The assessment of dietary carotenoid intake of the Cardio-Med FFQ using food records and biomarkers in an Australian cardiology cohort: a pilot validation.

Dietary carotenoids are associated with lower risk of CHD. Assessment of dietary carotenoid intake using questionnaires can be susceptible to measurement error. Consequently, there is a need to validate data collected from FFQs which measure carotenoid intake. This study aimed to assess the performance of the Cardio-Med Survey Tool (CMST)-FFQ-version 2 (v2) as a measure of dietary carotenoid intake over 12-months against plasma carotenoids biomarkers and 7-Day Food Records (7DFR) in an Australian cardiology cohort. Dietary carotenoid intakes (ß- and α-carotene, lycopene, ß-cryptoxanthin and lutein/zeaxanthin) were assessed using the 105-item CMST-FFQ-v2 and compared to intakes measured by 7DFR and plasma carotenoid concentrations. Correlation coefficients were calculated between each dietary method, and validity coefficients (VCs) were calculated between each dietary method and theoretical true intake using the 'methods of triads'. Thirty-nine participants aged 37-77 years with CHD participated in the cross-sectional study. The correlation between FFQ and plasma carotenoids were largest and significant for ß-carotene (0.39, p=0.01), total carotenoids (0.37, p=0.02) and ß-cryptoxanthin (0.33, p=0.04), with weakest correlations observed for α-carotene (0.21, p=0.21) and lycopene (0.21, p=0.21). The FFQ VCs were moderate (0.3-0.6) or larger for all measured carotenoids. The strongest were observed for total carotenoids (0.61) and ß-carotene (0.59), while the weakest were observed for α-carotene (0.33) and lycopene (0.37). In conclusion, the CMST-FFQ-v2 measured dietary carotenoids intakes with moderate confidence for most carotenoids, however, there was less confidence in ability to measure α-carotene and lycopene intake, thus further research is warranted using a larger sample.

Circumstances that promote social connectedness in older adults participating in intergenerational programmes with adolescents: a realist review.

OBJECTIVES: Limited social connectedness in older adults is a risk factor for poor physical and mental health. Older adults who are socially isolated, lonely and disconnected have a higher risk of chronic illness, depression and premature death. Current literature suggests that improved social connectedness reduces these risks. Intergenerational programmes are an effective way to improve health outcomes. Despite this, there is yet to be a review using realist review methods that seeks to identify the circumstances that promote social connectedness in older adults participating in intergenerational programmes with adolescents. DESIGN: A realist review methodology was chosen to account for the complexity of intergenerational interventions. Nine studies were included. In line with realist review methodology, iterative data extraction and analysis was conducted to identify the specific contexts, mechanisms and outcomes of the programmes. Specific circumstances were identified to develop theories relating to improved social connectedness in older adults. DATA SOURCES: MEDLINE, PsycINFO, CINAHL were searched using English language limitation. ELIGIBILITY CRITERIA: Included participants were aged 65 and over (older adults) and between 13 and 19 years (adolescents) participating in intergenerational programmes from non-familial generations. Studies had to be published in English between 2000 and 2020 and could be quantitative, qualitative or mixed-methods primary research studies. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers used a bespoke data extraction form. All authors were involved in the synthesis process which used the extracted data to illuminate the contexts, mechanisms and outcomes that underpinned reviewed programmes. RESULTS: The nine included studies were set in different contexts, including community organisations, schools and aged care facilities. They used an array of interventions including reminiscence therapy, craft or space for conversation. Despite study heterogeneity, the parallels in psychosocial development between older adults and adolescents were shown to be a likely driver for improved social health outcomes. Programmes most likely to improve social health outcomes were those that acknowledged psychosocial development, were delivered in community settings, leveraged pedagogical frameworks, used trained facilitators and supported participants to build relationships through shared purpose. CONCLUSIONS: This review contributes a logic model to support the design and development of intergenerational programmes involving adolescents to improve social connectedness in older adults. Future research to test the logic model in practice is needed.

Pandemic policing and the construction of publics: an analysis of COVID-19 lockdowns in public housing.

COVID-19 responses have cast a spotlight on the uneven impacts of public health policy with particular populations or sites targeted for intervention. Perhaps the starkest example in Australia was the 'hard' lockdown of nine public housing complexes in inner-city Melbourne from 4 to 18 July 2020, where residents were fully confined to their homes. These complexes are home to diverse migrant communities and the lockdown drew public criticism for unfairly stigmatising ethnic minorities. This article draws on media articles published during the lockdown and the Victorian Ombudsman's subsequent investigation to explore the implications of broad, top-down public health measures for culturally and linguistically diverse (CALD) communities. Drawing on Lea's (2020) conceptualisation of policy ecology, we analyse the lockdown measures and community responses to explore the normative assumptions underpinning health policy mechanisms, constituting 'target populations' in narrow, exclusionary terms. We argue that the lockdown measures and use of police as compliance officers positioned tower residents as risky subjects in risky places. Tracing how such subject positions are produced, and resisted at the grassroots level, we highlight how policy instruments are not neutral interventions, but rather instantiate classed and racialised patterns of exclusion, reinforcing pervasive social inequalities in the name of public health.

Estimates of drug treated diabetes incidence and prevalence using Australian administrative pharmaceutical data.

INTRODUCTION: The incidence and prevalence of diabetes within a population are important public health metrics. Pharmaceutical administrative data may offer a resource that can contribute to quantifying these measures using the recorded signals derived from the drugs used to treat people with diabetes. OBJECTIVE: To estimate the longitudinal incidence and prevalence of drug treated (DT) diabetes in Australia utilising an Australian Pharmaceutical Benefits Scheme (PBS) dataset and compare estimates with community survey data for all diabetes reported in the Australian National Health Survey (NHS). METHODS: Persons with DT diabetes were identified within the PBS dataset using assigned Anatomic Therapeutic Chemical codes for 'Drugs used in diabetes'. Prevalent persons with DT diabetes were determined by a single annual treatment, and incident cases from the earliest treatment with diabetes medications. Counts were aggregated by age group and utilised Australian national census data as a denominator to calculate diabetes disease frequencies for the period 2004-14. Comparison of PBS prevalence data was made with NHS surveys over equivalent years. RESULTS: The age adjusted incidence of DT diabetes was 3.4/1000 in 2006 and increased to 3.8/1000 in 2011 and 5.1/1000 in 2014. Age adjusted prevalence of DT diabetes in Australia also rose from 26.7/1000 in 2006 to 32.1/1000 in 2011 and 42.1/1000 in 2014. DT diabetes prevalence estimates correlated with NHS estimates of self-reported diabetes prevalence across age groups and in 2014 was r = 0.987. However, PBS estimates of DT diabetes prevalence generally underestimated NHS values of self-reported diabetes in older age groups with mean percentage differences of -22% to -3%. In contrast, PBS data captured more younger persons with diabetes in comparison to NHS data. These differences were then used to adjust DT diabetes incidence rates to provide age specific estimates that could potentially reflect diabetes incidence estimates acquired by community survey. CONCLUSIONS: PBS data representing dispensed medications prescribed to persons with diabetes offers a perspective for the assessment of diabetes incidence and prevalence. PBS derived DT diabetes prevalence estimates correlate well with community survey estimates of self-reported diabetes, but underestimate NHS data in older age groups. Calibrated DT incidence estimates may potentially reflect community survey derived diabetes incidence estimates and may offer a method for longitudinal monitoring.

Estimates of age specific death rates in people with diabetes and associated multimorbidity using Australian administrative pharmaceutical data.

INTRODUCTION: Estimating the mortality risk of persons with diabetes can be challenging. Associated conditions such as cardiovascular disease can become the primary cause of mortality and the underlying contribution of diabetes not recorded. Alternative methods to assess mortality risk in people with diabetes would be useful. OBJECTIVE: To evaluate an Australian pharmaceutical database to identify multi-morbidity cohorts associated with diabetes and determine mortality rates in these groups using prescription exchange cessation as a proxy event for death. METHODS: Australian Pharmaceutical Benefits Scheme data covering the period 2003-14 were used. Persons with diabetes, cardiovascular diseases and dyslipidemia were identified using Anatomic Therapeutic Chemical codes allocated to their recorded dispensed treatments. People with combinations of these conditions were followed and the last recorded prescription exchange used as a proxy event for mortality. Age and gender specific mortality rates and mortality rate ratios for the multi-morbidity cohorts were then calculated from the number of deaths occurring within 10 years. RESULTS: 346,201 individuals were identified as taking treatments for diabetes, dyslipidemia and cardiovascular conditions in 2004, 86,165 deaths occurred within 10 years of follow up. Overall crude mortality was 26.2/1,000 person years. Age specific mortality rates and rate ratios were calculated for various multi-morbidity groupings. Statin treatments improved the mortality rates associated with diabetes and cardiovascular disease in persons age >54 (Log-Rank <.001). CONCLUSIONS: Administrative pharmaceutical data can be used to identify persons with diabetes and associated multi-morbidities. Proxy mortality events defined by the cessation of treatment can generate mortality rates, providing an alternative perspective for the assessment of mortality risk.

Understanding local government responses to alcohol-related harm.

INTRODUCTION: Local governments (LG) have a key role in reducing alcohol-related harm, yet, Australian research investigating this is limited. This study aimed to explore Australian LGs' role in alcohol policy by investigating how LGs respond to alcohol-related harm and what influences their responses. METHODS: A collective case study approach guided two-stage purposive sampling. Victorian metropolitan and regional LGs were invited to participate based on alcohol-related harm profiles. Officers within LGs with alcohol policy knowledge participated in semi-structured interviews. Transcripts were analysed deductively using a pre-existing alcohol policy framework and inductively using thematic analysis. RESULTS: Nine officers from eight LGs participated. LG responses to alcohol-related harm predominately included bans on alcohol in public spaces, licensed premises planning and alcohol-free youth events. Half implemented liquor forums/accords and most implemented education programs in sporting clubs, schools or workplaces. In some LGs, the reduction of alcohol-related harm was not considered a priority. Key influences on alcohol initiatives were legislation, the composition of licensed venues, extent of alcohol-related harms, resources and priorities, and stakeholder feedback. DISCUSSION AND CONCLUSIONS: While particular policies were widespread, participating LGs varied greatly in activity in, and responses to, reducing alcohol-related harm. LGs reported varied influences on their responses. LGs recognised the long-term health harms of alcohol in their health planning documents, however, most prioritised interventions targeting short-term amenity and safety harms. Changes to Victorian planning and liquor licensing legislation to give additional powers to LGs and providing pre-developed alcohol programs with dedicated funding should be considered.

The Cardio-Med survey tool: development and pilot validation of a FFQ in a multicultural cardiology cohort.

OBJECTIVE: (i) Describe the development of a multipurpose Cardio-Med survey tool (CMST) comprising a semi-quantitative FFQ designed to measure dietary intake in multicultural patients with or at high risk of CVD and (ii) report pilot evaluation of test-retest reliability and validity of the FFQ in measuring energy and nutrient intakes. DESIGN: The CMST was developed to identify CVD risk factors and assess diet quality over 1 year using an FFQ. Design of the ninety-three-item FFQ involved developing food portion photographs, and a list of foods appropriate for the Australian multicultural population allowing the capture of adherence to a Mediterranean diet pattern. The FFQ was administered twice, 2 weeks apart to assess test-retest reliability, whilst validity was assessed by comparison of the FFQ with a 3-d food record (3DFR). SETTING: The Northern Hospital and St Vincent's Hospital, Melbourne, Australia. PARTICIPANTS: Thirty-eight participants aged 34-81 years with CVD or at high risk. RESULTS: Test-retest reliability of the FFQ was good: intraclass correlation coefficient (ICC) ranged from 0·52 (Na) to 0·88 (alcohol) (mean 0·79), with energy and 70 % of measured nutrients being above 0·75. Validity was moderate: ICC ranged from 0·08 (Na) to 0·94 (alcohol) (mean 0·59), with energy and 85 % of measured nutrients being above 0·5. Bland-Altman plots demonstrated good levels of agreement between the FFQ and 3DFR for carbohydrates, protein, alcohol, vitamin D and Na. CONCLUSIONS: The CMST FFQ demonstrated good test-retest reliability and moderate validity for measuring dietary energy and nutrients in a multicultural Australian cardiology population.

Coverage of Aboriginal and Torres Strait Islander nutrition in the Koori Mail.

OBJECTIVE: To examine the extent and nature of coverage of nutrition in the Koori Mail. METHODS: Content and framing analysis were used to examine articles in the Koori Mail published between 2013 and 2017 that included the terms 'nutrition∗', 'diet∗', 'food', 'eating', 'weight', 'tucker' or 'sugary drinks'. The analysis focused on the portrayal of Aboriginal and Torres Strait Islander people/communities, inclusion of First Peoples' voices and the framing of nutrition issues. RESULTS: A total of 102 articles were included. Most articles (88%, n=90) portrayed Aboriginal and Torres Strait Islander communities in a neutral or positive way and more than half (53%, n=54) included an Aboriginal or Torres Strait Islander voice. While nutrition was often framed as an individual or community responsibility, articles predominantly promoted programs or initiatives undertaken in local communities. CONCLUSION: Despite the limited prominence of Aboriginal and Torres Strait Islander nutrition in the mainstream media, the coverage of nutrition issues in the Koori Mail demonstrates the salience of this topic for local communities. This study highlights how journalism can better reflect the diversity and strengths of First Peoples. Implications for public health: Including more Aboriginal and Torres Strait Islander voices and using a strengths-based approach in press releases may improve media advocacy.

Prevalence and sociodemographic factors of risky drinking in Australian older adults.

INTRODUCTION AND AIMS: This study describes the prevalence of risky drinking in older adults (aged 60+ years) in Australia and explores the socioeconomic and lifestyle factors associated with this. The negative consequences of drinking behaviours in older adults were also explored. DESIGN AND METHODS: Cross-sectional design, with data obtained from the Australian 2016 National Drug Strategy Household Survey, yielding a sample size of 7976 participants. Multivariable logistic regression was used to assess the correlates of risky drinking. RESULTS: Approximately 17% of older Australians reported risky drinking and their most popular drinking location was in the home (93%). Respondents who were male [odds ratio 3.78, 95% confidence interval (3.22, 4.43)], of younger age group (60-69 years) [2.96, (2.25, 3.89)], in a higher socioeconomic status [1.76, (1.41, 2.21)], had no dependents [1.51, (1.10, 2.07)], were unemployed [1.64, (1.10, 2.44)] and were either current or ex-smokers [2.32, (1.90, 2.83) or 3.55, (2.95, 4.29)], were more likely to report risky drinking. Approximately 54% of risky drinkers experienced a negative outcome as a result of their drinking in the last year. DISCUSSION AND CONCLUSIONS: Risky drinking in older adults is a key public health issue, with a concerning rate of risky drinking and associated negative outcomes seen in the current study. Interventions aimed at older drinkers thus need to focus beyond socio-economically disadvantaged groups, while self-moderation on risky drinking, controlling accessibility to take-away alcohol and increasing the awareness of harms of risky drinking may help to reduce risky drinking among older people.

A comparison of Australian chronic disease prevalence estimates using administrative pharmaceutical dispensing data with international and community survey data.

INTRODUCTION: Chronic disease (CD) is a leading cause of population mortality, illness and disability. Identification of CD using administrative data is increasingly used and may have utility in monitoring population health. Pharmaceutical administrative data using World Health Organization, Anatomic Therapeutic Chemical Codification (ATC) assigned to prescribed medicines may offer an improved method to define persons with certain CD and enable the calculation of population prevalence. OBJECTIVE: To assess the feasibility of Australian Pharmaceutical Benefits Scheme (PBS) dispensing data, to provide realistic measures of chronic disease prevalence using ATC codification, and compare values with international data using similar ATC methods and Australian community surveys. METHODS: Twenty-two chronic diseases were identified using World Health Organization (WHO) formulated ATC codes assigned to treatments received and recorded in a PBS database. Distinct treatment episodes prescribed to individuals were counted annually for prevalence estimates. Comparisons were then made with estimates from international studies using pharmaceutical data and published Australian community surveys. RESULTS: PBS prevalence estimates for a range of chronic diseases listed in European studies and Australian community surveys demonstrated good correlation. PBS estimates of the prevalence of diabetes, cardiovascular disease and hypertension, dyslipidemia, and respiratory disease with comparable Australian National Health Survey in older adults showed correlations of between (r = 0.82 - 0.99) and a range of percentage error of -11% to 59%. However, other conditions such as psychological disease and migraine showed greater disparity and correlated less well. CONCLUSIONS: Although not without limitations, Australian administrative pharmaceutical dispensing data may provide an alternative perspective on population health and a useful resource to estimate the prevalence of a number of chronic diseases within the Australian population.

Cervical re-explorations and proxy survival following parathyroidectomy for primary hyperparathyroidism using Australian administrative data.

BACKGROUND: Administrative data may have utility in the impartial assessment of surgical outcomes and rare events. We have used a publicly available sample of the Australian pharmaceutical and health service provision (medical benefits scheme) databases to assess outcomes following parathyroidectomy for primary hyperparathyroidism (PHP). METHODS: A cohort study using linked pharmaceutical and medical benefits schemes data was performed covering the period 1993-2014. Procedure codes identified participants undergoing parathyroidectomy for PHP and subsequent cervical re-exploration surgery (CRX), and the last service date used as a proxy for survival. Time to CRX and survival were modelled using Kaplan-Meier analysis. Demographic data and the era of parathyroid surgery were managed as covariates for Cox regression survival analyses. RESULTS: A total of 2165 persons undergoing parathyroidectomy for PHP were identified. Median follow-up was 5.3 years (range 0.2-22). The annual number of parathyroidectomies for PHP increased gradually; 72 individuals underwent CRX (3.3%). The median time to CRX was 152 days (confidence interval 0-396) in 2000-2004 reducing to 47 days (confidence interval 15-78) for the period 2010-2014 (log-rank P = 0.027). The proportion of persons requiring CRX reduced over time from 6.1% in 1997 to 2.1% in 2012 (r2 = 0.5817, P = 0.023). Overall median survival (24.6 years) was poorer when compared with age matched controls (log-rank P = 0.025) but was not associated with CRX or gender. CONCLUSION: Administrative data can be used for the assessment of surgical outcomes and may be useful for comparisons of surgical performance, and the appraisal of infrequent events. CRX rates following parathyroidectomy for PHP are improving in Australia.

Long-term survival following successful abdominal aortic aneurysm repair evaluated using Australian administrative data.

BACKGROUND: Long-term survival (LTS) following abdominal aortic aneurysm (AAA) surgery is an outcome that can compare open surgical repair (OSR) and endovascular AAA repair (EVAR) methods. We examined the LTS of persons following successful AAA repair using administrative health data covering the Australian Pharmaceutical Benefits and Medicare Benefits Schemes from 1993 to 2014. METHODS: Participants undergoing AAA surgery were identified using procedure codes and the last service provision date used as a proxy mortality marker. LTS and relative survival with control populations in those who survived the initial post-operative period were used to compare OSR and EVAR and estimates between the first and second halves of the study. RESULTS: A total of 2060 persons who had undergone AAA repair were identified. Overall median LTS (95% CI) following elective, ruptured OSR and EVAR were 10.4 (9.1-11.0), 8.5 (6.7-10.3) and 9.7 (8.1-11.3) years, respectively. Relative survival rates at 5 and 10 years were 0.89 and 0.7 for OSR and 0.87 and 0.66 for EVAR. LTS rates were similar for OSR and EVAR in age groups 65-84 years (EVAR/OSR range 0.96-1.16); however, EVAR was superior to OSR in persons aged >85 years at 5 years (EVAR/OSR 1.32, log-rank P < 0.05). Relative survival following all techniques of AAA repair showed no significant change over the duration of the study. CONCLUSION: LTS following AAA repair was heterogeneous in comparison with control populations and varied with age and procedure. The 5-year LTS following EVAR in persons aged >85 years is superior to OSR. Administrative data can define long-term outcomes following aortic aneurysm surgery and may complement data already collected by surgeons.

The Impact of a School-Based Water, Sanitation and Hygiene Intervention on Knowledge, Practices, and Diarrhoea Rates in the Philippines.

A school-based water, sanitation, and hygiene (WASH) intervention in the Philippines was evaluated. Students and households from four schools that received the WASH intervention (intervention schools) were compared with four schools that had not (comparison schools). Knowledge of critical handwashing times was high across all schools, but higher in intervention schools. Students reported higher rates of handwashing after toilet use (92% vs. 87%; RR = 1.06; p = 0.003) and handwashing with soap (83% vs. 60%; RR = 1.4; p < 0.001) in intervention versus comparison schools. In intervention schools, 89% of students were directly observed to handwash after toilet use versus 31% in comparison schools (RR = 2.84; p < 0.0001). Observed differences in handwashing with soap after toilet use were particularly marked (65% vs. 10%; RR = 6.5; p < 0.0001). Reported use of school toilets to defecate (as opposed to use of toilet elsewhere or open defecation) was higher among intervention versus comparison schools (90% vs. 63%; RR = 1.4; p < 0.001). Multilevel modelling indicated that students from intervention schools reported a 10-fold reduction in odds (p < 0.001) of school absence due to diarrhoea. In addition to school-based findings, self-reported handwashing at critical times was found to be higher among household members of students from intervention schools. This school-based WASH program appeared to increase knowledge and hygiene behaviours of school students, reduce absences due to diarrhoea, and increase handwashing at critical times among household members.

Anatomy of a demand shock: Quantitative analysis of crowding in hospital emergency departments in Victoria, Australia during the 2009 influenza pandemic.

OBJECTIVE: An infectious disease outbreak such as the 2009 influenza pandemic is an unexpected demand shock to hospital emergency departments (EDs). We analysed changes in key performance metrics in (EDs) in Victoria during this pandemic to assess the impact of this demand shock. DESIGN AND SETTING: Descriptive time-series analysis and longitudinal regression analysis of data from the Victorian Emergency Minimum Dataset (VEMD) using data from the 38 EDs that submit data to the state's Department of Health and Human Services. MAIN OUTCOME MEASURES: Daily number of presentations, influenza-like-illness (ILI) presentations, daily mean waiting time (time to first being seen by a doctor), daily number of patients who did-not-wait and daily number of access-blocked patients (admitted patients with length of stay >8 hours) at a system and hospital-level. RESULTS: During the influenza pandemic, mean waiting time increased by up to 25%, access block increased by 32% and did not wait presentations increased by 69% above pre-pandemic levels. The peaks of all three crowding variables corresponded approximately to the peak in admitted ILI presentations. Longitudinal fixed-effects regression analysis estimated positive and statistically significant associations between mean waiting times, did not wait presentations and access block and ILI presentations. CONCLUSIONS: This pandemic event caused excess demand leading to increased waiting times, did-not-wait patients and access block. Increases in admitted patients were more strongly associated with crowding than non-admitted patients during the pandemic period, so policies to divert or mitigate low-complexity non-admitted patients are unlikely to be effective in reducing ED crowding.

Partner violence and postnatal mental health: cross-sectional analysis of factors associated with depression and anxiety in new mothers.

Intimate-partner violence and poor mental health are common, harmful issues for women of childbearing age. Although the prevalence and correlates of postpartum depression are well established, far less is known about postpartum anxiety. We aimed to investigate the association between postnatal depression and anxiety, and intimate-partner violence among women attending Victorian Maternal and Child Health services, using data from a randomised control trial: Improving Maternal and Child Health care for Vulnerable Mothers (MOVE). These data included postnatal women who had given birth between May and December 2010. Multiple logistic regression was used to estimate the association between intimate partner violence (using the Composite Abuse Scale) and postnatal depression and anxiety (Depression, Anxiety and Stress Scale), controlling for participant socio-demographic characteristics. Findings showed that abused women were more likely to report postnatal depressive and anxiety symptoms. There was an almost two-fold (odds ratio (OR) 1.76, 95% CI 1.03-3.01) and three-fold (OR 2.6, 95% CI 1.58-4.28) increase in the odds of reporting depressive and anxiety symptoms respectively, among abused compared with non-abused women. Abused women are at a higher risk of mental health problems. This study validated findings that intimate-partner violence is strongly associated with an increased risk of postnatal depression and highlighted the previously under-reported relationship with postnatal anxiety.

Intimate-partner violence and reproductive decision-making by women attending Victorian Maternal- and Child-Health services: a cross-sectional study.

The reproductive years are a critical period where women experience greater risk of intimate-partner violence (IPV). Most studies investigating the association between IPV and reproductive health have been completed in low- and middle-income countries. This study aimed to examine the relationship between IPV and women's reproductive decision-making in Victoria, Australia. We analysed secondary data from a cluster-randomised trial of IPV screening that surveyed new mothers attending Maternal- and Child-Health centres in Melbourne. Survey measures included the experience of partner abuse in the past 12 months using the Composite Abuse Scale and four reproductive decision-making indicators. Results showed that IPV affects reproductive decision-making among postpartum women. Women who reported abuse were less likely to plan for a baby (adjusted Odds Ratio 0.48, 95% CI: 0.31-0.75) than were non-abused women, significantly more likely to have partners make decisions for them about contraception (Risk ratio (RR) 4.09, 95% CI: 1.31-12.75), and whether and when to have a baby (RR 12.35, 95% CI: 4.46-34.16), than they were to make decisions jointly. Pregnant and postpartum women need to be screened for partner violence that compromises women's decision-making power regarding their reproductive rights.

The AUStralian MEDiterranean Diet Heart Trial (AUSMED Heart Trial): A randomized clinical trial in secondary prevention of coronary heart disease in a multiethnic Australian population: Study protocol.

The Mediterranean diet was first characterized as a heart-protective diet in the 1960s. The significant cardioprotective effects of the Mediterranean diet in comparison to the standard-care low-fat diet have been established in the primary prevention of cardiovascular disease (CVD); however, there is insufficient evidence in secondary prevention research to influence the current standard of care. Opportunity exists to assess the Mediterranean diet as a therapeutic target for secondary CVD prevention within Australia's ethnoculturally diverse communities. The AUSMED Heart Trial is a multisite randomized controlled trial that will evaluate the efficacy of the Mediterranean diet for secondary prevention of CVD in the Australian health care setting. This trial aims to evaluate the effect of a 6-month Mediterranean diet intervention (delivered by dietitians) versus a "standard-care" low-fat diet in reducing the composite incidence of cardiovascular events at 12 months and at trial end in participants with documented evidence of a previous acute myocardial infarction at trial entry. The quality of the diet at baseline and follow-up will be assessed using comprehensive dietary questionnaires and diaries as well as relevant dietary biomarkers (such as urinary polyphenols and erythrocyte fatty acids). Cardiovascular risk markers, including novel measures of immune and inflammatory status, endothelial function, vascular compliance, platelet activity, and body composition, will be collected to explore possible mechanisms for treatment effect. Cost-effectiveness will also be estimated to support policy translation. We plan to recruit 1,032 participants (516 per arm) from cardiology clinics in major Australian hospitals in Melbourne, Adelaide, and Brisbane.

Description of social contacts among student cases of pandemic influenza during the containment phase, Melbourne, Australia, 2009.

INTRODUCTION: Students comprised the majority of early cases of influenza A(H1N1)pdm09 in Melbourne, Australia. Students and school settings were targeted for public health interventions following the emergence of pH1N1. This study was conducted to describe changes in social contacts among the earliest confirmed student cases of pH1N1 in Melbourne, Australia, to inform future pandemic control policy and explore transmission model assumptions. METHODS: A retrospective cross-sectional behavioural study of student cases with laboratory-confirmed pH1N1 between 28 April and 3 June 2009 was conducted in 2009. Demographics, symptom onset dates and detailed information on regular and additional extracurricular activities were collected. Summary measures for activities were calculated, including median group size and median number of close contacts and attendance during the students' exposure and infectious periods or during school closures. A multivariable model was used to assess associations between rates of participation in extracurricular activities and both school closures and students' infectious periods. RESULTS: Among 162 eligible cases, 99 students participated. Students reported social contact in both curricular and extra-curricular activities. Group size and total number of close contacts varied. While participation in activities decreased during the students' infectious periods and during school closures, social contact was common during periods when isolation was advised and during school closures. DISCUSSION: This study demonstrates the potential central role of young people in pandemic disease transmission given the level of non-adherence to prevention and control measures. These finding have public health implications for both informing modelling estimates of future pandemics and targeting prevention and control strategies to young people.