Transferring community-based interventions to new settings: a case study in heart health cholesterol testing from urban USA to rural Australia

Health promoters wishing to successfully replicate community-basedheart health interventions from major research and demonstrationprograms, face numerous obstacles in the adoption process. Unfortunately,there is little specific literature to guide them through theprocess. A case study is presented to demonstrate that by closelyexamining differences between the resources and user settingsin terms of geography, socio-demography, policy, organizationalstructure and perceived goals, health promoters can identifyand avoid failure points. We examine the transfer and adaptionof a cholesterol intervention from Pawtucket Heart Health Programin urban USA to a rural setting in Australia and we recommenda series of five logical steps when considering such adoptions.Process data from the adapted intervention, North Coast CholesterolCheck campaign, indicates that it is as successful as its counterpartin the USA. The new intervention his itself become a model programin Australia. This success can be largely attributed to theconsiderable planning effort which made it possible to modifythe organizational structure to accept an innovative strategyand also to tailor the resource program for an ideal fit tothe new user setting.     

Social capital and adherence to cervical and breast cancer screening guidelines: a cross‐sectional study in rural Crete

Breast and cervical cancers are among the leading causes of female mortality. The reasons that make women adhere, or not, to screening guidelines are not only related to individual and health characteristics but are also placed in a wider social and cultural context. Social capital might facilitate the dissemination of relevant knowledge of and the adherence to cancer screening guidelines. This cross‐sectional study explored the associations of individual‐level social capital with breast and cervical cancer screening and the knowledge for the existence of relevant screening tests (Pap test and mammography) in the municipality of Gorgolaini, a rural area in Crete, Greece. A random sample of 131 of the 592 women of the 2001 electoral register were invited to participate in the study and 125 completed the Social Capital Questionnaire and two questions on self‐reported health knowledge and behaviour (participation rate 95.4%). Women were eligible to participate if they were aged 35–75, had lived in the area for the last 10 years and were of Greek origin. Multiple logistic regressions were performed to establish associations among each social capital factor (total, participation in the community, value of life, tolerance for diversity, feelings of safety, family/friends connections) and knowledge of and adherence to breast and cervical cancer screening guidelines after adjustment for confounders. Our results suggest that early detection of breast and cervical cancers may be facilitated when taking into account the social context of the population.     

Physical activity and body mass shape quality of life trajectories in mid‐age women

Objective: To determine the combined longitudinal effect of body mass index (BMI) and physical activity (PA) on health‐related quality of life (HrQoL), using the SF‐6D (SF‐36) utility measure. Methods: Five waves of self‐reported data from the 1946–51 cohort (n=5,200; data collection, 2001–2013) of the Australian Longitudinal Study on Women’s Health were used. Mixed effect models were employed to address the objective. Results: Women with high PA experienced higher HrQoL regardless of BMI group, however, for those healthy or overweight, there was a very small decline in HrQoL over time. Women reporting no PA levels experienced the lowest baseline mean SF‐6D score within each BMI group, with decreasing trajectories over the follow‐up period. The rate of decline was greatest in women with obesity. Within each BMI group, there was a large, increasing gap in HrQoL between those who reported no and low PA over time. Women with obesity and high PA experienced similar HrQoL trajectories to women with normal weight or overweight with low PA levels. Overweight women with moderate PA experienced similar HrQoL to those with low PA but normal weight. Conclusions: PA may mitigate the adverse effect of overweight and obesity on HrQoL at mid‐life, at higher activity levels. Implications for public health: PA benefits HrQoL regardless of body mass, with larger gains for those currently not physically active. Moderate to high PA may mitigate the effect of overweight and obesity.     

Falls from ladders in Australia: comparing occupational and non‐occupational injuries across age groups

Objective : To examine national ladder‐related fall injury patterns and trends, and compare the changes over time in occupational and non‐occupational falls across age groups. Methods : Analysis of national hospital morbidity data to examine trends over time and differences between groups. Results : There were 41,092 hospitalised falls from ladders in Australia over the ten year period from July 2002 to June 2012, rising from 3,374 hospitalisations in 2002/03 to 4,945 hospitalisations in 2011/12. The age standardised rate of ladder‐related fall hospitalisations rose significantly for males, and a higher increase was evident in people aged over 60 years. Occupational falls accounted for 20% of hospitalisations, and the hospitalisation rate for both occupational and non‐occupational falls increased significantly over the ten year period. Conclusions : With almost 5,000 hospital admissions per year in recent years and a significant rise in the rate of hospitalisations over the past decade, this paper highlights the importance of focusing injury prevention efforts to reduce the growing number of ladder‐related falls. Implications : This study demonstrates the significant burden that ladder‐related falls are continuing to have on the community, both in the occupational and domestic setting.     

Primary health care for Aboriginal women and children in the year after birth: findings from a population‐based study in South Australia

Objective: To investigate the extent to which Aboriginal women access primary care for themselves and their infant in the year after childbirth. Method: Cross sectional population‐based survey of women giving birth to Aboriginal babies in South Australia between July 2011 and June 2013. Results: A total of 344 women took part in the study 4–9 months after giving birth. The majority had seen a primary health care practitioner since the birth: 86% had seen a Child and Family Health Service (CaFHS) nurse, 81% a general practitioner (GP), and 61% an Aboriginal health worker (AHW). Women living in remote areas were more likely to have seen primary care practitioners than women living in Adelaide (GP: OR 2.3, 95% CI 1.0–5.2; CaFHS: OR 2.4, 95% CI 1.0–5.8; AHW: OR 5.2, 95% CI 2.8–9.8). Around 16% of women with gestational diabetes and 10% with hypertension had not seen a GP since the birth, and 24% of women who had a low birthweight infant had not seen a CaFHS nurse. Conclusions: Despite high prevalence of maternal and infant morbidity, a sizeable minority of women did not access primary care practitioners postpartum. Implications for public health: Stronger efforts are needed to ensure Aboriginal women and families receive appropriate postnatal follow‐up.     

Exploring breast cancer screening barriers among Barbadian women: a focus group study of mammography in a resource-constrained setting

Breast cancer affects women worldwide. Early detection strategies, notably mammography, aim to reduce mortality from breast cancer. However, mammography is a costly screening tool, generates controversy in terms of its impact and adverse effects, and its uptake remains low among some populations. This qualitative study (12 focus groups with 110 participants) explored experiences with mammography among Barbadian women by investigating how barriers are negotiated in a setting of resource-constrained health care provision without a national screening programme. The study findings indicate that, firstly, Barbadian women have to actively seek understanding of both breast cancer and the mammography process. Women described how, with little public awareness and knowledge, they borrow from available public health information on diabetes and HIV/AIDS to give meaning to mammographic screening. Secondly, many women expressed their fear about mammography and its potential consequences, such as experiencing social stigma and losing a romantic relationship after diagnosis. Thirdly, the cost of screening for women who opted for the more reliable private facilities was discussed, along with the potential cost of health care following a diagnosis and the emotional cost of enduring the societal taboo of breast cancer. If breast cancer screening is to be acceptable for this or similar populations, there should be provision of additional services to ensure better access to free screening or alternative strategies, as well as post-diagnostic social and financial support. The policies to develop these services must also address women’s concerns about screening and breast cancer, and provide comprehensive information to allow informed decisions about screening.     

Effectiveness of probiotics for preventing infections in the elderly: Systematic review and meta‐analysis – study protocol

Older persons have greater susceptibility to infections than younger adults, with generally more severe and atypical episodes. Probiotics are living microorganisms that confer a health benefit to the host when administered in sufficient quantities. Studies in older people receiving probiotic supplementation suggest a potential role of probiotics in infection prevention. We present a systematic review protocol aimed to assess the efficacy of probiotics in the prevention of community acquired infection in elderly people living either in the community or in long‐term care facilities. We will include only randomised controlled trials (RCTs). We will comply with the recommendations of the Cochrane Collaboration and the principles PRISMA Statement. This protocol is registered in the PROSPERO database (CRD42014013707).     

A prospective study of Toxoplasma-positive pregnant women in southern Brazil: a health alert

We evaluated anti-Toxoplasma gondii IgM-reactive pregnant women seen at a high-risk pregnancy outpatient clinic. From March 2005 to January 2008 in Paraná, Brazil, pregnant women seen by the Brazilian Public Health System, in any gestational period, who were anti-T. gondii IgM-positive, were followed. Clinical symptoms were noted, and tests performed including IgA, IgG avidity, ultrasonogram, and amniocentesis (PCR/inoculation in mice). Of 75 patients, 8 showed low, 3 intermediate and 31 high IgG avidity. Of those who underwent the avidity test, 31 (70.5%) were in the second trimester of pregnancy. Thirty-two (42.7%) pregnant women received specific treatment. Six received triple combination treatment; in three, tachyzoites were isolated, although only one was PCR-positive, showing changes in the cerebral sonogram, borderline IgA, and the Sabin tetrad. One fetus died, and one non-reactive IgM pregnant woman showed ocular recurrence. The municipality of residence, contact with cats during adulthood, and ingestion of unpasteurized milk were shown to be important risk factors. Congenital toxoplasmosis was observed in a pregnancy referred late for treatment. Follow-up of children born to mothers with diagnosed or suspected acute toxoplasmosis is crucial in the management of the changes that toxoplasmosis may cause.     

Adherence to medical follow‐up recommendations reduces hospital admissions: Evidence from diabetic patients in France

The aim of this study was to document the extent to which diabetic patients who adhered to required medical follow‐ups in France experienced reduced hospital admissions over time. The main assumption was that enhanced monitoring and follow‐up of diabetic patients in the primary care setting could be a substitute for hospital use. Using longitudinal claim data of diabetic patients between 2010 and 2015 from MGEN, a leading mutuelle insurance company in France, we estimated a dynamic logit model with lagged measures of the quality of adherence to eight medical follow‐up recommendations. This model allowed us to disentangle follow‐up care in hospitals from other forms of inpatient care that could occur simultaneously. We found that a higher adherence to medical guidance is associated with a lower probability of hospitalization and that the take‐up of each of the eight recommendations may help reduce the rates of hospital admission. The reasons for the variation in patient adherence and implications for health policy are discussed.     

Living and dying: responsibility for end‐of‐life care in care homes without on‐site nursing provision ‐ a prospective study

The aim of the study was to describe the expectations and experiences of end‐of‐life care of older people resident in care homes, and how care home staff and the healthcare practitioners who visited the care home interpreted their role. A mixed‐method design was used. The everyday experience of 121 residents from six care homes in the East of England were tracked; 63 residents, 30 care home staff with assorted roles and 19 National Health Service staff from different disciplines were interviewed. The review of care home notes demonstrated that residents had a wide range of healthcare problems. Length of time in the care homes, functional ability or episodes of ill‐health were not necessarily meaningful indicators to staff that a resident was about to die. General Practitioner and district nursing services provided a frequent but episodic service to individual residents. There were two recurring themes that affected how staff engaged with the process of advance care planning with residents; ‘talking about dying’ and ‘integrating living and dying’. All participants stated that they were committed to providing end‐of‐life care and supporting residents to die in the care home, if wanted. However, the process was complicated by an ongoing lack of clarity about roles and responsibilities in providing end‐of‐life care, doubts from care home and primary healthcare staff about their capacity to work together when residents’ trajectories to death were unclear. The findings suggest that to support this population, there is a need for a pattern of working between health and care staff that can encourage review and discussion between multiple participants over sustained periods of time.     

Plasma antioxidant concentrations in a population of elderly women: Findings from the nun study

Low plasma alpha-tocopherol and beta-carotene concentrations have been associated with an increased risk of numerous degenerative diseases, including cancer. Several characteristics that accompany aging, including changes in dietary habits and physiologic capacity, may place elderly populations at a high risk of low plasma antioxidant concentrations. Thus, the present study was undertaken to characterize plasma concentrations of alpha-tocopherol, beta-carotene and several other carotenoids in elderly subjects, to describe the relationship between age and plasma antioxidant concentrations in this population and to compare the concentrations of plasma antioxidants in middle-aged and elderly individuals. The study recruited 94 participants from the Nun Study, a longitudinal study of aging and Alzheimer disease. Women in this population were unique for their advanced age, 77–99 years old, and their comparability across age groups due to the absence of several potential confounders of plasma antioxidant concentrations. The population mean and standard deviation of several plasma carotenoids and alpha-tocopherol concentrations (μg/dl) were as follows: lycopene, 15.0+/− 10.0; beta-carotene, 30.0+/− 19.7; alpha-carotene, 15.0 +/− 9.6; zeaxanthin plus lutein, 22.0+/− 7.4; beta-cryptoxanthin, 14.0 +/− 8.6 and alpha-tocopherol, 980 +/− 310. Concentrations of all analytes, except lycopene, were similar to or higher than those reported for several middle-aged American populations. Lycopene concentrations were significantly lower in the population of sisters as compared with the middle-aged populations and tended to decrease across age groups within the population of sisters. Age appeared to be a relatively minor determinant of plasma alpha-tocopherol and the concentrations of carotenoids, other than lycopene, in this population. Importantly, the plasma concentrations of most carotenoids and alpha-tocopherol in this population of independent elderly women were apparently adequate on the basis of population comparisons. Further studies of this population may define determinants essential for the maintenance of antioxidant status in elderly populations.     

Towards a harmonised approach to reducing quad‐related fatal injuries in Australia and New Zealand: a cross‐sectional comparative analysis

Objective: This study compares the patterns of quad‐related fatal injuries between Australia and New Zealand (NZ). Method: Fatal injuries from July 2007 to June 2012 involving a quad (quad bike or all‐terrain vehicle) were identified from coronial files. Data described the socio‐demographic, injury, vehicle and environment factors associated with incidents. Injury patterns were compared between countries. Results: A total of 101 quad‐related fatalities were identified: 69 in Australia and 32 in NZ (7.3 and 8.0 annual fatalities per 100,000 vehicles). Of these, 95 closed cases were examined in detail and factors in common included fatalities occurring mainly in males, on farms, involving a rollover and resulting in crush injuries to the head and thorax. Helmet use and alcohol/drug involvement were infrequent. Differences were observed with regard to age, season of fatal incident and the presence of a slope. Conclusions: Fatality patterns are broadly similar. The few differences could be attributed to differing agricultural commodity mix, demographics and topography. Implications: This study's findings support harmonised cross‐country injury prevention efforts primarily focused on safe design and engineering principles to reduce this injury burden.     

Folate status and socio‐demographic predictors of folate status,among a national cohort of women aged 26–36 in Australia, 2004–2006

Objective : To describe serum folate status and the socio‐demographic correlates of serum folate status in a national sample of women aged 26–36 years in Australia, 2004–2006. Methods: Stored serum samples from 1,046 women, collected as part of the Childhood Determinants of Adult Health study, were analysed for serum folate. Results: Median (IQR) serum folate was 27.1 nmol/L (18.8–35.0 nmol/L) with only 7.0% of samples below 11 nmol/L. Serum folate was positively associated with supplement use, educational level, occupational status and urban dwelling. Conclusions: In this population‐based sample, most women had folate levels in the normal range with few having low serum folate. Those of lower socioeconomic position or with poorer health behaviours had lower folate levels, though most were still within the normal range. Implications: In the absence of comprehensive national survey data on the folate status of women of child‐bearing age, these data provide a valuable baseline for evaluating the impact of mandatory folic acid fortification in Australia, which commenced in 2009. It is likely that mandatory fortification of the food supply with folic acid will reduce the disparities in folate status between socioeconomic groups and in people with poorer health behaviours.