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Issue 3 - 14 February 2013

Articles - Heart Disease

1. Delaying help for a heart attack could be especially deadly for women
Harvard Women's Health Watch. Jan 2013, Vol. 20
Issue 5: p1-8
The article discusses how the delaying of help for a heart attack can be especially dangerous for women resulting in their death. A study by French researchers revealed that women tended to waited longer after their symptoms began to call for medical help and were less aggressive in treatments, resulting in a much higher heart attack death rate..

2. Assessment and treatment of patients with acute unstable bradycardia. (cover story)
By Swift, Jennie. Nursing Standard. 1/30/2013, Vol. 27
Issue 22: p48-56
Bradycardia is a slow heart rate that can lead to cardiac arrest or occur after initial resuscitation following cardiac arrest. This article provides information on acute unstable bradycardia and common arrhythmias. It focuses on the assessment of patients with acute bradycardia and how the presence or absence of adverse clinical features, in conjunction with an arrhythmia, dictates the necessity and choice of treatment. [ABSTRACT FROM AUTHOR].

3. The Association Between Midlife Cardiorespiratory Fitness Levels and Later-Life Dementia
By DeFina, Laura F.; Willis, Benjamin L.; Radford, Nina B.; Gao, Ang; Leonard, David; Haskell, William L.; Weiner, Myron F.; Berry, Jarett D. Annals of Internal Medicine. 2/5/2013, Vol. 158 Issue 3: p162-168
Background: Primary prevention of Alzheimer disease and other types of dementia (all-cause dementia) is an important public health goal. Evidence to date is insufficient to recommend any lifestyle change to prevent or delay the onset of dementia. Objective: To assess the association between objectively measured midlife cardiorespiratory fitness ("fitness") levels and development of all-cause dementia in advanced age.
Design: Prospective, observational cohort study. Setting: Preventive medicine clinic. Patients: 19 458 community-dwelling, nonelderly adults who had a baseline fitness examination. Measurements: Fitness levels, assessed using the modified Balke treadmill protocol between 1971 and 2009, and incident all-cause dementia using Medicare Parts A and B claims data from 1999 to 2009. Results: 1659 cases of incident all-cause dementia occurred during 125 700 person-years of Medicare follow-up (median follow-up, 25 years [interquartile range, 19 to 30 years]). After multivariable adjustment, participants in the highest quintile of fitness level had lower hazard of all-cause dementia than those in the lowest quintile (hazard ratio, 0.64 [95% CI, 0.54 to 0.77]). Higher fitness levels were associated with lower hazard of all-cause dementia with previous stroke (hazard ratio, 0.74 [CI, 0.53 to 1.04]) or without previous stroke (hazard ratio, 0.74 [CI, 0.61 to 0.90]). Limitations: Dementia diagnoses were based on Medicare claims, and participants generally were non-Hispanic white, healthy, and well-educated and had access to preventive health care. This study evaluated fitness levels, so a specific exercise prescription cannot be generated from results and the findings may not be causal. Conclusion: Higher midlife fitness levels seem to be associated with lower hazards of developing all-cause dementia later in life. The magnitude and direction of the association were similar with or without previous stroke, suggesting that higher fitness levels earlier in life may lower risk for dementia later in life, independent of cerebrovascular disease.
Primary Funding Source: The Cooper Institute; University of Texas Southwestern Medical Center; National Heart, Lung, and Blood Institute; and American Heart Association. [ABSTRACT FROM AUTHOR].

4. Effectiveness of a Community Health Worker Cardiovascular Risk Reduction Program in Public Health and Health Care Settings
By Krantz, Mori J.; Coronel, Stephanie M.; Whitley, Elizabeth M.; Dale, Rita; Yost, Jason; Estacio, Raymond O. American Journal of Public Health. Jan 2013, Vol. 103 Issue 1: pe19-e27 (9p)
Objectives. We evaluated whether a program to prevent coronary heart disease (CHD) with community health workers (CHWs) would improve CHD risk in public health and health care settings.
Methods. The CHWs provided point-of-service screening, education, and care coordination to residents in 34 primarily rural Colorado counties. The CHWs utilized motivational interviewing and navigated those at risk for CHD into medical care and lifestyle resources. A software application generated a real-time 10-year Framingham Risk Score (FRS) and guideline-based health recommendations while supporting longitudinal caseload tracking. We used multiple linear regression analysis to determine factors associated with changes in FRS. Results. From 2010 to 2011, among 4743 participants at risk for CHD, 53.5% received medical or lifestyle referrals and 698 were retested 3 or more months after screening. We observed statistically significant improvements in diet, weight, blood pressure, lipids, and FRS with the greatest effects among those with uncontrolled risk factors. Successful phone interaction by the CHW led to lower FRS at retests (P = .04).
Conclusions. A CHW-based program within public health and health care settings improved CHD risk. Further exploration of factors related to improved outcomes is needed. [ABSTRACT FROM AUTHOR].

5. The heparin recall of 2008
By Hedlund, Kd; Coyne, Dp; Sanford, Dm; Huddelson, J. Perfusion. Jan 2013, Vol. 28 Issue 1: p61-65
Heparin is one of the oldest drugs still in widespread clinical use. Its discovery in 1916 predates the establishment of the Food and Drug Administration. Since 1935, over 15,000 research papers have been published on the effects of heparin. Because the exact chemical formula of heparin is unknown, synthetic manufacturing has proven difficult. In 2008, a worldwide recall of heparin occurred. Scientists determined that a contaminant known as oversulfated chondroitin sulfate was responsible for the numerous deaths and adverse events. This contaminant was first traced to a chemical plant in Changzou, China. This article will review the discovery of heparin and the adulteration process that jeopardized the world’s heparin supply. [ABSTRACT FROM PUBLISHER].

Articles - Health Promotion Journal of Australia

6. Evidence-based practice?
By Binns, Colin; Jancey, Jonine; Howat, Peter; Carter, Stacy. Health Promotion Journal of Australia. 01/12/2012, Vol. 23 Issue 3: p163-164
: The authors comment on evidence-based health promotion guidelines from health departments, universities and various health councils in Australia. A background of the establishment of the Cochrane Collaboration which elevated systematic reviews to its position as a the top standard for health prevention is presented. They highlight the limitation of randomised controlled trials (RCTs) when it comes to testing health promotion efforts..

7. Advocacy for health: revisiting the role of health promotion
By Gould, Trish; Fleming, Mary Louise; Parker, Elizabeth. Health Promotion Journal of Australia. 01/12/2012, Vol. 23 Issue 3: p165-170
Issue addressed: The importance of advocacy in protecting the population's health; and suggested strategies to advance an advocacy role.
Discussion: This article explores the concept of health advocacy, discusses an example of successful health advocacy within Australia, and outlines and addresses some of the barriers to advocacy. It aims to encourage discussion on advocacy's potential to improve the public's health.
Conclusions: Many of the major successes of health promotion have been facilitated through the efforts of advocates. This article supports the proposition that advocacy is a fundamental instrument of health promotion practice and suggests strategies to apply these principles in practice. [ABSTRACT FROM AUTHOR].

8. The Early Childhood Oral Health Program: promoting prevention and timely intervention of early childhood caries in NSW through shared care
By Maher, Louise; Phelan, Claire; Lawrence, Glenda; Dawson, Angela; Torvaldsen, Siranda; Wright, Clive. Health Promotion Journal of Australia. 01/12/2012, Vol. 23 Issue 3: p171-176
Issue addressed: Early childhood caries (ECC) continues to have high prevalence worldwide, despite being largely preventable. The Early Childhood Oral Health (ECOH) Program was established in New South Wales (NSW) using a model of shared responsibility for oral health, which involves a partnership between child health professionals, oral health professionals and parents of young children, to facilitate the primary prevention, early identification and early intervention of ECC.
Methods: An evaluation of the ECOH program was conducted, using mixed methods. Data were obtained through document review, surveys and interviews with program implementers, and analysis of the Information System for Oral Health (ISOH) database for public oral health services activity in NSW.
Results: Key achievements of the ECOH program include the establishment of governance mechanisms, policy, structures and responsibilities for implementation, support mechanisms for child health professionals, referral processes, communications resources, and the delivery of training. Parents receive oral health information, education and support through written resources and contact with child health professionals. Child and family health nurses interviewed reported routinely incorporating oral health promotion and early identification for ECC into their practices. The referral rate to public oral health services for children under five years of age by community health professionals has increased steadily since the program began, with the rate in 2009 five times higher than in 2007.
Conclusions: Models of shared responsibility for oral health between parents, child health professionals and oral health professionals can facilitate primary prevention and early intervention for ECC. [ABSTRACT FROM AUTHOR].

9. Participant perceptions of a community-based lifestyle intervention: the CHIP
By Chang, Esther; Bidewell, John; Brownhill, Suzanne; Farnsworth, Judy; Ward, Jean; Diehl, Hans. Health Promotion Journal of Australia. 01/12/2012, Vol. 23 Issue 3: p177-182
Issue addressed: The Coronary Health Improvement Project (CHIP) is a community-based educational initiative designed to improve cardiovascular fitness and other health indicators associated with common, lifestyle-related health disorders in developed societies. Evaluations of the CHIP since the late 1990s, though yielding positive statistical results for change in participant physical health indicators, have not included qualitative assessments of the CHIP experience from the perspectives of CHIP participants.
Methods: Data were obtained using a mixed methods survey design via a questionnaire completed by 79 respondents (71% female) who had participated in Australian CHIP programs. Responses were analysed using descriptive statistics and thematic analysis.
Results: Participants commonly undertook the CHIP to fulfil their lifestyle and health aspirations and to target specific health conditions. Improved diet, enhanced exercise and weight loss were the most commonly reported benefits. Participation in the CHIP involves a process of conviction (involving risks and motivation), connection (involving support and reinforcement), challenge (involving control and struggle) and change (involving more and less).
Conclusion: This study offers a model of a change process generated from the perspectives of participants of the CHIP in Australia. Not all participants found CHIP lifestyle recommendations straightforward to adopt, as some encountered resistance from within themselves or from family and friends. [ABSTRACT FROM AUTHOR].

10. The implementation of a pilot playground markings project in four Australian primary schools
By Kelly, Angela; Arjunan, Punitha; van der Ploeg, Hidde P.; Rissel, Chris; Borg, Janelle; Li Ming Wen. Health Promotion Journal of Australia. 01/12/2012, Vol. 23 Issue 3: p183-187
: Issue addressed: Increasing childhood overweight and obesity rates need strategies that promote and engage children in more physical activity and school is one setting for this. This pilot project aimed to determine if coloured playground markings are an effective strategy, in the Australian context, to increase students' physical activity during school break times in primary schools.
Methods: Four schools participated, two as intervention schools and two as control schools. A combination of data collection methods were used, including accelerometers on students, playground observations and a teacher survey. Results: The accelerometer and observation data did not show an improvement in the physical activity levels of the intervention students compared to the control students. The teacher survey was positive in all aspects of the project implementation. Observations suggest that most students were active in large grass areas rather than around the playground markings. Conclusion: Based on our data, it is unclear whether playground markings are an effective intervention to increase physical activity in the school setting. The amount of playing space available appears to influence the use of the playground markings. [ABSTRACT FROM AUTHOR].

11. Can social and community service organisations embrace tobacco control for their disadvantaged clients?
By Hull, Philip; Salmon, Allison M.; O'Brien, Jon; Chapman, Kathy; Williams, Kelly. Health Promotion Journal of Australia. 01/12/2012, Vol. 23 Issue 3: p188-193
Issue addressed: High smoking rates among the disadvantaged lead to inequalities in health, quality-of-life and financial well-being. Non-government social and community service organisations (SCSO) are a promising setting for tobacco control interventions targeting disadvantaged smokers. Methods: Financial grants were provided to twenty SCSO in New South Wales to support multi-level changes in service culture, smoking-related policies and cessation support between 2007 and 2009. Evaluation was conducted using a mixed-methods approach that included key informant interviews, document analysis and staff survey data. Results: SCSO working with disadvantaged clients can feasibly implement tobacco control activities, including smoking-related policy changes and cessation support. Tobacco control activities were generally acceptable to staff and clients, and staff pessimism regarding their clients' ability to quit reduced, as did the acceptability of staff smoking with their clients. Improvements in levels of organisational support for cessation training and resources, smoking policies and provision of free nicotine replacement therapy (NRT) were reported. Within mental health SCSO there was a positive response from staff to cessation support, financial benefits of quitting and the role of NRT. Conclusions: The evaluation pointed to the acceptability and feasibility of engaging disadvantaged smokers by SCSO, and that tobacco policy and attitude changes can be achieved by small investments, such as grant programs. [ABSTRACT FROM AUTHOR].

12. Evaluation of a sexual health and blood-borne virus health education website for youth
By Mak, Donna B.; Grace, Jocelyn; Bastian, Lisa; Aquilina, Heather; Sweeting, Jennifer. Health Promotion Journal of Australia. 01/12/2012, Vol. 23 Issue 3: p194-200
Issue addressed: The 'Get the Facts' website, aimed at Western Australian (WA) youth aged 14 -17 years, provides information about sexual health, blood-borne viruses and sexual relationships, and how to access appropriate health services. It was developed as one component of a comprehensive sexually transmitted infection (STI) prevention and control program implemented within Western Australia.
Methods: An evaluation was undertaken to assess how the website might be improved and be more effectively marketed to its target audience. Website usage data, on-line survey responses and qualitative data from focus group testing of the website were collected and analysed. Results: Website visitors were from 194 countries, with the majority being Australian (65%) and 27% of Australian visitors being from WA. Website usage patterns indicated that the site was of greater relevance to WA than other visitors. An estimated 5% of 14-17 year old WA residents had visited the site in 2010. Online survey and focus group data indicated that the website provides sexual health and blood-borne virus information that is relevant to young people and in a format that they find acceptable and accessible. Conclusions: The 'Get the Facts' website appeals to its target audience and provides them with relevant information. The challenge is to improve its promotion so it reaches its full potential WA youth audience. [ABSTRACT FROM AUTHOR].

13. Active, healthy cities -- how does population physical activity vary between Australian cities?
By Bauman, Adrian; Curac, Nada; King, Lesley; Venugopal, Kamalesh; Merom, Dafna. Health Promotion Journal of Australia. 01/12/2012, Vol. 23 Issue 3: p201-207
Issue addressed: Despite recognition that urban infrastructure influences physical activity, there have been no comparisons between Australian city-level patterns of physical activity. This study ranked Australian cities in terms of adults' participation in leisure-time physical activity and examined city-level variations in activity trends between 2001 and 2009. Methods: Data on participation in leisure-time physical activity in adults (=15 years) between 2001 and 2009 were obtained from the Exercise Recreation and Sport Survey (ERASS), a computer-assisted telephone interview conducted to collect population-level sport participation information by the Australian Sports Commission. Data were analysed for respondents residing in the eight capital cities of Australia. The prevalence of meeting recommended 'health-enhancing physical activity' (HEPA) and levels of walking were calculated by age, gender and survey year. Multiple linear logistic regression analyses were used to compare cities.
Results: Pooled data from 174,323 adults across years showed that Melbourne, Brisbane, Perth and Canberra residents were significantly more active than Sydney, Adelaide and Hobart residents in terms of HEPA. Hobart, Perth and Melbourne residents were significantly more likely to walk =5 sessions a week compared with their counterparts in other cities. HEPA and walking increased across most cities between 2001 and 2009. Conclusion: There are significant differences between Australian cities in physical activity and walking levels, over and above differences attributable to age, gender or educational levels. While this may be due to infrastructure differences, comparative information on indicators of the built environment and transport infrastructure are not available. [ABSTRACT FROM AUTHOR].

14. Occupational sitting: practitioner perceptions of health risks, intervention strategies and influences.
By Gilson, Nicholas; Straker, Leon; Parry, Sharon. Health Promotion Journal of Australia. 01/12/2012, Vol. 23 Issue 3: p208-212
Issue addressed: Workplace practitioners are well placed to provide practical insights on sedentary behaviour issues in the workplace. This study consulted occupational health and safety (OHS) practitioners, examining their perceptions of sedentary health risks and views on strategies and influences to reduce and break prolonged occupational sitting.
Methods: Three focus groups were conducted with convenience samples of OHS practitioners (n=34; 6 men; 46.4±9.6 years) attending an Australian national conference in November 2010. Open-ended questions concerning health risks, sitting reduction strategies and influences were posed by lead researchers and practitioners invited to express opinions, viewpoints and experiences. Audio-recordings and notes of focus group discussions were reviewed by researchers to identify key response themes.
Results: OHS practitioners were well informed about the chronic disease and musculoskeletal risks associated with prolonged occupational sitting, but noted the importance of not replacing one workplace health issue (too much sitting) with another (too much standing). Ideas for strategies were diverse and explored the dichotomy between providing choices for employees to stand and move more (e.g. sit-stand desks), as opposed to obligating change through adapting job and office design (e.g. centralising printers and scanners). Productivity concerns were cited as a major influence for change. OHS practitioners also highlighted the value of using cross-disciplinary expertise to bridge the gap between research and practice.
Conclusions: This study identified that OHS practitioners in Australia have a good understanding of the risks of prolonged occupational sitting and potential strategies to manage these risks. [ABSTRACT FROM AUTHOR].

15. Prevalence and socio-demographic distribution of eating, physical activity and sedentary behaviours among Australian adolescents
By Morley, Belinda; Scully, Maree; Niven, Philippa; Baur, Louise A.; Crawford, David; Flood, Victoria; Okely, Anthony D.; Pratt, Iain S.; Salmon, Jo; Wakefield, Melanie. Health Promotion Journal of Australia. 01/12/2012, Vol. 23 Issue 3: p213-218
: Issue addressed: To examine the prevalence and socio-demographic distribution of adherence to national dietary and physical activity recommendations among Australian secondary school students. Methods: Cross-sectional survey of 12,188 students in Years 8 to 11 (aged 12-17 years). Students' self-reported eating, physical activity and sedentary behaviours were assessed using validated instruments administered via an online questionnaire.
Results: Less than one-quarter of students (24%) reported meeting the daily requirement of at least four serves of vegetables, while 41% reported consuming the recommended three or more daily serves of fruit. Just 15% of students reported engaging in at least 60 minutes of moderate-to-vigorous activity every day, and only one in five students met the recommendation of spending no more than two hours per day in small screen recreation. Males were performing better than females in terms of fruit intake and physical activity, but worse in relation to frequency of consumption of sugary drinks and fast food, and time spent using electronic media. The proportion of students meeting fruit and vegetable recommendations declined with advancing year level, while lower socio-economic position (SEP) students were faring less well than those from high SEP neighbourhoods, particularly with regards to healthy eating. Conclusions: There is considerable scope for improving young people's health behaviours in line with national dietary and physical activity recommendations. [ABSTRACT FROM AUTHOR].

Journal - Table of Contents

16. From Registered Nurse Journal, November/December 2012
. One member, one vote [New provincial legislation for not-for-profit corporations means individual RNAO members get a say on governance issues]
16B. President's view: Bullying is alive and well in nursing
16C. Visionary leadership: Charting a course for the future of nursing
16D. Building on RNAO's success [Members asked to approve first RNAO fee increase in 14 years]
16E. Full scope nursing [Primary care nurses have the skills and desire to provide more comprehensive care that will benefit patients]
16F. Conquering cancer [Nurses have a unique role to play in the lives of patients diagnosed with cancer. Experiences and views of four nurses from different vantage points]
16G. RN becomes leader to inspire others [Denise Bryant-Lukosius]
Policy at work
. More than quick fix needed to deal with elder abuse; New model for community care receives much attention; Sale of Shouldice Hospital stopped

Conferences & Training

17. New Zealand Home Health Association 2013 Conference
Squeeze, stretch and flex: home and community
  10–12 April 2013
Venue: Rendezvous Hotel, Auckland
The conference will focus on these questions:
•The government wants service integration – what does that mean for home and community agencies?
•Are we responsive to client need? Choice, cultural context, independence?
•Service models are changing, and there is pressure on the public purse – what are the implications, what is the future?
•How can we value our workforce?
•How do we know that our work is effective?

News - National

18. Popular painkiller deadly, study

Health Experts seek painkiller ban Professor backs coded food labels Home criticised after autistic resident harmed Support buoyed insurance battler in final days Coca-Cola warning label recommended  Stunt buddies let good times roll Boxing plan to make teens' exercise fun Whooping cough epidemic not tapering off Calls for pill to be over the counter Heart transplant approval too late A popular painkiller should be banned worldwide because it raises the risk of heart attack and stroke by almost half, joint British and Canadian researchers academics say. Risks from diclofenac, widely sold as Voltaren, were highest in those who used it regularly, and safer options were available, they said. Medsafe in New Zealand said it would consider the research, but noted previous reviews had shown the drug's benefits outweighed potential risks

19. Professor backs coded food labels
A professor at the National Addiction Centre is calling for a major overhaul of food labelling in New Zealand following the tragic death of Invercargill woman Natasha Harris
A coroner this week found that Ms Harris died from drinking too much Coca-Cola. She consumed up to 10 litres a day, the equivalent of a 1 kilogram bag of sugar. Professor Doug Sellman said the tragedy was a reminder of the potential dangers of over-consuming certain foods stocked on the supermarket shelves

20. Smoking calculator stringency challenged
A smoking lounge in Auckland’s SkyCity casino is being held up as an example of an "inadequate" Ministry of Health tool to decide what an open space for smoking is. The "open areas" calculator was a tool created in the 1990s, used by the ministry to assess whether an area counted as an open area or an internal one for the purposes of the Smoke-free Environments Act.

News - International

21. Desire to help young mothers proved catalyst for foundation of Maternal and Child Health Line
Melbourne Age - 14 Feb 2013

27-1-1927 — 19-11-2012CARMEL Scarfe, who died in Box Hill Hospital aged 85, was one of four Victorian nurses who set up a voluntary telephone hotline service to reassure and advise young parents in 1973. Realising that people often had no recourse to after-hours help, Carmel, along with Barbara Potter, Lorna Blair and Nancy Collie, manned phones from their homes from 6pm to midnight, and with the help of others managed the service daily for many years.

22. For health's sake, time to take on food giants
Opinion - Bruce Neal

Bruce Neal is a senior director at the George Institute for Global Health and professor of medicine at the University of Sydney
A woman dies from a 10-litre a day Coke habit. Children's clothing sports advertisements for Jim Beam bourbon. These are extreme examples, but just the tip of the iceberg when it comes to the alcohol and processed food companies using the same tactics as Big Tobacco to increase profits at the same time as increasing sugar and salt in our diets.



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