used to evaluate two approaches to an intervention, both of which included education. Fifty seniors completed a measure of stroke knowledge and beliefs twice: before and after an intervention that was either standard (educational brochure plus activities that were not about stroke) or enhanced (educational brochure plus activities designed to enhance beliefs about stroke). Outcome measures were health beliefs, intention to exercise to reduce stroke, and stroke knowledge. --------- Results: Selected beliefs changed significantly over time but not differentially across conditions. Beliefs that changed were (a) perceived susceptibility to stroke and (b) perceived benefit of exercise to reduce risk. Benefit beliefs, in particular, were strongly and positively associated with intention to exercise. -------- Conclusion: Findings suggest that basic approaches to patient education may influence health beliefs. More effective stroke prevention programs may result from continued consideration of the role of health beliefs in such programs.

The Exeter Hip. 40 Years of Innovation in Total Hip Arthroplasty

* Propoerties and use of acrylic cement * Design and biomechaniscs of a cemented hip replacement * The science of loosening, lysis and wear * Preparation of patients for surgery * Potential complications and their avoidance * Modern primary surgical techniques and new developments * Complex primary hip replacement and specialist techniques * Outcomes of cemented hip replacement * Principles of revision hip replacement * Basic science of bone grafting in revision surgery * Femoral acetabular impaction bone grafting techniques * Results of revision with bone graft and cement

National Aboriginal and Torres Strait Islander women's health strategy

The Strategy presented in this report was developed through the Australian Women’s Health Network Talking Circle in 2009-2010. Over 400 Aboriginal and Torres Strait Islander women were involved in the consultations. The Action Areas and Recommendations presented in this Strategy were raised and discussed by the women who contributed to the Talking Circle. This Strategy is not intended to replace any other national or state/territory identified priorities or needs. Instead, this Strategy supplements other work. Aboriginal and Torres Strait Islander women experience extremely poor health outcomes. They have a right to determine for themselves what their health system will look like. This Strategy is part of that process. If Aboriginal and Torres Strait Islander women continue to have their sense of identity marginalised and eroded, they will continue to have the poorest health of any group of women in Australian society.

The mechanical response of the ovine lumbar anulus fibrosus to uniaxial, biaxial and shear loads

Analytical and computational models of the intervertebral disc (IVD) are commonly employed to enhance understanding of the biomechanics of the human spine and spinal motion segments. The accuracy of these models in predicting physiological behaviour of the spine is intrinsically reliant on the accuracy of the material constitutive representations employed to represent the spinal tissues. There is a paucity of detailed mechanical data describing the material response of the reinforced­ground matrix in the anulus fibrosus of the IVD. In the present study, the ‘reinforced­ground matrix’ was defined as the matrix with the collagen fibres embedded but not actively bearing axial load, thus incorporating the contribution of the fibre-fibre and fibre-matrix interactions. To determine mechanical parameters for the anulus ground matrix, mechanical tests were carried out on specimens of ovine anulus, under unconfined uniaxial compression, simple shear and biaxial compression. Test specimens of ovine anulus fibrosus were obtained with an adjacent layer of vertebral bone/cartilage on the superior and inferior specimen surface. Specimen geometry was such that there were no continuous collagen fibres coupling the two endplates. Samples were subdivided according to disc region - anterior, lateral and posterior - to determine the regional inhomogeneity in the anulus mechanical response. Specimens were loaded at a strain rate sufficient to avoid fluid outflow from the tissue and typical stress-strain responses under the initial load application and under repeated loading were determined for each of the three loading types. The response of the anulus tissue to the initial and repeated load cycles was significantly different for all load types, except biaxial compression in the anterior anulus. Since the maximum applied strain exceeded the damage strain for the tissue, experimental results for repeated loading reflected the mechanical ability of the tissue to carry load, subsequent to the initiation of damage. To our knowledge, this is the first study to provide experimental data describing the response of the ‘reinforced­ground matrix’ to biaxial compression. Additionally, it is novel in defining a study objective to determine the regionally inhomogeneous response of the ‘reinforced­ground matrix’ under an extensive range of loading conditions suitable for mechanical characterisation of the tissue. The results presented facilitate the development of more detailed and comprehensive constitutive descriptions for the large strain nonlinear elastic or hyperelastic response of the anulus ground matrix.

Sustained release and osteogenic potential of heparan sulfate-doped fibrin glue scaffolds within a rat cranial model

This paper explores the potential therapeutic role of the naturally occurring sugar heparan sulfate (HS) for the augmentation of bone repair. Scaffolds comprising fibrin glue loaded with 5 lg of embryonically derived HS were assessed, firstly as a release-reservoir, and secondly as a scaffold to stimulate bone regeneration in a critical size rat cranial defect. We show HS-loaded scaffolds have a uniform distribution of HS, which was readily released with a typical burst phase, quickly followed by a prolonged delivery lasting several days. Importantly, the released HS contributed to improved wound healing over a 3-month period as determined by microcomputed tomography (lCT) scanning, histology, histomorphometry, and PCR for osteogenic markers. In all cases, only minimal healing was observed after 1 and 3 months in the absence of HS. In contrast, marked healing was observed by 3 months following HS treatment, with nearly full closure of the defect site. PCR analysis showed significant increases in the gene expression of the osteogenic markers Runx2, alkaline phosphatase, and osteopontin in the heparin sulfate group compared with controls. These results further emphasize the important role HS plays in augmenting wound healing, and its successful delivery in a hydrogel provides a novel alternative to autologous bone graft and growth factorbased therapies.

Human osteoblast cell spreading and vinculin expression upon biomaterial surfaces

Any biomaterial implanted within the human body is influenced by the interactions that take place between its surface and the surrounding biological milieu. These interactions are known to influence the tissue interface dynamic, and thus act to emphasize the need to study cell-surface interactions as part of any biomaterial design process. The work described here investigates the relationship between human osteoblast attachment, spreading and focal contact formation on selected surfaces using immunostaining and digital image processing for vinculin, a key focal adhesion component. Our observations show that a relationship exists between levels of cell attachment, the degree of vinculin-associated plaque formation and biocompatibility. It also suggests that cell adhesion is not indicative of how supportive a substrate is to cell spreading, and that cell spreading

The osteogenic differentiation of adipose tissue-derived precursor cells in A 3D scaffold/matrix environment

Abstract: This paper details an in-vitro study using human adipose tissue-derived precursor/stem cells (ADSCs) in three-dimensional (3D) tissue culture systems. ADSCs from 3 donors were seeded onto NaOH-treated medical grade polycaprolactone-tricalcium phosphate (mPCL-TCP) scaffolds with two different matrix components; fibrin glue and lyophilized collagen. ADSCs within these scaffolds were then induced to differentiate along the osteogenic lineage for a 28-day period and various assays and imaging techniques were performed at Day 1, 7, 14, 21 and 28 to assess and compare the ADSC’s adhesion, viability, proliferation, metabolism and differentiation along the osteogenic lineage when cultured in the different scaffold/matrix systems. The ADSC cells were proliferative in both collagen and fibrin mPCL-TCP scaffold systems with a consistently higher cell number (by comparing DNA amounts) in the induced group over the non-induced groups for both scaffold systems. In response to osteogenic induction, these ADSCs expressed elevated osteocalcin, alkaline phosphatase and osteonectin levels. Cells were able to proliferate within the pores of the scaffolds and form dense cellular networks after 28 days of culture and induction. The successful cultivation of osteogenic by FDM process manufactured ADSCs within a 3D matrix comprising fibrin glue or collagen, immobilized within a robust synthetic scaffold is a promising technique which should enhance their potential usage in the regenerative medicine arena, such as bone tissue engineering.

Health, endogenous time preference, and inequality : a political economy perspective

We study an overlapping-generations model in which agents' mortality risks, and consequently impatience, are endogenously determined by private and public investment in health care. Revenues allocated for public health care arc determined by a voting process. We find that the degree of substitutability between public and private health expenditures matters for macroeconomic outcomes of the model. Higher substitutability implies a “crowding-out" effect, which in turn impacts adversely on morality risks and impatience leading to lower public expenditures on health care in the political equilibrium. Consequently, higher substitutability is associated with greater polarization in wealth, and long-run distributions that are bimodal.

Lifting the lifegiving dollar : case samples of creative practice in health and medical research philanthropy

This study aims to stimulate thought, debate and action for change on this question of more vigorous philanthropic funding of Australian health and medical research (HMR). It sharpens the argument with some facts and ideas about HMR funding from overseas sources. It also reports informed opinions from those working, giving and innovating in this area. It pinpoints the range of attitudes to HMR giving, both positive and negative. The study includes some aspects of Government funding as part of the equation, viewing Government as major HMR givers, with particular ability to partner, leverage and create incentives. Stimulating new philanthropy takes active outreach. The opportunity to build more dialogue between the HMR industry and the wider community is timely given the ‘licence to practice’ issues and questioned trust that applies currently somewhat both to science and to the charitable sector. This interest in improving HMR philanthropy also coincides with the launch last year by the Federal Government of Nonprofit Australia Limited (NAL), a group currently assessing infrastructure improvements to the charitable sector. History suggests no one will create this change if Research Australia does not. However, interest in change exists in various quarters. For Research Australia to successfully change the culture of Australian HMR giving, the process will drive the outcomes. Obviously stakeholder buy-in and partners will be needed and the ultimate blueprint for greater philanthropic HMR funding here will not be this document. Instead it will be the one that wears the handprint and ‘mindprint’ of the many architects and implementers interested in promoting HMR philanthropy, from philanthropists to nonprofit peaks to government policy arms. As the African proverb says, ‘If you want to go fast, go alone; but if you want to go far, go with others’.

25th anniversary of BUA for the assessment of osteoporosis : time for a new paradigm?

The measurement of broadband ultrasonic attenuation (BUA) in cancellous bone at the calcaneus for the assessment of osteoporosis was first described within this journal 25 years ago. It was recognized in 2006 by Universities UK as being one of the ‘100 discoveries and developments in UK Universities that have changed the world’ over the past 50 years. In 2008, the UK's Department of Health also recognized BUA assessment of osteoporosis in a publication highlighting 11 projects that have contributed to ‘60 years of NHS research benefiting patients’. The BUA technique has been extensively clinically validated and is utilized worldwide, with at least seven commercial systems currently providing calcaneal BUA measurement. However, there is still no fundamental understanding of the dependence of BUA upon the material and structural properties of cancellous bone. This review aims to provide an ‘engineering in medicine’ perspective and proposes a new paradigm based upon phase cancellation due to variation in propagation transit time across the receive transducer face to explain the non-linear relationship between BUA and bone volume fraction in cancellous bone.

The role of social capital in reducing negative health outcomes among police officers

This paper investigates the role of social capital on the reduction of short and long run negative health effects associated with stress, as well as indicators of burnout among police officers. Despite the large volume of research on either social capital or the health effects of stress, the interaction of these factors remains an underexplored topic. In this empirical analysis we aim to reduce such a shortcoming focusing on a highly stressful and emotionally draining work environment, namely law enforcement agents who perform as an essential part of maintaining modern society. Using a multivariate regression analysis focusing on three different proxies of health and three proxies for social capital conducting also several robustness checks, we find strong evidence that increased levels of social capital is highly correlated with better health outcomes. Additionally we observe that while social capital at work is very important, social capital in the home environment and work-life balance are even more important. From a policy perspective, our findings suggest that work and stress programs should actively encourage employees to build stronger social networks as well as incorporate better working/home life arrangements.

Strategic directions report for the social determinants of health project

This report presents the outcomes of a project undertaken by the VACCHO Public Health Research Unit to explore ways to build capacity in Aboriginal and Torres Strait Islander social determinants research. The project was funded by the Cooperative Research Centre for Aboriginal Health.----- The project involved a series of four social determinants research workshops conducted in July and August 2009 and a collaborative forum conducted in September 2009. Invitations to participate were extended to the VACCHO membership and the nine universities in Victoria. Three workshops were held with ACCHOs (in Bendigo, Melbourne and Gippsland), and one workshop with universities (in Melbourne).----- The workshops aimed to build VACCHO’s social determinants research capacity and provide direction for VACCHO on ways to more effectively engage in Aboriginal health research. Through the workshops, VACCHO aimed to work with ACCHOs to identify research processes and issues that are equitable and sustainable, and which address the social determinants of health.----- At the workshops, participants explored questions around the priorities for the social determinants of Aboriginal health and considered the key partnerships that might be important to social determinants research.----- At the workshops with ACCHOs, participants identified key research priorities and questions in Aboriginal social determinants and health. This focus reflects the need for Aboriginal and Torres Strait Islander community representatives to identify the priorities in health and social determinants research. Identifying these priorities is important if researchers are to respond in a meaningful way and undertake relevant research in the most urgent areas of need. At the university workshop, participants focused on identifying research process and implementation issues in social determinants research.----- The final forum brought together ACCHOs, university representatives, invited presenters and participants from justice, education and housing departments, and representatives from non-government funding organisations. The forum aimed to provide an insight into how priorities and funding decisions are made, and how research can help to ensure they are influenced by the priorities of the community. The findings from the workshops were presented at the forum and used to develop pathways for future research.

How Australia’s Indigenous people are positioned within health service sites by our presence and by our absence

De Certeau (1984) constructs the notion of belonging as a sentiment which develops over time through the everyday activities. He explains that simple everyday activities are part of the process of appropriation and territorialisation and suggests that over time belonging and attachment are established and built on memory, knowledge and the experiences of everyday activities. Based on the work of de Certeau, non-Indigenous Australians have developed attachment and belonging to places based on the dispossession of Aboriginal people and on their everyday practices over the past two hundred years. During this time non-Indigenous people have marked their appropriation and territorialisation with signs, symbols, representations and images. In marking their attachment, they also define how they position Australia’s Indigenous people by both our presence and our absence. This paper will explore signs and symbols within spaces and places in health services and showcase how they reflect the historical, political, cultural, social and economic values, and power relations of broader society. It will draw on the voices of Aboriginal women to demonstrate their everyday experiences of such sites. It will conclude by highlighting how Aboriginal people assert their identities and un-ceded sovereignty within such health sites and actively resist on-going white epistemological notions of us and the logic of patriarchal white sovereignty.

Mildura, Victoria : Aboriginal health promotion short course

The Victorian Aboriginal Community Controlled Health Organisation’s (VACCHO) Public Health and Research Unit delivered an Aboriginal Health Promotion Short Course in Mildura in 2009. ----- The VACCHO delivered Aboriginal Health Promotion Short Course included current health promotion theory and practice as it specifically relates to Aboriginal people within Victoria. As Aboriginal people have a higher risk of cardiovascular disease and type 2 diabetes, the course specifically addressed risk factors for chronic disease including smoking, physical activity, nutrition and mental health and well-being. Hence, a key part of the course involved participants working in groups to plan a health promotion program for one of the key health issues- smoking, physical activity and nutrition, or spiritual health and wellbeing. The aim is for participants to use these programs in their daily work with Aboriginal clients.