Age-specific trends in cardiovascular mortality rates in Australia between 1980 and 2005

Aim: Recent analyses suggest the decline in coronary heart disease (CHD) mortality rates is slowing in younger age groups in countries such as the UK and US. We aimed to assess recent mortality rate trends in all circulatory disease and its subtypes in Australia.

Methods: Annual all circulatory, CHD, and cerebrovascular disease mortality rates between 1980 and 2005 for Australia were analysed. Data were stratified by sex and ten-year age group (age 35 to 85+). The annual rate of change and significant changes in trends were identified using joinpoint Poisson regression.

Results: Age standardised all circulatory disease mortality rates continue to decline in Australia, falling from 441 per 100,000 in 1980 to 145 per 100,000 in 2005 for males and from 264 per 100,000 to 96 per 100,000 for females. The rate of decline from both CHD and cerebrovascular disease appears to be stable or accelerating for individuals aged 55 years and over. However, the decline in young men and women aged 35-54 years is slowing for CHD and cerebrovascular disease mortality alike (except cerebrovascular disease mortality in males aged 35-44). For females aged 35-44 and 45-54 there has been no change in the cerebrovascular mortality rate since 1993 and 1999, respectively.

Conclusions: In Australia, whilst in older adults the decline in cardiovascular mortality rates is generally accelerating, in younger adults it appears to be slowing. It will be important to identify the causes of these trends.

Effects of continuity of care by a primary midwife (caseload midwifery) on caesarean section rates in women of low obstetric risk : the COSMOS randomised controlled trial

Objective  To determine whether primary midwife care (caseload midwifery) decreases the caesarean section rate compared with standard maternity care.

Design  Randomised controlled trial.

Setting  Tertiary-care women’s hospital in Melbourne, Australia.

Population  A total of 2314 low-risk pregnant women.

Methods  Women randomised to caseload received antenatal, intrapartum and postpartum care from a primary midwife with some care by ‘back-up’ midwives. Women randomised to standard care received either midwifery or obstetric-trainee care with varying levels of continuity, or community-based general practitioner care.

Main outcome measures  Primary outcome: caesarean birth. Secondary outcomes included instrumental vaginal births, analgesia, perineal trauma, induction of labour, infant admission to special/neonatal intensive care, gestational age, Apgar scores and birthweight.

Results  In total 2314 women were randomised–1156 to caseload and 1158 to standard care. Women allocated to caseload were less likely to have a caesarean section (19.4% versus 24.9%; risk ratio [RR] 0.78; 95% CI 0.67–0.91; P = 0.001); more likely to have a spontaneous vaginal birth (63.0% versus 55.7%; RR 1.13; 95% CI 1.06–1.21; P < 0.001); less likely to have epidural analgesia (30.5% versus 34.6%; RR 0.88; 95% CI 0.79–0.996; P = 0.04) and less likely to have an episiotomy (23.1% versus 29.4%; RR 0.79; 95% CI 0.67–0.92; P = 0.003). Infants of women allocated to caseload were less likely to be admitted to special or neonatal intensive care (4.0% versus 6.4%; RR 0.63; 95% CI 0.44–0.90; P = 0.01). No infant outcomes favoured standard care.

Conclusion  In settings with a relatively high baseline caesarean section rate, caseload midwifery for women at low obstetric risk in early pregnancy shows promise for reducing caesarean births.

Age-specific trends in cardiovascular mortality rates in the Netherlands between 1980 and 2009

Recent analyses suggest the decline in coronary heart disease mortality rates is slowing in younger age groups in countries such as the US and the UK. This work aimed to analyse recent trends in cardiovascular mortality rates in the Netherlands. Analysis was of annual all circulatory, ischaemic heart disease (IHD), and cerebrovascular disease mortality rates between 1980 and 2009 for the Netherlands. Data were stratified by sex and 10-year age group (age 35–85+). The annual rate of change and significant changes in the trend were identified using joinpoint Poisson regression. For almost all age and sex groups examined the rate of IHD and cerebrovascular disease mortality in the Netherlands has more than halved between 1980 and 2009. The decline in mortality from both IHD and cerebrovascular disease is continuing for all ages and sex groups, with anacceleration in the decline apparent from the late 1990s/early 2000s. The decline in age-specific all circulatory, coronary heart disease and cerebrovascular disease mortality rates continues for all age and sex groups in the Netherlands.

The impact of climate variability and change on cryptosporidiosis and giardiasis rates in New Zealand

Aim: To investigate the spatial relationship between climate variability and cryptosporidiosis and giardiasis notifications in New Zealand between 1997 and 2006.

Methods: Negative binomial regression was used to analyse spatial relationships between cryptosporidiosis and giardiasis notifications in New Zealand between 1997 and 2006, and climatological average rainfall and temperature at the Census Area Unit (CAU) level. The quality of domestic water supplies, urban-rural status and deprivation were included as covariates.

Main results: Giardiasis: There was a positive association between rainfall and giardiasis and between temperature and giardiasis.

Cryptosporidiosis: There was a positive association between rainfall and cryptosporidiosis and a negative association between temperature and cryptosporidiosis. The effect of rainfall was modified by the quality of the domestic water supply.

Conclusions: These findings suggest that climate variability affects protozoan disease rates in New Zealand. However, predicting the effect of climate change from this study is difficult, as these results suggest that the projected increases in temperature and rainfall may have opposing effects on cryptosporidiosis rates. Nevertheless, water supply quality appeared to modify the impact of increased rainfall on cryptosporidiosis rates. This finding suggests that improving water supply quality in New Zealand could reduce vulnerability to the impact of climate change on protozoan diseases.

Predators select against high growth rates and risk-taking behaviour in domestic trout populations

Domesticated (farm) salmonid fishes display an increased willingness to accept risk while foraging, and achieve high growth rates not observed in nature. Theory predicts that elevated growth rates in domestic salmonids will result in greater risk–taking to access abundant food, but low survival in the presence of predators. In replicated whole–lake experiments, we observed that domestic trout (selected for high growth rates) took greater risks while foraging and grew faster than a wild strain. However, survival consequences for greater growth rates depended upon the predation environment. Domestic trout experienced greater survival when risk was low, but lower survival when risk was high. This suggests that animals with high intrinsic growth rates are selected against in populations with abundant predators, explaining the absence of such phenotypes in nature. This is, to our knowledge, the first large–scale field experiment to directly test this theory and simultaneously quantify the initial invasibility of domestic salmonid strains that escape into the wild from aquaculture operations, and the ecological conditions affecting their survival.

Behavioural trade-offs between growth and mortality explain evolution of submaximal growth rates

1. The importance of body size and growth rate in ecological interactions is widely recognized, and both are frequently used as surrogates for fitness. However, if there are significant costs associated with rapid growth rates then its fitness benefits may be questioned.

2. In replicated whole-lake experiments, we show that a domestic strain of rainbow trout (artificially selected for maximum intrinsic growth rate) use productive but risky habitats more than wild trout. Consequently, domestic trout grow faster in all situations, experience greater survival in the absence of predators, but have lower survival in the presence of predators. Therefore, rapid growth rates are selected against due to increased foraging effort (or conversely, lower antipredator behaviour) that increases vulnerability to predators. In other words, there is a behaviourally mediated trade-off between growth and mortality rates.

3. Whereas rapid growth is beneficial in many ecological interactions, our results show the mortality costs of achieving it are large in the presence of predators, which can help explain the absence of an average phenotype with maximized growth rates in nature.

Conducting field research in a primary school setting : methodological considerations for maximizing response rates, data quality and quantity

Background: Schools are an ideal setting in which to involve children in research. Yet for investigators wishing to work in these settings, there are few method papers providing insights into working efficiently in this setting.

Objective: The aim of this paper is to describe the five strategies used to increase response rates, data quality and quantity in the TRansport Environment and Kids (TREK) project.

Setting: The TREK project examined the association between neighbourhood urban design and active transport in Grade 5–7 school children (n = 1480) attending 25 primary schools in metropolitan Perth, Western Australia during 2007.

Method: Children completed several survey components during school time (i.e. questionnaire, mapping activity, travel diary and anthropometric measurements) and at home (i.e. pedometer study, parent questionnaire).

Results: Overall, 69.4% of schools and 56.6% of children agreed to participate in the study and, of these, 89.9% returned a completed travel diary, 97.8% returned their pedometer and 88.8% of parents returned their questionnaire. These return rates are superior to similar studies. Five strategies appeared important: (1) building positive relationships with key school personnel; (2) child-centred approaches to survey development; (3) comprehensive classroom management techniques to standardize and optimize group sessions; (4) extensive follow-up procedures for collecting survey items; and (5) a specially designed data management/monitoring system.

Conclusion: Sharing methodological approaches for obtaining high-quality data will ensure research opportunities within schools are maximized. These methodological issues have implications for planning, budgeting and implementing future research.

Measurement and solutions to thermal comfort, CO2 and ventilation rates in schools

An Australian research facility, conducted a study on several different school classrooms in regards to their thermal comfort, CO2 levels, air temperature stratification and ventilation rates in a selection of Victorian (Melbourne, Australia) schools during a winter season. A brief literature review reveals similar IAQ problems elsewhere (outside Australia) and suggests several HVAC concepts that provide potential solutions. Our intention is to highlight particular IAQ discrepancies in existing school classroom design resulting from these case study measurements, suggesting construction and mechanical operational conditioning improvements.In particular this research confirms the urgency and necessity of addressing IAQ problems in schools, world wide. Our results of the Australian school classroom measurements are similar to other parts of the world, indicating that CO2 levels, ventilation rates and air temperatures are non-compliant with the standards.

Probability distributions of number of children and maternal age at various order births using age-specific fertility rates by birth order

In this study, a simple analytical framework to find the probability distributions of number of children and maternal age at various order births by making use of data on age-specific fertility rates by birth order was proposed. The proposed framework is applicable to both the period and cohort fertility schedules. The most appealing point of the proposed framework is that it does not require stringent assumptions. The proposed framework has been applied to the cohort birth order-specific fertility schedules of India and its different regions and period birth order-specific fertility schedules, including the United States of America, Russia, and the Netherlands, to demonstrate its usefulness.