Association Between Overweight or Obesity and Household Income and Parental Body Mass Index in Australian Youth: Analysis of the Australian National Nutrition Survey, 1995

This study is a secondary data analysis based on the 1995 Australian National Nutrition Survey (NNS). A random subsample of 1581 school children aged 7 15 years old from the NNS was studied. The results show the prevalence of overweight, obesity and combined overweight and obesity was 10.6 20.9%, 3.7 7.2% and 15.6 25.7%, respectively. The odds ratio of overweight or obese boys with highest household income was significantly smaller than those with the lowest household income. The proportion of combined overweight and obesity in children whose parents were overweight or obese was significantly greater compared with those whose parents were not. The trend of increasing prevalence of overweight or obesity among children with increasing parental body mass index (BMI) was significant after adjusting for age except the trend of father's BMI for boys. This study provided baseline data on the recent prevalence of overweight or obesity of Australian school children using new international absolute BMI cut-off points. It indicated that young school girls (7 9 years) were more likely to be overweight or obese compared with boys, the prevalence rates of overweight or obesity in older boys (13 15 year) was significantly greater than in other age groups while in girls it was the opposite. The boys with lowest household income ($0 17 500) were more likely to be overweight or obese compared with those with the highest household income (greater than$67 500). Having parents especially mothers who were overweight or obese may increase the risk of children being overweight or obese

Psychoactive prescribing for older people-what difference does 15 years make?

Objective: The objective of the study was to review prescribing of psychoactive medications for older residents of the Tayside region of Scotland. Methods: The analysis used community prescribing data in 1995 and 2010 for all older residents in Tayside. For each psychoactive drug class, the name of the most recently prescribed drug and the date prescribed were extracted. The relative risk (RR) and 95% confidence intervals (CI) for patients receiving psychoactive medication in 2010 were compared with those for patients in 1995. Psychoactive prescribing was analyzed by year, age, gender, and deprivation classification. The chi-squared test was used to calculate statistical significance. Results: Total psychoactive prescribing in people over the age of 65years has increased comparing 1995 with 2010. Antidepressant [RR=2.5 (95% CI 2.41-2.59) p&lt;0.001] and opioid analgesia [RR=1.21 (1.19-1.24) p&lt;0.001] prescriptions increased between 1995 and 2010. Hypnotics/anxiolytic [RR=0.69 (0.66-0.71) p&lt;0.001] and antipsychotic [RR=0.83 (0.77-0.88) p&lt;0.001] prescriptions decreased between 1995 and 2010. An increase in psychoactive prescribing is particularly marked in lower socioeconomic groups. Patients in the least affluent fifth of the population had RR=1.25 (1.20-1.29) [p&lt;0.001] of being prescribed one to two psychoactive medications and RR=1.81 (1.56-2.10) [p&lt;0.001] of being prescribed three or more psychoactive medications in 2010 compared with those in 1995. The RRs for the most affluent fifth were RR=1.14 (1.1-1.19) [p&lt;0.001] and RR=1.2 (1.01-1.42) [p&lt;0.001] for one to two, and three or more medications, respectively. Conclusion: Psychoactive medication prescribing has increased comparing 1995 with 2010, with increases disproportionately affecting patients in lower socioeconomic groups. The availability of new psychoactive drugs, safety concerns, and economic factors may explain these increases.</p

Describing pre‐appointment written materials as an intervention in the context of children’s NHS therapy services: A national survey

Context: Pre-appointment written materials, including letters and leaflets, are commonly used by healthcare organisations to deliver professional-patient interactions. The written materials potentially change patients’ knowledge and behaviour as part of a healthcare intervention but have received little investigation. Objective: To describe the content of pre-appointment written materials through a behaviour change intervention perspective. Design: Mixed methods study with an online questionnaire about pre-appointment written materials and an analysis of actual materials. Questionnaire data were analysed descriptively and pre-appointment materials by qualitative framework analysis. Setting and participants: Children's community/outpatient occupational therapy, physiotherapy and/or speech and language therapy services across the UK. Service managers/clinical leads provided data. Intervention: Pre-appointment written materials. Results: Questionnaire responses were received from n = 110 managers/clinical leads from n = 58 NHS organisations. Written materials (n = 64) were received from n = 24 organisations. Current materials are used by therapy services as a conduit to convey the therapy service's expectations related to: accessing the service, decision-making about care and help-giving. The materials enrol the parent and child to the therapy services’ expectations by behaviour change techniques. The materials configure the parent/child expectations, knowledge and behaviour towards the therapy services’ operational procedures. Conclusion: Pre-appointment written materials configure patients to organisations’ operational procedures. The written materials currently lack support for parent/child empowerment, shared decision-making and self-management to improve health. Patient Contribution: Four parents of children accessing therapy services were involved in the study. The parents shared their experiences to highlight the importance of the topic and contributed to the final research design and methods

Initiation of Breastfeeding and Factors Associated with Prelacteal Feeds in Central Nepal

Background: Prelacteal feeds and delayed initiation of breastfeeding may lead to undernutrition of the infant but are still prevalent in many countries.Objective: A prospective cohort community-based study was conducted in central Nepal to ascertain the rate of early breastfeeding initiation and factors associated with the introduction of prelacteal feeds.Methods: Breastfeeding information was collected from 639 women who recently gave birth in the Kaski district of central Nepal. Backward stepwise logistic regression analysis was performed to determine factors associated with the use of prelacteal feeds.Results: The incidence of prelacteal feeds was 9.1%, with infant formula being the most common prelacteal food. Approximately 67% and 90% of mothers breastfed within 1 hour and 4 hours of delivery, respectively. Women who reside in urban areas (odds ratio [OR] = 2.68; 95% confidence interval [CI], 1.35-5.39), first-time mothers (OR = 2.15; 95% CI,1.15-4.02), and those who underwent cesarean section (OR = 10.10; 95% CI, 5.47-18.67) were more likely to give prelacteal feeds to their infants.Conclusion: The early initiation of breastfeeding with colostrum as the first feed was common in the study area. The introduction of prelacteal feeds was associated with urban residency, first-time motherhood, and cesarean delivery

Public attitudes to the management of invasive non-native species in Scotland

Invasive non-native species are one of the main threats to biodiversity. Consequently there is a need to control or eradicate those species that are causing problems in order to mitigate their impact. Such management programmes can be controversial and in some cases have been delayed or halted because of opposition from pressure groups. Public support can be critical to the success of such projects, and understanding the underlying attitudes of the public can help inform outreach education activities. To assess attitudes towards invasive species management and investigate socio-demographic factors influencing such attitudes, a questionnaire survey of 600 randomly selected members of the public in Scotland was conducted, and a total of 248 completed questionnaires returned. The level of support for control and eradication programmes was, in general, high and was higher amongst men, older people, and people who had previously heard of control and eradication projects. The species to be managed influenced levels of support, and projects to control birds were the least supported. Respondents with prior knowledge of control and eradication programmes and members of conservation organisations, in general, showed higher levels of support, indicating the important role that awareness and education has in terms of increasing public support for invasive non-native species management projects

Understanding how education/support groups help lone mothers

<p>Abstract</p> <p>Background</p> <p>Lone-mother led families are at increased risk of psychosocial disadvantage, social isolation and mental health morbidity. Community-based programs are more accessible for families seeking assistance. We examine the experiences of eight lone mothers participating in a larger randomized controlled trial (RCT) of a community-based education/support group program using mixed methods.</p> <p>Methods</p> <p>A purposeful sample of eight mothers participating in the intervention arm of an RCT of community-based support/education groups was selected for the qualitative study. Individual interviews asked mothers about themselves and their relationships with their children before and after the group. Interviews were taped, transcribed and content analysis was used to code and interpret the data. Quantitative data collected in the RCT were used to describe these mothers.</p> <p>Results</p> <p>Mothers participating in the RCT and qualitative study experienced multiple difficulties, including financial and mood problems. These mothers reported that before participating in the group, they had shared experiences of social isolation, stigma, a sense of failure, poor relationships with their children and difficulties with financial management. After the group, mothers identified improved self-esteem, support from other mothers, improved parenting skills and improved communication with their children as outcomes of group participation.</p> <p>Conclusions</p> <p>The qualitative data revealed mothers' perceptions of specific areas that improved by participating in the group. The utility of complementary information provided by qualitative and quantitative methods in understanding program impact, as well as the need for broader assistance is noted.</p

Use and perceived helpfulness of smoking cessation methods: results from a population survey of recent quitters

<p>Abstract</p> <p>Background</p> <p>Increasing rates of smoking cessation is one of the most effective measures available to improve population health. To advance the goal of increasing successful cessation at the population level, it is imperative that we understand more about smokers' use of cessation methods, as well as the helpfulness of those methods in real-world experiences of quitting. In this survey of recent quitters, we simultaneously examined rates of use and perceived helpfulness of various cessation methods.</p> <p>Methods</p> <p>Recent quitters (within 12 months; n = 1097) completed a telephone survey including questions relating to 13 cessation methods. Indices of use and perceived helpfulness for each method were plotted in a quadrant analysis. Socio-demographic differences were explored using bivariate and multivariate analyses.</p> <p>Results</p> <p>From the quadrant analysis, cold turkey, NRT and gradual reduction before quitting had high use and helpfulness; GP advice had high use and lower helpfulness. Prescribed medication and online programs had low use but high helpfulness. Remaining methods had low use and helpfulness. Younger quitters were more likely to use unassisted methods such as cold turkey; older or less educated quitters were more likely to use assisted methods such as prescribed medication or advice from a general practitioner.</p> <p>Conclusions</p> <p>The majority of recent quitters quit cold turkey or cut down before quitting, and reported that these methods were helpful. Efforts to influence population smoking prevalence should attempt to provide support and motivation for smokers choosing these methods, in addition to assessing the effectiveness and accessibility of other methods for smokers who need or choose them.</p

Assessment of human resources for health using cross-national comparison of facility surveys in six countries

Abstract Background Health facility assessments are being increasingly used to measure and monitor indicators of health workforce performance, but the global evidence base remains weak. Partly this is due to the wide variability in assessment methods and tools, hampering comparability across and within countries and over time. The World Health Organization coordinated a series of facility-based surveys using a common approach in six countries: Chad, Côte d'Ivoire, Jamaica, Mozambique, Sri Lanka and Zimbabwe. The objectives were twofold: to inform the development and monitoring of human resources for health (HRH) policy within the countries; and to test and validate the use of standardized facility-based human resources assessment tools across different contexts. Methods The survey methodology drew on harmonized questionnaires and guidelines for data collection and processing. In accordance with the survey's dual objectives, this paper presents both descriptive statistics on a number of policy-relevant indicators for monitoring and evaluation of HRH as well as a qualitative assessment of the usefulness of the data collection tool for comparative analyses. Results The findings revealed a large diversity in both the organization of health services delivery and, in particular, the distribution and activities of facility-based health workers across the sampled countries. At the same time, some commonalities were observed, including the importance of nursing and midwifery personnel in the skill mix and the greater tendency of physicians to engage in dual practice. While the use of standardized questionnaires offered the advantage of enhancing cross-national comparability of the results, some limitations were noted, especially in relation to the categories used for occupations and qualifications that did not necessarily conform to the country situation. Conclusion With increasing experience in health facility assessments for HRH monitoring comes greater need to establish and promote best practices regarding methods and tools for their implementation, as well as dissemination and use of the results for evidence-informed decision-making. The overall findings of multi-country facility-based survey should help countries and partners develop greater capacity to identify and measure indicators of HRH performance via this approach, and eventually contribute to better understanding of health workforce dynamics at the national and international levels.</p

Are time-trends of smoking among pregnant immigrant women in Sweden determined by cultural or socioeconomic factors?

<p>Abstract</p> <p>Background</p> <p>The widening socioeconomic gap in smoking during pregnancy remains a challenge to the Swedish antenatal care services. However, the influence of cultural factors in explaining the socioeconomic differences in smoking during pregnancy is not clear among the immigrant women. The aim of this study was to investigate whether the development of smoking prevalence among pregnant immigrant women in Sweden followed the trajectory which could be expected from the stages of the global smoking epidemic model in the women's countries of origin, or not.</p> <p>Methods</p> <p>Delivery data on pregnancies in Sweden from 1982 to 2001 was collected from the Swedish Medical Birth Registry. From a total of 2,224,469 pregnant women during this period, all immigrant pregnant women (n = 234,731) were selected to this study. A logistic regression analysis and attributable fraction were used to investigate the association between smoking during pregnancy and the socioeconomic differences among immigrant women.</p> <p>Results</p> <p>Overall, the prevalence of smoking among pregnant immigrant women decreased from 30.3% in 1982 to 11.0% in 2001, albeit with remarkable differences between educational levels and country of origin. The greatest decline of absolute prevalence was recorded among low educated women (27,9%) and among other Nordic countries (17,9%). In relative terms, smoking inequalities increased between educational levels regardless of country of origin. The odds ratios for low educational level for women from other Nordic countries increased from 4.9 (95% CI 4.4-5.4) in 1982 to 13.4 (95% CI 11.2-16.2) in 2001, as compared to women with high education in the same group. Further, the total attributable fraction for educational difference increased from 55% in 1982 to 62% in 2001, demonstrating the strong effect of educational attainment.</p> <p>Conclusions</p> <p>Our hypothesis that the socioeconomic time trend of smoking based on the stage of the world wide tobacco epidemic model related to country of origin of the immigrant women was not supported by our analyses. Our findings does not support a call for specific "culture sensitive" antismoking policies or interventions in Sweden or similar countries, but reinforce the existing evidence with a focus on women with a low educational level, regardless of cultural background.</p