Flexible employment policies, temporal control and health promoting practices: A qualitative study in two Australian worksites.

For four decades, theories of job demand-control have proposed that higher occupational status groups have lower health risks due to the stress accompanying jobs featuring high demands but high control. This research examines whether Flexible Work Arrangements (FWAs) can improve the health prospects of a range of workers by giving greater control over work time arrangements. Our setting is Australia, where FWAs were introduced in 2009. In line with these early studies alongside studies of work-life balance, we expected to observe that workers with access to control over daily work times could better control the activities outside of work that influence chronic disease. Using a practice sociology approach, we compared the accounts of twenty-eight workers in blue and white collar industries with differing degrees of work time flexibility. The findings do not contradict early theories describing occupational differences of job demand-control dynamics and their relationship to health risks. However, this study suggests that a) time demands and strains have increased for a broad sweep of workers since the 1980s, b) the greater control of higher occupational status groups has been eroded by the high performance movement, which has attracted less scrutiny than FWAs, and c) more workers are forced to adapt their daily lives, including their approach to health, to accommodate their job demands. Job insecurity further impedes preventative health practices adoption. What might appear to be worker-controlled flexibility can-under the pressures of job insecurity and performance expectations without time limits-transform into health-eroding unpredictability. The answer however is not greater flexibility in the absence of limits on the well-documented precursors of work stress: long hours, job insecurity and intensity-related exhaustion. While there have been welcome developments in job demand-control-health conceptualizations, they typically ignore the out-of-work temporal demands that workers face and which compound on-the-job demands. Redesign of the temporalities of working life within worksites need to be accompanied by society-level policies which address caring responsibilities, gender equality as well as broad labour market conditions.

Social determinants of household food expenditure in Australia: the role of education, income, geography and time.

OBJECTIVE: To examine socio-economic status (SES) and time-related factors associated with less healthy food purchases in Australia. DESIGN: Data were from the 2009/10 Household Expenditure Survey (HES) conducted by the Australian Bureau of Statistics. Regression analysis was used to examine the associations between the proportion of the household food budget spent on various food types (processed and unprocessed foods, foods purchased from takeaways and restaurants) and SES and time constraint variables. SETTING: Australia, 2009-2010. SUBJECTS: Nationally representative sample of Australian households. RESULTS: Household income seems to be the most important correlate with food expenditure patterns once other SES indicators are controlled for. Time constraints appear to explain some, but not all, of the adjusted SES gradients in food expenditure. Comparing home food consumption categories (processed and unprocessed foods) with foods purchased away from home (takeaway and restaurant foods) shows that wealthier, more highly educated and least disadvantaged households spend relatively less of their total food budget on processed and unprocessed foods prepared at home and more on foods purchased away from home at restaurants. CONCLUSIONS: Simple SES gradients in dietary behaviour are influenced by correlations between different SES indicators and between SES and time constraints. Examining these factors separately obscures some of the possible causal effects of disadvantage on healthy eating. When formulating policy responses to unhealthy diets, policy makers should consider alternative sources of disadvantage, including time pressure.

Translation and validation of the Canadian diabetes risk assessment questionnaire in China.

OBJECTIVES: To adapt the Canadian Diabetes Risk Assessment Questionnaire for the Chinese population and to evaluate its psychometric properties. DESIGN AND SAMPLE: A cross-sectional study was conducted with a convenience sample of 194 individuals aged 35-74 years from October 2014 to April 2015. METHODS: The Canadian Diabetes Risk Assessment Questionnaire was adapted and translated for the Chinese population. Test-retest reliability was conducted to measure stability. Criterion and convergent validity of the adapted questionnaire were assessed using 2-hr 75 g oral glucose tolerance tests and the Finnish Diabetes Risk Scores, respectively. Sensitivity and specificity were evaluated to establish its predictive validity. RESULTS: The test-retest reliability was 0.988. Adequate validity of the adapted questionnaire was demonstrated by positive correlations found between the scores and 2-hr 75 g oral glucose tolerance tests (r = .343, p < .001) and with the Finnish Diabetes Risk Scores (r = .738, p < .001). The area under receiver operating characteristic curve was 0.705 (95% CI .632, .778), demonstrating moderate diagnostic value at a cutoff score of 30. The sensitivity was 73%, with a positive predictive value of 57% and negative predictive value of 78%. CONCLUSIONS: Our results provided evidence supporting the translation consistency, content validity, convergent validity, criterion validity, sensitivity, and specificity of the translated Canadian Diabetes Risk Assessment Questionnaire with minor modifications. This paper provides clinical, practical, and methodological information on how to adapt a diabetes risk calculator between cultures for public health nurses.

Adapting an Evidence-Based Pediatric Acute Asthma Exacerbation Severity Assessment Tool for Pediatric Primary Care.

INTRODUCTION: The purposes of this project were (a) to examine criteria derived from evidence-based pediatric acute asthma exacerbation assessment tools, asthma scores, and the acute asthma prediction rule validated and used in the emergency department and (b) to adapt these criteria for pediatric primary care. METHOD: The three stages of the project included (a) identification of criteria in a literature review, (b) validation of the criteria by an expert panel, and (c) adaptation of the criteria in the design of an assessment tool. RESULTS: The criteria were validated and adapted in the design of The Pediatric Acute Asthma Exacerbation Severity Assessment and Disposition Decision-Making Tool for Pediatric Primary Care. DISCUSSION: The adaptation of criteria derived from the evidence and validated by an expert panel will inform and guide clinicians in assessing severity and support decision making in determining disposition of pediatric patients presenting with an acute asthma exacerbation in primary care.

Frailty determinants in two long-term care settings: Assistant living facilities and home and community-based programs.

There is limited knowledge on differences in frailty among residents in assisted living facilities (ALF) and home and community-based services (HCBS). This study used a retrospective cross-sectional design to compare frailty determinants in two long-term care settings. The HCBS setting had a greater proportion of positive responses to 9 of 14 frailty indicators. The ALF setting had a greater proportion to only 2 of the 14 frailty indicators. The finding that the HCBS setting had a significantly greater proportion of participants with positive frailty indicators as compared to the ALF setting suggests the degree of frailty risk is different by health care setting.

Urbanization and health in China, thinking at the national, local and individual levels.

BACKGROUND: China has the biggest population in the world, and has been experiencing the largest migration in history, and its rapid urbanization has profound and lasting impacts on local and national public health. Under these conditions, a systems understanding on the correlation among urbanization, environmental change and public health and to devise solutions at national, local and individual levels are in urgent need. METHODS: In this paper, we provide a comprehensive review of recent studies which have examined the relationship between urbanization, urban environmental changes and human health in China. Based on the review, coupled with a systems understanding, we summarize the challenges and opportunities for promoting the health and wellbeing of the whole nation at national, local, and individual levels. RESULTS: Urbanization and urban expansion result in urban environmental changes, as well as residents' lifestyle change, which can lead independently and synergistically to human health problems. China has undergone an epidemiological transition, shifting from infectious to chronic diseases in a much shorter time frame than many other countries. Environmental risk factors, particularly air and water pollution, are a major contributing source of morbidity and mortality in China. Furthermore, aging population, food support system, and disparity of public service between the migrant worker and local residents are important contributions to China's urban health. CONCLUSIONS: At the national level, the central government could improve current environmental policies, food safety laws, and make adjustments to the health care system and to demographic policy. At the local level, local government could incorporate healthy life considerations in urban planning procedures, make improvements to the local food supply, and enforce environmental monitoring and management. At the individual level, urban residents can be exposed to education regarding health behaviour choices while being encouraged to take responsibility for their health and to participate in environmental monitoring and management.

Traditional, modern or mixed? Perspectives on social, economic, and health impacts of evolving food retail in Thailand.

Transnational food retailers expanded to middle-income countries over recent decades responding to supply (liberalized foreign investment) and demand (rising incomes, urbanization, female workforce participation, and time poverty). Control in new markets diffuses along three axes: socio-economic (rich to poor), geographic (urban to rural), and product category (processed foods to fresh foods). We used a mixed method approach to study the progression of modern retail in Thailand on these three axes and consumer preferences for food retailing. In Thailand modern retail controls half the food sales but traditional fresh markets remain important. Quantitative questionnaires administered to members of a large national cohort study revealed around half of respondents were primarily traditional shoppers and half either utilized modern and traditional formats equally or primarily shopped at supermarkets. Fresh foods were mainly purchased at traditional retail formats and dry packaged foods at supermarkets. Qualitative interviews found price and quality of produce and availability of culturally important products to be significant reasons for continued support of fresh markets. Our results show socio-economic and geographic diffusion is already advanced with most respondents having access to and utilizing modern retail. Control of the fresh food sector by transnationals faces barriers in Thailand and may remain elusive. The short to mid-term outcome may be a bifurcated food system with modern and traditional retail each retaining market share, but fresh markets longer term survival may require government assistance as supermarkets become more established. Fresh markets supply affordable, healthy foods, and livelihoods for poorer Thais and are repositories of Thai food culture and social networks. If they survive they will confer cultural, social, economic, and health benefits.

Health, happiness and eating together: what can a large Thai cohort study tell us?

Our research investigates the significance of frequent solo consumption of main meals and the association with a holistic wellbeing measure of happiness using data from 39820 Thai Cohort Study members who completed 8-year follow-up in 2013. This nationwide cohort has been under study since 2005 to analyse the dynamics and determinants of the health-risk transition from infectious to chronic diseases. Here we analyse data from the 2009 and 2013 follow-ups. Approximately 11% reported eating more than half of the main meals per week alone. Sociodemographic attributes associated with eating alone were being male, older age, unmarried, smaller household, lower income, and urban residence. Dissatisfaction with amount of spare time (ie 'busyness') was also linked to eating alone. In the multivariate cross-sectional model, reporting being unhappy was associated with frequent solo eating (Adjusted Odds Ratio - AOR 1.54, 95% Confidence Intervals 1.30-1.83). Stratified by age and sex groups, the effects were strongest among females (AOR 1.90 1.52-2.38).  A monotonic relationship linked frequent eating alone and 4-year longitudinal unhappiness. The larger the dose of unhappiness the greater the odds of eating alone - AOR 1.29, 1.31, 1.72 after controlling for potential covariates. Having a meal is not only important for nutritional and health outcomes; it is also a vital part of daily social interaction. Our study provided empirical evidence from a non-Western setting that sharing meals could contribute to increasing happiness.

Exploratory factor analysis of the 12-item Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale in people newly diagnosed with advanced cancer.

BACKGROUND AND PURPOSE: The purpose of this study was to reexamine the factor pattern of the 12-item Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp-12) using exploratory factor analysis in people newly diagnosed with advanced cancer. METHODS: Principal components analysis (PCA) and 3 common factor analysis methods were used to explore the factor pattern of the FACIT-Sp-12. Factorial validity was assessed in association with quality of life (QOL). RESULTS: Principal factor analysis (PFA), iterative PFA, and maximum likelihood suggested retrieving 3 factors: Peace, Meaning, and Faith. Both Peace and Meaning positively related to QOL, whereas only Peace uniquely contributed to QOL. CONCLUSION: This study supported the 3-factor model of the FACIT-Sp-12. Suggestions for revision of items and further validation of the identified factor pattern were provided.

Patterns of family management of childhood chronic conditions and their relationship to child and family functioning.

Understanding patterns of family response to childhood chronic conditions provides a more comprehensive understanding of their influence on family and child functioning. In this paper, we report the results of a cluster analysis based on the six scales comprising the Family Management Measure (FaMM) and the resulting typology of family management. The sample of 575 parents (414 families) of children with diverse chronic conditions fell into four patterns of response (Family Focused, Somewhat Family Focused, Somewhat Condition Focused, Condition Focused) that differed in the extent family life was focused on usual family routines or the demands of condition management. Most (57%) families were in either the Family Focused or Somewhat Family Focused pattern. Patterns of family management were related significantly to family and child functioning, with families in the Family Focused and Somewhat Family Focused patterns demonstrating significantly better family and child functioning than families in the other two patterns.

Measurement and monitoring of health care worker aggression exposure.

Aggression exposure is highly prevalent in healthcare workers, and is a complex problem that negatively impacts patient and worker safety and health. Typically only events of high severity (e.g., use of physical restraint or incident reports) are monitored in healthcare settings. Unfortunately, these events are likely a small fraction of all aggressive events that range from verbal to physical. Improved measurement and monitoring of healthcare worker aggression exposure may lead to improved patient and worker safety and health. This article provides an overview of aggression exposure in healthcare and reviews the measurement of aggression, including challenges and common measures. Discussion of a pilot study presents insights gained from using a novel measure of aggression, handheld counters. The conclusion offers implications for research and clinical practice.

Urbanisation and human health in China: spatial features and a systemic perspective.

BACKGROUND, AIMS AND SCOPE: Current studies have paid little attention to the dynamism in urban spatial expansion and its possible environmental and health effects or to the health effects of rapid urban environmental change at different points along the urbanisation gradient. This study adopts a public health ecology approach to systematically understand the relationship between urbanisation, urban environmental change and human health in China. METHOD: Remote sensing image analysis, based on night light data at five different time periods in recent decades, was used to determine changes to the overall urban area. Through a review of the evidence on the relationships between environmental health, urbanisation and health, we advance a pathway framework for explaining urban human health ecology. The Spearman rank correlation coefficient was used to measure the correlation between disease prevalence and urbanisation level, adding a further dimension to a systemic understanding of urban health. RESULTS AND CONCLUSIONS: Urban areas have been increasing spatially, but unevenly, in recent decades, with medium and small cities also expanding rapidly in the past decade. Urbanisation and urban expansion result in changes to land use/coverage change, the urban environment and the residents' lifestyle, which result in human health problems. Regions with the highest urbanisation level were more inclined to have a high prevalence of chronic disease in recent decades. An ecological public health approach provides insights into the multiple types of data which need to be routinely collected if human disease is not to become a barrier to social and economic development.

Climate change adaptation at the intersection of food and health.

Nutritious, safe, affordable, and enjoyable food is a fundamental prerequisite for health. As a nation, Australia is currently classified as food secure with the domestic production exceeding domestic consumption of most major food groups. The domestic system is almost self-sufficient in terms of nutritious plant foods, although these foods have seen steady higher price increases relative to other foods, with nutrition equity implications. However, the viability of Australia's food security sits counter to the continued presence of a stable and supportive climate. This article reviews the current state of science concerning the interface between climate change, food systems, and human health to reveal the key issues that must be addressed if Australia is to advance human health and sustainable food systems under a changing climate.

Socioeconomic inequalities in the diffusion of health technology: Uptake of coronary procedures as an example.

This paper examines socioeconomic lags in the diffusion of high technology health care, focusing on the diffusion of coronary procedures in people with ischaemic heart disease. Using linked hospital and mortality data, we studied patients admitted to Western Australian hospitals with a first admission for acute myocardial infarction between 1989 and 2003 (n = 27,209). An outcome event was the receipt, within a year, of a coronary procedure-angiography, angioplasty and/or coronary artery bypass surgery (CABG). Socioeconomic status (SES) was assigned to each individual using the SEIFA Index of Disadvantage. Cox regression was used to model the association between SES and procedure rates in five consecutive three-year time periods. Angiography and CABG showed socioeconomic lags in diffusion, with rates peaking earlier in higher SES patients, such that the inequality patterns were consistent with the inverse equity hypothesis. The evidence for a lag in diffusion for angioplasty was weaker. Overall, that there is some evidence for a lag in diffusion of health technology indicates that it is essential to consider trends over time when examining the equity impact of health technologies.

Assessment of the psychometric properties of the Family Management Measure.

OBJECTIVE: This paper reports development of the Family Management Measure (FaMM) of parental perceptions of family management of chronic conditions. METHOD: By telephone interview, 579 parents of children age 3 to 19 with a chronic condition (349 partnered mothers, 165 partners, 65 single mothers) completed the FaMM and measures of child functional status and behavioral problems and family functioning. Analyses addressed reliability, factor structure, and construct validity. RESULTS: Exploratory factor analysis yielded six scales: Child's Daily Life, Condition Management Ability, Condition Management Effort, Family Life Difficulty, Parental Mutuality, and View of Condition Impact. Internal consistency reliability ranged from .72 to .91, and test-retest reliability from .71 to .94. Construct validity was supported by significant correlations in hypothesized directions between FaMM scales and established measures. CONCLUSION: Results support FaMM's; reliability and validity, indicating it performs in a theoretically meaningful way and taps distinct aspects of family response to childhood chronic conditions.

Psychometric testing of the Health Quotient questionnaire: a measure of self-reported holistic health.

AIM: This paper is a report of a test of the psychometric properties of the Health Quotient questionnaire. BACKGROUND: The Health Quotient questionnaire is an existing self-reported holistic health measure developed by integrating Western and Eastern perspectives, but limited psychometric properties have been reported. METHODS: Content validity was estimated by five experts. A pilot study allowed for feasibility testing and examination of reliability and validity. A total of 1874 Chinese college undergraduates took part in the study in 2007-2008. Internal consistency reliability of the five dimensions (Self-Care, Health Knowledge, Lifestyle, Mind Health and Life Skills) of the Health Quotient questionnaire was examined and item-to-dimension score correlation analysis was also completed. Construct validity was determined using the convergent validity, hypothesis testing approach and factor analysis. The single-item self-rated health status assessment by the American College Health Association-National Council was used to measure health status. RESULTS: Strong content validity and internal consistency reliability correlations were demonstrated. Test-retest reliability was acceptable, ranging from 0.72 to 0.82 for the five dimensions. Statistically significant relationships between the Health Quotient's total and dimension scores with self-rated health status (P < 0.001) provided evidence of convergent validity. In exploration of the factor structure by dimensions, four of five dimensions were consistent with the theoretical framework, with only the Life Skills dimension demonstrating lack of theoretical fit. CONCLUSION: The results provide some evidence for the reliability and validity of the Health Quotient questionnaire, as well as several recommendations for further research on the questionnaire.

Nutrition transition, food retailing and health equity in Thailand.

AIM: Here we examine the influence of changes in food retailing, the food supply and the associated nutrition transition on health equity in Thailand, a middle income country experiencing rapid economic development. METHODS: The dietary transition underway in Thailand is reviewed along with theories regarding convergence to a globalised energy dense obesogenic diet and subsequent socio-economically related dietary divergence along with the implications for health inequity. RESULTS: Thailand is part way through a dietary, nutrition and health transition. The food distribution and retailing system is now 50% controlled by modern supermarkets and convenience stores. The problem of increasing availability of calorie dense foods is especially threatening because a substantial proportion of the adult population is short statured due to child malnutrition. Obesity is an emerging problem and for educated Thai women has already developed an inverse relationship to socio-economic status as found in high income countries. CONCLUSIONS: Thailand has reached an important point in its nutrition transition. The challenge for the Thai government and population is to boost affordable healthy diets and to avoid the socio-economic inequity of nutritional outcomes observed in many rich countries.

Weighing it up: the missing social inequalities dimension in Australian obesity policy discourse.

ISSUE ADDRESSED: Debate on obesity spans complex health and social issues drawing on varying representations of fat bodies. This paper seeks to determine whether the recent public health focus on social inequalities is reflected in broader policy debate on obesity. METHODS: We reviewed public submissions to the 2008 Australian House Standing Committee on Health and Ageing inquiry into obesity. Using a qualitative framing approach we categorised the 95 submissions, analysing a sample of 20 of them, thereby, elucidating attitudes to obesity held by a range of interested stakeholders. RESULTS: Two primary frames and one lesser frame were identified. While it was common for contributors to situate obesity as a problem of individuals, it was equally common for contributors to draw on environmental level arguments where obesity is located in structural forces outside of the individual. The range of attributing factors reflects disagreement as to the causes of obesity, although adherents to both the individual and environmental frames called for more government regulation and financial support. Only two submissions directed policy reform to issues of inequality. CONCLUSIONS: Empirically, this study represents a novel investigation of the role of public health ethics in obesity debate and policy. Politically, we highlight the relative lack of explicit attention given to inequality in the debate, even though social inequalities are demonstrably relevant.

Functional foods and urban agriculture: two responses to climate change-related food insecurity.

Affluent diets have negative effects on the health of the population and the environment. Moreover, the ability of industrialised agricultural ecosystems to continue to supply these diets is threatened by the anticipated consequences of climate change. By challenging the ongoing supply the diets of affluent countries, climate change provides a population and environmental health opportunity. This paper contrasts two strategies for dealing with climate change-related food insecurity. Functional foods are being positioned as one response because they are considered a hyper-efficient mechanism for supplying essential micronutrients. An alternative response is civic and urban agriculture. Rather than emphasising increased economic or nutritional efficiencies, civic agriculture presents a holistic approach to food security that is more directly connected to the economic, environmental and social factors that affect diet and health.