Australian and New Zealand Journal of Public Health, Mar 6, 2015
To examine 25(OH)D testing patterns and frequency among general practitioners in a major communit... more To examine 25(OH)D testing patterns and frequency among general practitioners in a major community health service. A clinical audit of patient records at a community health centre in Melbourne was undertaken. Patients aged 18 years and above were included. Univariate and multivariate logistic regression was used to examine the association between vitamin D testing and socio-demographic characteristics while Poisson regression was used for the frequency of testing. There were 1,217 patients tested for serum 25(OH)D. The community health centre was served by 12 general practitioners and an infectious disease specialist. The odds of vitamin D testing showed a positive, albeit weak, association with age (OR 1.01, 95%CI 1.00-1.02, p<0.05), were higher among females than males (OR 1.42, 95%CI 1.18-1.70, p<0.05) and higher among migrants compared to non-migrants (OR 2.57, 95%CI 2.14-3.09, p<0.05). The frequency of testing was also higher among females than males (IRR 1.17, 95%CI 1.07-1.28, p<0.05) and higher among migrants than non-migrants (IRR 1.19, 95%CI 1.08-1.31, p<0.05). Advancing age, being female and being a migrant were associated with an increased likelihood of vitamin D testing. Development of evidence-based policies and guidelines are needed to manage over-testing of vitamin D in Australia. Studies that include health services from different areas are required to understand vitamin D testing patterns among the general practitioners.
Australian and New Zealand journal of public health, Jan 10, 2015
To examine 25(OH)D testing patterns and frequency among general practitioners in a major communit... more To examine 25(OH)D testing patterns and frequency among general practitioners in a major community health service. A clinical audit of patient records at a community health centre in Melbourne was undertaken. Patients aged 18 years and above were included. Univariate and multivariate logistic regression was used to examine the association between vitamin D testing and socio-demographic characteristics while Poisson regression was used for the frequency of testing. There were 1,217 patients tested for serum 25(OH)D. The community health centre was served by 12 general practitioners and an infectious disease specialist. The odds of vitamin D testing showed a positive, albeit weak, association with age (OR 1.01, 95%CI 1.00-1.02, p<0.05), were higher among females than males (OR 1.42, 95%CI 1.18-1.70, p<0.05) and higher among migrants compared to non-migrants (OR 2.57, 95%CI 2.14-3.09, p<0.05). The frequency of testing was also higher among females than males (IRR 1.17, 95%CI 1...
To identify the optimal measurement instrument for assessing health literacy in a clinical settin... more To identify the optimal measurement instrument for assessing health literacy in a clinical setting. Seven databases were searched for studies evaluating health literacy instruments used with patients. Standardised systematic review methods were used by two reviewers independently assessing eligibility, extracting data and evaluating study quality. A narrative summary was produced. The searches identified 626 articles of which 64 were eligible. Forty-three different health literacy instruments were identified. The quality of these instruments, based on their psychometric properties, varied considerably. The majority of health literacy instruments were found to only assess communicative health literacy of which the numeracy element was often not represented. The NVS instrument was found to be the most practical health literacy instrument to use. There is an urgent need to develop and psychometrically test a more encompassing health literacy instrument applicable in clinical settings as well as health promotion in general. In the absence of a more comprehensive health literacy instrument, the NVS is a practical instrument to quickly assess for health literacy in a clinical setting.
Clinical and experimental pharmacology & physiology, Jan 9, 2015
The study was designed to model the effectiveness and cost effectiveness of oral Vitamin D supple... more The study was designed to model the effectiveness and cost effectiveness of oral Vitamin D supplementation as a primary prevention strategy for cardiovascular disease among a migrant population in Australia. It was carried out in the Community Health Service, Kensington, Melbourne. Best-case scenario analysis using a Markov model was employed to look at the health care providers' perspective. Adult migrants who were vitamin D deficient and free from cardiovascular disease visiting the medical centre at least once during the period from 1(st) January 2010 to 31(st) December 2012 was included to the study. The blood pressure-lowering effect of vitamin D was taken from a published meta-analysis and applied in the Framingham 10 year cardiovascular risk algorithm (with and without oral vitamin D supplements) to generate the probabilities of cardiovascular events. A Markov decision model was used to estimate the provider costs associated with the events and treatments. Uncertainties w...
Laos is a low-income food-deficit country with pockets of high levels of wasting in the highland ... more Laos is a low-income food-deficit country with pockets of high levels of wasting in the highland areas. We implemented a 3-year health/nutrition project in 12 villages in the highlands of Savannakhet province to reduce acute malnutrition in children. Volunteer nutrition teams in each village monitored child growth and promoted healthy feeding practices; a multisectoral district committee conducted monthly outreach to assess child growth, manage acute malnutrition and deliver primary health care services. We conducted a cross-sectional assessment before project activities began and at the end of the project. The baseline survey randomly sampled 60% of all households; the endline assessment aimed to survey all eligible registered participants. Anthropometric measures were taken from children aged 6-59 months; mothers with children aged <12 months were asked about infant feeding practices, antenatal and post-partum care; and child immunizations were recorded for children aged betwee...
Migration to industrialised countries poses a "double whammy" for type 2 diabetes among... more Migration to industrialised countries poses a "double whammy" for type 2 diabetes among sub-Saharan African migrant and refugee adults. This population group has been found to be at an increased risk of obesity and type 2 diabetes, which may be further aggravated by inadequate vitamin D status. Thus, this study aimed to describe the demographics of vitamin D insufficiency, obesity, and risk factors for type 2 diabetes among sub-Saharan African migrants and refugees aged 20 years or older living in Melbourne, Australia (n=49). Data were obtained by a questionnaire, medical assessment, and fasting blood samples. The mean serum 25-hydroxyvitamin D level was 27.3 nmol/L (95% CI: 22.2, 32.4 nmol/L); with 25-hydroxyvitamin D levels <50 nmol/L occurring in 88% of participants. Participants displayed a cluster of risk factors for type 2 diabetes and cardiovascular disease: 62% were overweight or obese, 47% had insulin resistance (HOMA-IR >=2), 25% had low density lipoprotein...
The study assessed the anthropometric status of 337 sub-Saharan African children aged between 3-1... more The study assessed the anthropometric status of 337 sub-Saharan African children aged between 3-12 years who migrated to Australia. These children were selected using a snowball sampling method stratified by age, gender and region of origin. The prevalence rates for overweight and obesity were 18.4% (95%CI: 14 - 23%) and 8.6% (95%CI: 6% -12%) respectively. The prevalence rates for the indicators of undernutrition were: wasting 4.3% (95%CI: 1.6%-9.1%), underweight 1.2% (95%CI: 0.3%-3.0%), and stunting 0.3 (95%CI: 0.0%-1.6%). Higher prevalence of overweight/obesity was associated with lower household income level, fewer siblings, lower birth weight, western African background, and single parent households (after controlling for demographic and socio-economic factors). Higher prevalence rates for underweight and wasting were associated with lower household income and shorter lengths of stay in Australia respectively. No effect was found for child's age, gender, parental education a...
Migrants from developing to developed countries rapidly develop more obesity than the host popula... more Migrants from developing to developed countries rapidly develop more obesity than the host population. While the effects of socio-economic status on obesity are well established, the influence of cultural factors, including acculturation, is not known. To examine the association between acculturation and obesity and its risk factors among African migrant children in Australia. A cross-sectional study using a non-probability sample of 3- to 12-year-old sub-Saharan African migrant children. A bidimensional model of strength of affiliation with African and Australian cultures was used to divide the sample into four cultural orientations: traditional (African), assimilated (Australian), integrated (both) and marginalized (neither). Body mass index (BMI), leisure-time physical activity (PA) and sedentary behaviours (SBs) and energy density of food. In all, 18.4% (95% confidence interval (CI): 14-23%) were overweight and 8.6% (95% CI: 6-12%) were obese. After adjustment for confounders, integrated (beta=1.1; P&lt;0.05) and marginalized (beta=1.4; P&lt;0.01) children had higher BMI than traditional children. However, integrated children had significantly higher time engaged in both PA (beta=46.9, P&lt;0.01) and SBs (beta=43.0, P&lt;0.05) than their traditional counterparts. In comparison with traditional children, assimilated children were more sedentary (beta=57.5, P&lt;0.01) while marginalization was associated with increased consumption of energy-dense foods (beta=42.0, P&lt;0.05). Maintenance of traditional orientation was associated with lower rates of obesity and SBs. Health promotion programs and frameworks need to be rooted in traditional values and habits to maintain and reinforce traditional dietary and PA habits, as well as identify the marginalized clusters and address their needs.
An influx of African migrants and refugees can strain a host country&amp;amp;amp;amp;amp;amp;... more An influx of African migrants and refugees can strain a host country&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s blood services, because often migrants have unique blood needs that cannot be sourced from local donors. To increase blood donation by the new migrants, host country blood services need to understand how blood and blood donations are viewed by immigrant communities, because recruitment models that are not culturally adapted may have limited success. Nine focus groups representing a cross-section of Australian-based African communities were conducted in multiple languages, facilitated by bilingual workers. The qualitative protocol was guided by the literature on blood donation by African migrants and communities in Africa. Thematic analysis identified the relevance of issues previously included in the literature and whether other issues facilitated or prohibited blood donation. Home country cultural issues were not generally raised as barriers to donation, and respondents were positively disposed toward donation. Home country experiences shaped respondents&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; views in Australia. Participants focused on assisting &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;individuals in need,&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; rather than giving to a blood service that many viewed with suspicion because of issues in their home country. There was a lack of knowledge about the donation process in Australia. More importantly, respondents perceived that their blood would not be wanted, based on a perception of host country mistrust and discrimination. Developing an intervention that encourages migrants to donate blood needs to be culturally focused. It appears that addressing perceptions based on home country experiences is essential. Overcoming a general perception of discrimination is beyond any blood service, but there can be an attempt to ensure that blood donation is seen as an inclusive process-blood from everyone, for everyone.
Green, Julie, Renzaho, Andre, Eisenbruch, Maurice, Williamson, Lara, Waters, Elizabeth, Lo Bianco... more Green, Julie, Renzaho, Andre, Eisenbruch, Maurice, Williamson, Lara, Waters, Elizabeth, Lo Bianco, Joseph and Oberklaid, Frank 2008, Parent-centred and culturally-competent literacies for health promotion with newly arrived African communities : a literature review Centre ...
... in Europe, which consists of a ban on all television and radio advertising targeted at ... Br... more ... in Europe, which consists of a ban on all television and radio advertising targeted at ... Brug, J., Oenema, A., Kroeze, W. & Raat, H. (2005b ) Nutrition education and the ... Burchett, H. (2003) Increasing fruit and vegetable consumption among British primary schoolchildren: a review. ...
Australian and New Zealand Journal of Public Health, Mar 6, 2015
To examine 25(OH)D testing patterns and frequency among general practitioners in a major communit... more To examine 25(OH)D testing patterns and frequency among general practitioners in a major community health service. A clinical audit of patient records at a community health centre in Melbourne was undertaken. Patients aged 18 years and above were included. Univariate and multivariate logistic regression was used to examine the association between vitamin D testing and socio-demographic characteristics while Poisson regression was used for the frequency of testing. There were 1,217 patients tested for serum 25(OH)D. The community health centre was served by 12 general practitioners and an infectious disease specialist. The odds of vitamin D testing showed a positive, albeit weak, association with age (OR 1.01, 95%CI 1.00-1.02, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05), were higher among females than males (OR 1.42, 95%CI 1.18-1.70, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05) and higher among migrants compared to non-migrants (OR 2.57, 95%CI 2.14-3.09, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). The frequency of testing was also higher among females than males (IRR 1.17, 95%CI 1.07-1.28, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05) and higher among migrants than non-migrants (IRR 1.19, 95%CI 1.08-1.31, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). Advancing age, being female and being a migrant were associated with an increased likelihood of vitamin D testing. Development of evidence-based policies and guidelines are needed to manage over-testing of vitamin D in Australia. Studies that include health services from different areas are required to understand vitamin D testing patterns among the general practitioners.
Australian and New Zealand journal of public health, Jan 10, 2015
To examine 25(OH)D testing patterns and frequency among general practitioners in a major communit... more To examine 25(OH)D testing patterns and frequency among general practitioners in a major community health service. A clinical audit of patient records at a community health centre in Melbourne was undertaken. Patients aged 18 years and above were included. Univariate and multivariate logistic regression was used to examine the association between vitamin D testing and socio-demographic characteristics while Poisson regression was used for the frequency of testing. There were 1,217 patients tested for serum 25(OH)D. The community health centre was served by 12 general practitioners and an infectious disease specialist. The odds of vitamin D testing showed a positive, albeit weak, association with age (OR 1.01, 95%CI 1.00-1.02, p<0.05), were higher among females than males (OR 1.42, 95%CI 1.18-1.70, p<0.05) and higher among migrants compared to non-migrants (OR 2.57, 95%CI 2.14-3.09, p<0.05). The frequency of testing was also higher among females than males (IRR 1.17, 95%CI 1...
To identify the optimal measurement instrument for assessing health literacy in a clinical settin... more To identify the optimal measurement instrument for assessing health literacy in a clinical setting. Seven databases were searched for studies evaluating health literacy instruments used with patients. Standardised systematic review methods were used by two reviewers independently assessing eligibility, extracting data and evaluating study quality. A narrative summary was produced. The searches identified 626 articles of which 64 were eligible. Forty-three different health literacy instruments were identified. The quality of these instruments, based on their psychometric properties, varied considerably. The majority of health literacy instruments were found to only assess communicative health literacy of which the numeracy element was often not represented. The NVS instrument was found to be the most practical health literacy instrument to use. There is an urgent need to develop and psychometrically test a more encompassing health literacy instrument applicable in clinical settings as well as health promotion in general. In the absence of a more comprehensive health literacy instrument, the NVS is a practical instrument to quickly assess for health literacy in a clinical setting.
Clinical and experimental pharmacology & physiology, Jan 9, 2015
The study was designed to model the effectiveness and cost effectiveness of oral Vitamin D supple... more The study was designed to model the effectiveness and cost effectiveness of oral Vitamin D supplementation as a primary prevention strategy for cardiovascular disease among a migrant population in Australia. It was carried out in the Community Health Service, Kensington, Melbourne. Best-case scenario analysis using a Markov model was employed to look at the health care providers' perspective. Adult migrants who were vitamin D deficient and free from cardiovascular disease visiting the medical centre at least once during the period from 1(st) January 2010 to 31(st) December 2012 was included to the study. The blood pressure-lowering effect of vitamin D was taken from a published meta-analysis and applied in the Framingham 10 year cardiovascular risk algorithm (with and without oral vitamin D supplements) to generate the probabilities of cardiovascular events. A Markov decision model was used to estimate the provider costs associated with the events and treatments. Uncertainties w...
Laos is a low-income food-deficit country with pockets of high levels of wasting in the highland ... more Laos is a low-income food-deficit country with pockets of high levels of wasting in the highland areas. We implemented a 3-year health/nutrition project in 12 villages in the highlands of Savannakhet province to reduce acute malnutrition in children. Volunteer nutrition teams in each village monitored child growth and promoted healthy feeding practices; a multisectoral district committee conducted monthly outreach to assess child growth, manage acute malnutrition and deliver primary health care services. We conducted a cross-sectional assessment before project activities began and at the end of the project. The baseline survey randomly sampled 60% of all households; the endline assessment aimed to survey all eligible registered participants. Anthropometric measures were taken from children aged 6-59 months; mothers with children aged <12 months were asked about infant feeding practices, antenatal and post-partum care; and child immunizations were recorded for children aged betwee...
Migration to industrialised countries poses a "double whammy" for type 2 diabetes among... more Migration to industrialised countries poses a "double whammy" for type 2 diabetes among sub-Saharan African migrant and refugee adults. This population group has been found to be at an increased risk of obesity and type 2 diabetes, which may be further aggravated by inadequate vitamin D status. Thus, this study aimed to describe the demographics of vitamin D insufficiency, obesity, and risk factors for type 2 diabetes among sub-Saharan African migrants and refugees aged 20 years or older living in Melbourne, Australia (n=49). Data were obtained by a questionnaire, medical assessment, and fasting blood samples. The mean serum 25-hydroxyvitamin D level was 27.3 nmol/L (95% CI: 22.2, 32.4 nmol/L); with 25-hydroxyvitamin D levels <50 nmol/L occurring in 88% of participants. Participants displayed a cluster of risk factors for type 2 diabetes and cardiovascular disease: 62% were overweight or obese, 47% had insulin resistance (HOMA-IR >=2), 25% had low density lipoprotein...
The study assessed the anthropometric status of 337 sub-Saharan African children aged between 3-1... more The study assessed the anthropometric status of 337 sub-Saharan African children aged between 3-12 years who migrated to Australia. These children were selected using a snowball sampling method stratified by age, gender and region of origin. The prevalence rates for overweight and obesity were 18.4% (95%CI: 14 - 23%) and 8.6% (95%CI: 6% -12%) respectively. The prevalence rates for the indicators of undernutrition were: wasting 4.3% (95%CI: 1.6%-9.1%), underweight 1.2% (95%CI: 0.3%-3.0%), and stunting 0.3 (95%CI: 0.0%-1.6%). Higher prevalence of overweight/obesity was associated with lower household income level, fewer siblings, lower birth weight, western African background, and single parent households (after controlling for demographic and socio-economic factors). Higher prevalence rates for underweight and wasting were associated with lower household income and shorter lengths of stay in Australia respectively. No effect was found for child's age, gender, parental education a...
Migrants from developing to developed countries rapidly develop more obesity than the host popula... more Migrants from developing to developed countries rapidly develop more obesity than the host population. While the effects of socio-economic status on obesity are well established, the influence of cultural factors, including acculturation, is not known. To examine the association between acculturation and obesity and its risk factors among African migrant children in Australia. A cross-sectional study using a non-probability sample of 3- to 12-year-old sub-Saharan African migrant children. A bidimensional model of strength of affiliation with African and Australian cultures was used to divide the sample into four cultural orientations: traditional (African), assimilated (Australian), integrated (both) and marginalized (neither). Body mass index (BMI), leisure-time physical activity (PA) and sedentary behaviours (SBs) and energy density of food. In all, 18.4% (95% confidence interval (CI): 14-23%) were overweight and 8.6% (95% CI: 6-12%) were obese. After adjustment for confounders, integrated (beta=1.1; P&lt;0.05) and marginalized (beta=1.4; P&lt;0.01) children had higher BMI than traditional children. However, integrated children had significantly higher time engaged in both PA (beta=46.9, P&lt;0.01) and SBs (beta=43.0, P&lt;0.05) than their traditional counterparts. In comparison with traditional children, assimilated children were more sedentary (beta=57.5, P&lt;0.01) while marginalization was associated with increased consumption of energy-dense foods (beta=42.0, P&lt;0.05). Maintenance of traditional orientation was associated with lower rates of obesity and SBs. Health promotion programs and frameworks need to be rooted in traditional values and habits to maintain and reinforce traditional dietary and PA habits, as well as identify the marginalized clusters and address their needs.
An influx of African migrants and refugees can strain a host country&amp;amp;amp;amp;amp;amp;... more An influx of African migrants and refugees can strain a host country&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s blood services, because often migrants have unique blood needs that cannot be sourced from local donors. To increase blood donation by the new migrants, host country blood services need to understand how blood and blood donations are viewed by immigrant communities, because recruitment models that are not culturally adapted may have limited success. Nine focus groups representing a cross-section of Australian-based African communities were conducted in multiple languages, facilitated by bilingual workers. The qualitative protocol was guided by the literature on blood donation by African migrants and communities in Africa. Thematic analysis identified the relevance of issues previously included in the literature and whether other issues facilitated or prohibited blood donation. Home country cultural issues were not generally raised as barriers to donation, and respondents were positively disposed toward donation. Home country experiences shaped respondents&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; views in Australia. Participants focused on assisting &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;individuals in need,&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; rather than giving to a blood service that many viewed with suspicion because of issues in their home country. There was a lack of knowledge about the donation process in Australia. More importantly, respondents perceived that their blood would not be wanted, based on a perception of host country mistrust and discrimination. Developing an intervention that encourages migrants to donate blood needs to be culturally focused. It appears that addressing perceptions based on home country experiences is essential. Overcoming a general perception of discrimination is beyond any blood service, but there can be an attempt to ensure that blood donation is seen as an inclusive process-blood from everyone, for everyone.
Green, Julie, Renzaho, Andre, Eisenbruch, Maurice, Williamson, Lara, Waters, Elizabeth, Lo Bianco... more Green, Julie, Renzaho, Andre, Eisenbruch, Maurice, Williamson, Lara, Waters, Elizabeth, Lo Bianco, Joseph and Oberklaid, Frank 2008, Parent-centred and culturally-competent literacies for health promotion with newly arrived African communities : a literature review Centre ...
... in Europe, which consists of a ban on all television and radio advertising targeted at ... Br... more ... in Europe, which consists of a ban on all television and radio advertising targeted at ... Brug, J., Oenema, A., Kroeze, W. & Raat, H. (2005b ) Nutrition education and the ... Burchett, H. (2003) Increasing fruit and vegetable consumption among British primary schoolchildren: a review. ...
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