92 results on '"Alston, L"'
Search Results
2. Design and implementation characteristics of research training for rural health professionals: a qualitative descriptive study
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Quilliam, C, Shee, AW, Corboy, D, Glenister, K, King, O, Mc Namara, K, Alston, L, Aras, D, Beauchamp, A, McKinstry, C, Quilliam, C, Shee, AW, Corboy, D, Glenister, K, King, O, Mc Namara, K, Alston, L, Aras, D, Beauchamp, A, and McKinstry, C
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BACKGROUND: Research capacity and capability of rural health professionals is essential to the delivery of evidence-based care and for informing strategies to address rural health inequities. Effective implementation of research education and training is fundamental to building rural health professional research capacity and capability. A lack of overarching guidance to inform the delivery of research education and training in rural health services can contribute to gaps in capacity-building approaches. The aim of this study was to identify characteristics of the design and implementation of current research training for rural health professionals in Victoria, Australia, to inform a future model for rural health professional research capacity and capability building. METHODS: A qualitative descriptive study was undertaken. Key informants, with extensive knowledge of research education and training in rural health services in Victoria, were invited to participate in semi-structured telephone interviews via snowballing recruitment methods. Interview transcripts were analysed inductively, with themes and codes mapped to the domains of the Consolidated Framework for Implementation Research. RESULTS: Of the 40 key informants approached, 20 agreed to participate including 11 regional health service managers, five rural health academics and four university managers. Participants suggested that research training varied in quality and relevance to rural health professionals. Training costs and lack of tailoring to the rural context were key barriers, whereas experiential learning and flexible modes of delivery enabled training uptake. Health service and government policies, structures, and processes both enabled or stifled implementation opportunities, with rural health professional networks from different regions offering capacity for research training development, and government departmental structures hampering training coordination. Tension between research activities an
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- 2023
3. Signal processing for transmitted-reference ultra wideband system
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Alston L. Emmanuel
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This thesis focuses on transmitted-reference ultra wideband (TR-UWB) systems coexistence with IEEE802.11a WLAN systems. TR-UWB systems can relax the difficult synchronization requirements and can provide a simple receiver architecture that gathers the energy from many resolvable multipath components. However, UWB TR systems are susceptible to interference which comes from other wireless systems. In this thesis, TR-UWB system performance is studied in the presence of strong IEEE 802.11a WLAN interference in both AWGN and IEEE channel model. In order to reduce both the effects of interference by and into UWB signals, we propose a new method in conjunction with a multi-carrier type transmission pulse using wavelet analysis and notch filtering. Using wavelet analysis, spectral density of the transmitted UWB signal around the interfering band is reduced by 60 dB lower than the peak. With the modified TR-UWB receiver, the TR-UWB system shows performance improvement in the presence of strong IEEE 8-2.11a interference in both AWGN and IEEE channel models. The proposed method can be used for the coexistence of different wireless systems with UWB system.
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- 2022
4. Community Health Programs Delivered Through Information and Communications Technology in High-Income Countries: Scoping Review
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Beks, H, King, O, Clapham, R, Alston, L, Glenister, K, McKinstry, C, Quilliam, C, Wellwood, I, Williams, C, Shee, AW, Beks, H, King, O, Clapham, R, Alston, L, Glenister, K, McKinstry, C, Quilliam, C, Wellwood, I, Williams, C, and Shee, AW
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BACKGROUND: The COVID-19 pandemic has required widespread and rapid adoption of information and communications technology (ICT) platforms by health professionals. Transitioning health programs from face-to-face to remote delivery using ICT platforms has introduced new challenges. OBJECTIVE: The objective of this review is to scope for ICT-delivered health programs implemented within the community health setting in high-income countries and rapidly disseminate findings to health professionals. METHODS: The Joanna Briggs Institute's scoping review methodology guided the review of the literature. RESULTS: The search retrieved 7110 unique citations. Each title and abstract was screened by at least two reviewers, resulting in 399 citations for full-text review. Of these 399 citations, 72 (18%) were included. An additional 27 citations were identified through reviewing the reference lists of the included studies, resulting in 99 citations. Citations examined 83 ICT-delivered programs from 19 high-income countries. Variations in program design, ICT platforms, research design, and outcomes were evident. CONCLUSIONS: Included programs and research were heterogeneous, addressing prevalent chronic diseases. Evidence was retrieved for the effectiveness of nurse and allied health ICT-delivered programs. Findings indicated that outcomes for participants receiving ICT-delivered programs, when compared with participants receiving in-person programs, were either equivalent or better. Gaps included a paucity of co-designed programs, qualitative research around group programs, programs for patients and carers, and evaluation of cost-effectiveness. During COVID-19 and beyond, health professionals in the community health setting are encouraged to build on existing knowledge and address evidence gaps by developing and evaluating innovative ICT-delivered programs in collaboration with consumers and carers.
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- 2022
5. Factors Influencing Implementation, Sustainability and Scalability of Healthy Food Retail Interventions: A Systematic Review of Reviews
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Gupta, A, Alston, L, Needham, C, Robinson, E, Marshall, J, Boelsen-Robinson, T, Blake, MR, Huggins, CE, Peeters, A, Gupta, A, Alston, L, Needham, C, Robinson, E, Marshall, J, Boelsen-Robinson, T, Blake, MR, Huggins, CE, and Peeters, A
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The aim of this systematic review of reviews was to synthesise the evidence on factors influencing the implementation, sustainability and scalability of food retail interventions to improve the healthiness of food purchased by consumers. A search strategy to identify reviews published up until June 2020 was applied to four databases. The Risk of Bias in Systematic Review tool was used. Review findings were synthesised narratively using the socio-ecological model. A total of 25 reviews met the inclusion criteria. A number of factors influenced implementation; these included retailers' and consumers' knowledge and preferences regarding healthy food; establishing trust and relationships; perceived consumer demand for healthy food; profitability; store infrastructure; organizational support, including resources; and enabling policies that promote health. Few reviews reported on factors influencing sustainability or scalability of the interventions. While there is a large and rapidly growing body of evidence on factors influencing implementation of interventions, more work is needed to identify factors associated with their sustainability and scalability. These findings can be used to develop implementation strategies that consider the multiple levels of influence (individual, intrapersonal and environmental) to better support implementation of healthy food retail interventions.
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- 2022
6. The Magnitude of NCD Risk Factors in Ethiopia: Meta-Analysis and Systematic Review of Evidence.
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Tesfay, FH, Backholer, K, Zorbas, C, Bowe, SJ, Alston, L, Bennett, CM, Tesfay, FH, Backholer, K, Zorbas, C, Bowe, SJ, Alston, L, and Bennett, CM
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BACKGROUND: Non-communicable Diseases (NCDs) and their risk factors are the leading contributors to morbidity and mortality globally, particularly in low- and middle-income countries including Ethiopia. To date, there has been no synthesis of the literature on the relative prevalence of NCD risk factors in Ethiopia. METHODOLOGY: We conducted a systematic review and meta-analysis of primary studies reporting on the prevalence of NCD risk factors in Ethiopia published in English from 2012 to July 2020. Pre-tested NCD search terms were applied to Medline, Embase, Scopus, CINAHL, and Global Health. Three reviewers screened and appraised the quality of the identified papers. Data extraction was conducted using a pilot tested proforma. Meta-analysis was conducted using Stata 16 and pooled prevalence estimated with associated 95% confidence intervals. Clinically heterogeneous studies that did not fulfil the eligibility criteria for meta-analysis were narratively synthesised. I2 was used to assess statistical heterogeneity. RESULTS: 47 studies fulfilled the inclusion criteria and contributed 68 NCD risk factor prevalence estimates. Hypertension was the most frequently examined NCD risk factor, with a pooled prevalence of 21% (n = 27 studies). The pooled prevalence percentages for overweight and obesity were 19.2% and 10.3%, respectively (n = 7 studies each), with a combined prevalence of 26.8% (n = 1 study). It was not possible to pool the prevalence of alcohol consumption, smoking, metabolic disorders, or fruit consumption because of heterogeneity across studies. The prevalence of alcohol use, as reported from the included individual studies, ranged from 12.4% to 13.5% (n = 7 studies). More than 90% of participants met the WHO-recommended level of physical activity (n = 5 studies). The prevalence of smoking was highly variable, ranging between 0.8% and 38.6%, as was the prevalence of heavy alcohol drinking (12.4% to 21.1%, n = 6 studies) and metabolic syndrome (4.8% to 9.6
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- 2022
7. What shapes research and research capacity building in rural health services? Context matters
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Shee, AW, Quilliam, C, Corboy, D, Glenister, K, McKinstry, C, Beauchamp, A, Alston, L, Maybery, D, Aras, D, Mc Namara, K, Shee, AW, Quilliam, C, Corboy, D, Glenister, K, McKinstry, C, Beauchamp, A, Alston, L, Maybery, D, Aras, D, and Mc Namara, K
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OBJECTIVE: To determine the contextual factors influencing research and research capacity building in rural health settings. DESIGN: Qualitative study using semi-structured telephone interviews to collect data regarding health professionals' research education and capacity building. Analysis involved inductive coding using Braun and Clark's thematic analysis; and deductive mapping to the Consolidated Framework for Implementation Research (CFIR). SETTING: Victorian rural health services and university campuses. PARTICIPANTS: Twenty senior rural health managers, academics and/or research coordinators. Participants had at least three years' experience in rural public health, health-related research or health education settings. MAIN OUTCOME MEASURES: Contextual factors influencing the operationalisation and prioritisation of research capacity building in rural health services. RESULTS: Findings reflected the CFIR domains and constructs: intervention characteristics (relative advantage); outer setting (cosmopolitanism, external policies and incentives); inner setting (implementation climate, readiness for implementation); characteristics of individuals (self-efficacy); and process (planning, engaging). Findings illustrated the implementation context and the complex contextual tensions, which either prevent or enhance research capacity building in rural health services. CONCLUSIONS: Realising the Australian Government's vision for improved health service provision and health outcomes in rural areas requires a strong culture of research and research capacity building in rural health services. Low levels of rural research funding, chronic workforce shortages and the tension between undertaking research and delivering health care, all significantly impact the operationalisation and prioritisation of research capacity building in rural health services. Effective policy and investment addressing these contextual factors is crucial for the success of research capacity building
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- 2022
8. Prevalence of chronic non-communicable diseases in Ethiopia: A systematic review and meta-analysis of evidence.
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Tesfay, FH, Zorbas, C, Alston, L, Backholer, K, Bowe, SJ, Bennett, CM, Tesfay, FH, Zorbas, C, Alston, L, Backholer, K, Bowe, SJ, and Bennett, CM
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BACKGROUND: Non-communicable diseases (NCDs) are a growing global health challenge disproportionately impacting low- and middle-income settings, including Ethiopia. Currently, the body of evidence describing the burden of NCDs is fragmented, inconsistent, health facility- or institution-based, and out-dated in Ethiopia. We conducted a systematic review of the literature and meta-analysis of the prevalence of NCDs in community settings in Ethiopia. REVIEW METHODOLOGY: Community-based quantitative studies published in English between January 1st, 2012, and June 30th, 2022, that reported on the prevalence of NCDs in Ethiopia were included. A systematic search of Medline, Embase, Scopus, CINAHL, and Global Health using pretested search terms related to NCDs was conducted, and data were extracted using a piloted data extraction proforma adapted from the Joanna Briggs Institute tool. Meta-analysis was performed using Stata 16. While the pooled prevalence of Diabetes Mellitus (DM) and undiagnosed (DM) was computed and presented using forest plots, then overall prevalence of NCDs and other various types of NCDs were narratively synthesized. I 2 was used to assess heterogeneity. Studies that did not fulfill the criteria (used similar tool to measure the types of NCDs) for meta-analysis were narratively synthesized. RESULTS: Twenty-two studies met the inclusion criteria. Five studies measured the prevalence of NCDs (all NCDs together), ranging from 29 to 35% (prevalence estimates not pooled). The pooled prevalence of Diabetes Mellitus (DM) across ten studies was 5% (95% CI: 4-7%). Three studies each reported on the prevalence of undiagnosed DM (pooled prevalence 5%, 95% CI: 4-7%) and pre-DM (pooled prevalence 7%, 95% CI: 3-14%%). In a narrative analysis the prevalence of cardiovascular conditions ranged from 13.4 to 32.2% (n = 3 studies), cancer mortality ranged from 4 to 18% (n = 3 studies) and respiratory conditions ranged from 1 to 18% (n = 3 studies). Some studies have de
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- 2022
9. Starting with us: Imagining relational, co-designed policy approaches to improve healthcare access for rural people with disability
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Quilliam, C, O'Shea, A, Holgate, N, Alston, L, Quilliam, C, O'Shea, A, Holgate, N, and Alston, L
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CONTEXT: Access to healthcare for rural Australians is a wicked problem, particularly for rural people with disability. Contemporary healthcare access frameworks in Australia tend to overlook geography, use a 'one-size-fits-all approach', and disregard the valuable relationships between key rural healthcare stakeholders, including rural people with disability, rural health services and health professionals. The United Nation's Convention on the Rights of Persons with Disabilities requires the Australian Government to engage people with disability in the design of policies that will shape their day-to-day lives, including their access to healthcare. However, the nature and extent to which rural people with disability, rural health professionals and other key rural stakeholders are involved in the design of Australian policies impacting the health of rural people with disability are unknown. AIM: This paper examines approaches taken to engage rural people with disability and health professionals in the design of Australian disability policy impacting healthcare access, and reimagines future processes which can improve healthcare access for rural people with disability. APPROACH: Co-design and ethics of care lenses are applied to policy design approaches in this paper. We approach this work as rural disability and health academics, rural health professionals, and as rural people with disability, neurodivergence and family members of people with disability. CONCLUSION: We argue future co-designed policy approaches could focus on driving change towards equity in healthcare access for rural people with disability by harnessing the relational nature of rural healthcare.
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- 2022
10. A201 UNDERSTANDING THE INFECTION DYNAMICS OF MYCOBACTERIUM PARATUBERCULOSIS (MAP)
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Baruta, G M, primary, Zhang, H, additional, Alston, L, additional, and Hirota, S A, additional
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- 2021
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11. A28 CHARACTERIZING THE ROLE OF NR4A1 IN THE REGULATION OF INTESTINAL SMOOTH MUSCLE CELL PHENOTYPE AND FUNCTION
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Szczepanski, H E, primary, Flannigan, K L, additional, Mainoli, B, additional, Alston, L, additional, Lee, J, additional, Baruta, G M, additional, Venu, V P, additional, Shearer, J, additional, Dufour, A, additional, and Hirota, S A, additional
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- 2021
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12. Responsibility for evidence-based policy in cardiovascular disease in rural communities: implications for persistent rural health inequalities
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Alston, L, Bourke, L, Nichols, M, Allender, S, Alston, L, Bourke, L, Nichols, M, and Allender, S
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Objective The aim of this study was to understand, from the perspective of policy makers, who holds the responsibility for driving evidence-based policy to reduce the high burden of cardiovascular disease (CVD) in rural Australia. Methods Qualitative interviews were conducted with policy makers at the local, state and federal government levels in Australia (n=21). Analysis was conducted using the Conceptual Framework for Understanding Rural and Remote Health to understand perceptions of policy makers around who holds the key responsibility in driving evidence-based policy. Results At all levels of government, there were multiple examples of disconnect in the understanding of who is responsible for driving the generation of evidence-based policy to reduce CVD in rural areas. Policy makers suggested that the rural communities themselves, health services, health professionals, researchers and the health sector as a whole hold large responsibilities in driving evidence-based policy to address CVD in rural areas. Within government, there was also a noticeable disconnect, with local participants feeling it was the federal government that held this responsibility; however, federal government participants suggested this was largely a local government issue. Overall, there seemed to be a lack of responsibility for CVD policy, which is reflected in a lack of action in rural areas. Conclusion There was a lack of clarity about who is responsible for driving evidence-based policy generation to address the high burden of CVD in Australia, providing one possible explanation for the lack of policy action. Clarity among policy makers over shared roles and leadership for policy making must be addressed to overcome the current burden of CVD in rural communities. What is known about the topic? Rural health inequalities, such as the increased burden of CVD in rural Australia are persistent. Such health inequalities are unjust, with global theory suggesting political processes have facil
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- 2020
13. A36 THE ROLE OF MICROBIAL INDOLE METABOLITES IN CONTROLLING INFLAMMATORY RESPONSES AND HEALING IN RESPONSE TO DSS-INDUCED COLITIS
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Nieves, K, primary, Flannigan, K L, primary, Alston, L, primary, Thomson, C, primary, McCoy, K, primary, Mani, S, primary, and Hirota, S A, primary
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- 2020
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14. A32 THE REGULATION OF INTESTINAL SMOOTH MUSCLE CELL PROLIFERATION IN CROHN’S DISEASE – IS NR4A1 A NOVEL TARGET TO TREAT FIBROSTENOSIS?
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Szczepanski, H, primary, Tsai, Y, primary, Venu, V P, primary, Alston, L, primary, and Hirota, S A, primary
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- 2020
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15. Spectral complexity of 5-ALA induced PpIX fluorescence in guided surgery: a clinical study towards the discrimination of healthy tissue and margin boundaries in high and low grade gliomas
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Alston, L., primary, Mahieu-Williame, L., additional, Hebert, M., additional, Kantapareddy, P., additional, Meyronet, D., additional, Rousseau, D., additional, Guyotat, J., additional, and Montcel, B., additional
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- 2019
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16. A87 ACTIVATION OF NR4A1 REDUCES INFLAMMATION-ASSOCIATED INTESTINAL FIBROSIS AND DAMPENS FIBROGENIC SIGNALING IN INTESTINAL MYOFIBROBLASTS
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Venu, V P, primary, Alston, L, additional, Szczepanski, H, additional, and Hirota, S A, additional
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- 2019
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17. A16 SENSING OF A MICROBIAL METABOLITE BY FIBROBLASTS THROUGH THE PREGNANE X RECEPTOR RESTRAINS INFLAMMATION AND FIBROSIS IN MICE
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Flannigan, K L, primary, Nieves, K, additional, Alston, L, additional, Mani, S, additional, and Hirota, S A, additional
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- 2019
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18. A209 XENOBIOTIC RECEPTOR REGULATION OF CLOSTRIDIUM DIFFICILE-ASSOCIATED TISSUE DAMAGE AND INFLAMMATION
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Erickson, S L, primary, Flannigan, K L, additional, Alston, L, additional, and Hirota, S A, additional
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- 2018
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19. A275 COMMENSAL BACTERIA IN THE SMALL INTESTINE INFLUENCE IMMUNE CELLS TO DICTATE HOST DRUG METABOLISM
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Flannigan, K L, primary, Nieves, K M, additional, Erickson, S L, additional, Alston, L, additional, and Hirota, S A, additional
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- 2018
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20. A119 THE MICROBIAL METABOLITE SENSOR PREGNANE X RECEPTOR (PXR) RESTRAINS FIBROBLASTS FROM PROMOTING INTESTINAL INFLAMMATION AND FIBROSIS IN MICE
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Flannigan, K L, primary, Alston, L, additional, Mani, S, additional, and Hirota, S A, additional
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- 2018
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21. Pregnane X Receptor Activation Attenuates Inflammation-Associated Intestinal Epithelial Barrier Dysfunction by Inhibiting Cytokine-Induced Myosin Light-Chain Kinase Expression and c-Jun N-Terminal Kinase 1/2 Activation
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Garg, A., primary, Zhao, A., additional, Erickson, S. L., additional, Mukherjee, S., additional, Lau, A. J., additional, Alston, L., additional, Chang, T. K. H., additional, Mani, S., additional, and Hirota, S. A., additional
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- 2016
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22. Limitations of visual memory in spatial frequency discrimination
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Wright, M. J, primary and Alston, L., additional
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- 2010
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23. Pork for Policy: Executive and Legislative Exchange in Brazil
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Alston, L. J., primary
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- 2005
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24. The Determinants and Impact of Property Rights: Land Titles on the Brazilian Frontier
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Alston, L. J., primary, Libecap, G. D., additional, and schneider, R., additional
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- 1996
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25. Investigation of Fuel Pump Failures with Navy Distillate Fuel.
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MECHANICAL TECHNOLOGY INC LATHAM N Y, Wilson,Donald S., Arwas,Elie B., Murray,Sylvester F., Gu,Alston L., MECHANICAL TECHNOLOGY INC LATHAM N Y, Wilson,Donald S., Arwas,Elie B., Murray,Sylvester F., and Gu,Alston L.
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A study was made of the probable cause or causes of the fuel pump failures that have been encountered in some Naval ships since conversion to navy distillate (ND) fuel. The study concentrated on the pumps of the USS Constellation, since this ship has suffered a very high rate of fuel pump failures. Analysis of the heavy load region of the idler bore showed that the film thicknesses in this region are very small with ND, in the range of 50 to 110 microinches. This analysis and the inspection of failed pumps showed that ultimate failures resulted from rupture of this film and subsequent high wear of the idler bores. Heavy contamination of the fuel with hard particles was at least a contributing factor in the failures. The processes whereby the various types of contamination (by solid particles, water, entrained gas, and ND-NSFO emulsions) can induce or contribute to pump failures is discussed. Materials for improved tolerance of the operating conditions are also discussed. Recommendations aimed at preventing future pump failures are provided. These include a run-in procedure necessary to burnish the surfaces in the idler bore region so that they can sustain a full, separating fluid film. Desirable revisions in start-up and operating procedures are identified. The need to reduce contamination level is stressed, however, acceptable levels should be experimentally established. (Author)
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- 1971
26. Scientific Management: A History and Criticism.
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Alston, L., primary and Drury, Horace Bookwalter, additional
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- 1916
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27. Russian Debts and Russian Reconstruction.
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Alston, L., primary, Pasvolsky, Leo, additional, and Moulton, H. G., additional
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- 1924
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28. An Introduction to Economics for Indian Students.
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Alston, L., primary and Moreland, W. H., additional
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- 1914
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29. Psychology and Industrial Efficiency.
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Alston, L., primary and Munsterberg, Hugo, additional
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- 1914
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30. Use of Guideline-Recommended Heart Failure Drugs in High-, Middle-, and Low-Income Countries: A Systematic Review and Meta-Analysis.
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Satheesh G, Dhurjati R, Alston L, Tesfay F, Pant R, Bahiru E, Bambs C, Agarwal A, Peters SAE, Salam A, and Johansson I
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- Humans, Practice Guidelines as Topic, Adrenergic beta-Antagonists therapeutic use, Mineralocorticoid Receptor Antagonists therapeutic use, Developed Countries, Heart Failure drug therapy, Heart Failure epidemiology, Developing Countries
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Optimal use of guideline-directed medical therapy (GDMT) can prevent hospitalization and mortality among patients with heart failure (HF). We aimed to assess the prevalence of GDMT use for HF across geographic regions and country-income levels. We systematically reviewed observational studies (published between January 2010 and October 2020) involving patients with HF with reduced ejection fraction. We conducted random-effects meta-analyses to obtain summary estimates. We included 334 studies comprising 1,507,849 patients (31% female). The majority (82%) of studies were from high-income countries, with Europe (45%) and the Americas (33%) being the most represented regions, and Africa (1%) being the least. Overall prevalence of GDMT use was 80% (95% CI 78%-81%) for β-blockers, 82% (80%-83%) for renin-angiotensin-system inhibitors, and 41% (39%-43%) for mineralocorticoid receptor antagonists. We observed an exponential increase in GDMT use over time after adjusting for country-income levels ( p < 0.0001), but significant gaps persist in low- and middle-income countries. Multi-level interventions are needed to address health-system, provider, and patient-level barriers to GDMT use., Competing Interests: IJ has received consultancy fees from AstraZeneca, Novo Nordisk and Boehringer Ingelheim and is supported by unrestricted research grants from Stockholm County Council, Swedish Heart-Lung Foundation, AstraZeneca, and Swedish Society of Cardiology. LA is supported by the Rural Health Multidisciplinary Training (RHMT) program funded by the Australian Government Department of Health and Aged Care. SAEP is supported by a VIDI Fellowship from the Dutch Organisation for Health Research and Development (ZonMW) (09150172010050). The remaining authors have no competing interests to declare., (Copyright: © 2024 The Author(s).)
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- 2024
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31. Models and approaches for building knowledge translation capacity and capability in health services: a scoping review.
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King O, West E, Alston L, Beks H, Callisaya M, Huggins CE, Murray M, Mc Namara K, Pang M, Payne W, Peeters A, Pithie M, Sayner AM, and Wong Shee A
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- Humans, Delivery of Health Care, Health Services, Organizations, Capacity Building, Translational Science, Biomedical, Health Personnel
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Background: Building healthcare service and health professionals' capacity and capability to rapidly translate research evidence into health practice is critical to the effectiveness and sustainability of healthcare systems. This review scoped the literature describing programmes to build knowledge translation capacity and capability in health professionals and healthcare services, and the evidence supporting these., Methods: This scoping review was undertaken using the Joanna Briggs Institute scoping review methodology. Four research databases (Ovid MEDLINE, CINAHL, Embase, and PsycInfo) were searched using a pre-determined strategy. Eligible studies described a programme implemented in healthcare settings to build health professional or healthcare service knowledge translation capacity and capability. Abstracts and full texts considered for inclusion were screened by two researchers. Data from included papers were extracted using a bespoke tool informed by the scoping review questions., Results: Database searches yielded 10,509 unique citations, of which 136 full texts were reviewed. Thirty-four papers were included, with three additional papers identified on citation searching, resulting in 37 papers describing 34 knowledge translation capability building programmes. Programmes were often multifaceted, comprising a combination of two or more strategies including education, dedicated implementation support roles, strategic research-practice partnerships and collaborations, co-designed knowledge translation capability building programmes, and dedicated funding for knowledge translation. Many programmes utilised experiential and collaborative learning, and targeted either individual, team, organisational, or system levels of impact. Twenty-seven programmes were evaluated formally using one or more data collection methods. Outcomes measured varied significantly and included participant self-reported outcomes, perceived barriers and enablers of knowledge translation, milestone achievement and behaviour change. All papers reported that programme objectives were achieved to varying degrees., Conclusions: Knowledge translation capacity and capability building programmes in healthcare settings are multifaceted, often include education to facilitate experiential and collaborative learning, and target individual, team, organisational, or supra-organisational levels of impact. Although measured differently across the programmes, the outcomes were positive. The sustainability of programmes and outcomes may be undermined by the lack of long-term funding and inconsistent evaluation. Future research is required to develop evidence-informed frameworks to guide methods and outcome measures for short-, medium- and longer-term programme evaluation at the different structural levels., (© 2024. The Author(s).)
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- 2024
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32. Determining the feasibility of a codesigned and personalised intervention (Veg4Me) to improve vegetable intake in young adults living in rural Australian communities: protocol for a randomised controlled trial.
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Livingstone KM, Rawstorn JC, Partridge SR, Zhang Y, O E, Godrich SL, McNaughton SA, Hendrie GA, Dullaghan K, Abbott G, Blekkenhorst LC, Maddison R, Barnett S, Mathers JC, and Alston L
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- Humans, Young Adult, Feasibility Studies, Diet, Victoria, Randomized Controlled Trials as Topic, Vegetables, Rural Population
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Introduction: Diets low in vegetables are a main contributor to the health burden experienced by young adults in rural communities. Digital health interventions provide an accessible delivery model that can be personalised to meet the diverse preferences of young adults. A personalisable digital vegetable intake intervention (Veg4Me) was codesigned to meet the needs of young adults living in rural communities. This study will determine the feasibility of delivering a personalised Veg4Me programme and compare preliminary effects with a non-personalised Veg4Me (control)., Methods and Analysis: A 12-week assessor-blinded, two-arm, parallel randomised controlled trial will be undertaken from August 2023 until April 2024. A total of 150 eligible and consenting young adults (18-35 years; eat<5 serves of vegetables/day; have an internet connected mobile device/computer) living in Loddon Campaspe or Colac Otway Shire in Victoria, Australia, will be randomised to receive 12 weeks of personalised (intervention) or non-personalised (control) support to increase vegetable intake via a free web application (app; Veg4Me). The primary outcome is feasibility (recruitment, participation and retention rates). Secondary outcomes are user engagement, usability and experience, as well as vegetable intake, eating habits and digital health equity. Process evaluation will be conducted in a subsample of participants using semistructured interviews. Descriptive statistics will be presented for the personalised and non-personalised groups at baseline and 12 weeks. Generalised linear models will be used to evaluate group differences in outcomes. Interviews will be transcribed and analysed thematically., Ethics and Dissemination: All procedures involving human subjects were approved by Deakin University's Human Ethics Advisory Group-Health (HEAG-H 06_2023) on 6 March 2023. Dissemination events will be held in the City of Greater Bendigo and the Colac Otway Shire. Summaries of the results will be disseminated to participants via email. Results will be disseminated to the scientific community through peer-reviewed publications and conference presentations., Trial Registration Number: Australia New Zealand Clinical Trials Registry, ACTRN12623000179639p, prospectively registered on 21 February 2023, according to the World Health Organizational Trial Registration Data Set. Universal Trial Number U1111-1284-9027., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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33. Co-design of a personalised digital intervention to improve vegetable intake in adults living in Australian rural communities.
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Livingstone KM, Rawstorn JC, Alston L, Partridge SR, Bastian A, Dullaghan K, McNaughton SA, Hendrie GA, Blekkenhorst LC, Maddison R, Zhang Y, Barnett S, Mathers JC, and Godrich SL
- Subjects
- Adult, Humans, Australasian People, Australia, Digital Health, Rural Population, Vegetables, Diet
- Abstract
Background: Diets low in vegetables are a main contributor to the health burden experienced by Australians living in rural communities. Given the ubiquity of smartphones and access to the Internet, digital interventions may offer an accessible delivery model for a dietary intervention in rural communities. However, no digital interventions to address low vegetable intake have been co-designed with adults living in rural areas. This paper describes the co-design of a digital intervention to improve vegetable intake with rural community members and research partners., Methods: Active participants in the co-design process were adults ≥ 18 years living in three rural Australian communities (total n = 57) and research partners (n = 4) representing three local rural governments and one peak non-government health organisation. An iterative co-design process was undertaken to understand the needs (pre-design phase) and ideas (generative phase) of the target population. Eight online workshops and a community survey were conducted between July and December 2021. The MoSCoW prioritisation method was used to help participants identify the 'Must-have, Should-have, Could-have, and Won't-have or will not have right now' features and functions of the digital intervention. Workshops were transcribed and inductively analysed using NVivo. Convergent and divergent themes were identified between the workshops and community survey to identify how to implement the digital intervention in the community., Results: Consensus was reached on a concept for a digital intervention that addressed individual and food environment barriers to vegetable intake, specific to rural communities. Implementation recommendations centred on (i) food literacy approaches to improve skills via access to vegetable-rich recipes and healthy eating resources, (ii) access to personalisation options and behaviour change support, and (iii) improving the community food environment by providing information on and access to local food initiatives., Conclusions: Rural-dwelling adults expressed preferences for personalised intervention features that can enhance food literacy and engagement with community food environments. This research will inform the development of the prototyping (evaluation phase) and feasibility testing (post-design phase) of this intervention., (© 2024. The Author(s).)
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- 2024
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34. A systems framework for implementing healthy food retail in grocery settings.
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Zorbas C, Blake MR, Brown AD, Peeters A, Allender S, Brimblecombe J, Cameron AJ, Whelan J, Ferguson M, Alston L, and Boelsen-Robinson T
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- Humans, Commerce, Emotions, Victoria, Food, Beverages
- Abstract
Background: Food retailers can be reluctant to initiate healthy food retail activities in the face of a complex set of interrelated drivers that impact the retail environment. The Systems Thinking Approach for Retail Transformation (START) is a determinants framework created using qualitative systems modelling to guide healthy food retail interventions in community-based, health-promoting settings. We aimed to test the applicability of the START map to a suite of distinct healthy food marketing and promotion activities that formed an intervention in a grocery setting in regional Victoria, Australia., Methods: A secondary analysis was undertaken of 16 previously completed semi-structured interviews with independent grocery retailers and stakeholders. Interviews were deductively coded against the existing START framework, whilst allowing for new grocery-setting specific factors to be identified. New factors and relationships were used to build causal loop diagrams and extend the original START systems map using Vensim., Results: A version of the START map including aspects relevant to the grocery setting was developed ("START-G"). In both health-promoting and grocery settings, it was important for retailers to 'Get Started' with healthy food retail interventions that were supported by a proof-of-concept and 'Focus on the customer' response (with grocery-settings focused on monitoring sales data). New factors and relationships described perceived difficulties associated with disrupting a grocery-setting 'Supply-side status quo' that promotes less healthy food and beverage options. Yet, most grocery retailers discussed relationships that highlighted the potential for 'Healthy food as innovation' and 'Supporting cultural change through corporate social responsibility and leadership'., Conclusions: Several differences were found when implementing healthy food retail in grocery compared to health promotion settings. The START-G map offers preliminary guidance for identifying and addressing commercial interests in grocery settings that currently promote less healthy foods and beverages, including by starting to address business outcomes and supplier relationships., (© 2023. The Author(s).)
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- 2024
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35. Diet-Related Disease Prevention in a Rural Australian Setting: Understanding Barriers, Enablers, and the Role of Rural Health Services in Supporting Changes in Local Rural Food Environments.
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Wheaton N, Alston E, Versace VL, Field M, Wong Shee A, Jacobs J, Backholer K, Allender S, Nichols M, Needham C, Bolton KA, Blake MR, Stewart F, Close E, and Alston L
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- Humans, Australia, Diet, Food, Rural Population, Rural Health Services
- Abstract
Bold and comprehensive action is needed to prevent diet-related diseases in rural areas, which includes improving food environments to enable healthier dietary practices. Rural health services are integral to the health of rural populations, yet their role in community disease prevention is not swell understood. This study sought to understand health service, local government, and food outlet stakeholders' perspectives on (1) the drivers of unhealthy retail environments in a rural setting; (2) the role of rural health services in supporting changes in local food environments; and to (3) identify characteristics of potential interventions. Two Group Model Building workshops were held with health service and local government leaders (n = 9), and interviews were conducted with local food outlet participants (n = 13). Key themes included 'enablers to healthier food environments', 'barriers to healthier food environments', 'Rural health services are a leading broker of knowledge for healthy food environments', and 'characteristics of desirable healthy food environment interventions.'. Rural health services can play a key role in addressing the current barriers to healthy food environments in rural areas. Effective promotion of healthier diets in rural populations will require consideration of key stakeholder perspectives and the development of further evidence on the role that rural health services can play in improving the healthiness of food environments.
- Published
- 2023
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36. A qualitative system model to describe the causes and drivers of frequent potentially avoidable presentations to the emergency department.
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Malakellis M, Wong Shee A, Murray M, Alston L, Versace VL, Allender S, and Mc Namara K
- Abstract
Frequent potentially avoidable presentations to Emergency Departments (EDs) represent a complex problem, driven by multiple interdependent and interacting factors that change over time and influence one another. We sought to describe and map the drivers of frequent potentially avoidable presentations to a regional ED, servicing regional and rural areas, and identify possible solutions from the perspectives of key stakeholders. This study used a qualitative, community-based systems dynamics approach utilising Group Model Building (GMB). Data were collected from two 3-h online workshops embedded with small-group discussions and conducted with stakeholder groups operating within a regional health system. Stakeholders were guided through a series of participatory tasks to develop a causal loop diagram (CLD) using Systems Thinking in Community Knowledge Exchange software (n=29, workshop one), identify potential action points and generate a prioritised action list to intervene in the system (n=21, workshop two). Data were collected through note taking, real-time system mapping, and recording the workshops. Each action was considered against the Public Health 12 framework describing twelve leverage points to intervene in a system. A CLD illustrating the complex and interrelated factors that drive frequent potentially avoidable ED presentations was developed and classified into four categories: (1) access to services; (2) coordination; (3) patient needs; and (4) knowledge and skills. Nine action areas were identified, with many relating to care and service coordination. Most actions aligned with lower-level system impact actions. This study provides an in-depth understanding of influencing factors and potential solutions for frequent potentially avoidable ED presentations across a regional health system. The CLD demonstrates frequent potentially avoidable ED presentations are a complex problem and identified that a prevention response should engage with system- and individual-level solutions. Further work is needed to prioritise actions to support the implementation of higher-level system impacts., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors. Published by Elsevier Ltd.)
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- 2023
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37. Development of a Scoring Tool for Australian Rural Food Retail Environments.
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Schumacher TL, Alderton CA, Brown LJ, Heaney S, Alston L, Kent K, and Godrich SL
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- Humans, Australia, Environment, Marketing, Residence Characteristics, Food Supply, Food
- Abstract
Current tools scoring the healthiness of food retail outlets do not reflect outlets found in rural locations. This study aimed to adapt pre-existing Australian scoring tools to represent non-metropolitan areas. Rural nutrition experts were identified, and a modified Delphi technique was used to adapt two pre-existing, food-scoring tools in five iterative stages. Stages included identifying all relevant outlets, providing a description and score for each, ensuring consistency between outlet scores and pre-existing, metro-centric tools, and providing instructions for correct use. Six rural nutrition experts were identified and engaged in the modified Delphi technique. The final tool consisted of 12 categories of food outlets and listed 35 individual outlets. Consistent with pre-existing Australian tools, scores ranged from +10 to -10 and included descriptions reflective of rural retail outlets. Scores were based on whether the majority of foods offered within the outlet were consistent with foods recommended in national health guidelines. The developed tool was designed to accommodate the diverse nature of food retail outlets found in non-metropolitan areas. This study assists in explaining the link between the food environment and health in populations living rurally.
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- 2023
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38. BMI and the Food Retail Environment in Melbourne, Australia: Associations and Temporal Trends.
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Needham C, Strugnell C, Allender S, Alston L, and Orellana L
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- Body Mass Index, Cross-Sectional Studies, Australia, Surveys and Questionnaires, Residence Characteristics, Food, Food Supply
- Abstract
Research into the link between food environments and health is scarce. Research in this field has progressed, and new comprehensive methods (i.e., incorporating all food retail outlets) for classifying food retail environments have been developed and are yet to be examined alongside measures of obesity. In this study, we examine the association and temporal trends between the food environment and BMI of a repeated cross-sectional sample of the adult population between 2008 and 2016. Methods: Food retail data for 264 postal areas of Greater Melbourne was collected for the years 2008, 2012, 2014, and 2016, and a container-based approach was used to estimate accessibility to supermarkets, healthy and unhealthy outlets. Data on BMI for postal areas was obtained from the Victorian Population Health Survey (n = 47,245). We estimated the association between the food environment and BMI using linear mixed models. Results indicated that BMI increased as accessibility to healthy outlets decreased by up to -0.69 kg/m
2 (95%CI: -0.95, -0.44). BMI was lower with high and moderate access to supermarkets compared to low access by -0.33 kg/m2 (-0.63, -0.04) and -0.32 kg/m2 (-0.56, -0.07), and with high access to unhealthy outlets compared to low access (-0.38 kg/m2 : -0.64, -0.12) and moderate access (-0.54 kg/m2 : -0.78, -0.30). Conclusion: Our results show that increasing access and availability to a diverse range of food outlets, particularly healthy food outlets, should be an important consideration for efforts to support good health. This research provides evidence that Australia needs to follow suit with other countries that have adopted policies giving local governments the power to encourage healthier food environments.- Published
- 2023
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39. Enhancing healthcare at home for older people in rural and regional Australia: A protocol for co-creation to design and implement system change.
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Needham C, Wheaton N, Wong Shee A, McNamara K, Malakellis M, Murray M, Alston L, Peeters A, Ugalde A, Huggins C, Yoong S, and Allender S
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- Humans, Aged, Victoria, Consensus, Health Workforce, Health Facilities, Biomedical Research
- Abstract
Background: World-wide, health service providers are moving towards innovative models of clinical home-based care services as a key strategy to improve equity of access and quality of care. To optimise existing and new clinical home-based care programs, evidence informed approaches are needed that consider the complexity of the health care system across different contexts., Methods: We present a protocol for working with health services and their partners to perform rapid identification, prioritisation, and co-design of content-appropriate strategies to optimise the delivery of healthcare at home for older people in rural and regional areas. The protocol combines Systems Thinking and Implementation Science using a Consensus Mapping and Co-design (CMC) process delivered over five workshops., Discussion: The protocol will be implemented with rural and regional healthcare providers to identify digital and non-digital solutions that have the potential to inform models of service delivery, improve patient experience, and optimise health outcomes. The combination of system and implementation science is a unique approach for optimising healthcare at home for older populations, especially in the rural context where need is high. This is the first protocol to integrate the use of systems and implementation science into one process and articulating these methods will help with replicating this in future practice. Results of the design phase will translate into practice through standard health service planning methods to enhance implementation and sustainability. The delivery of the protocol will include building capacity of health service workers to embed the design, implementation, and evaluation approach into normal practice. This protocol forms part of the DELIVER (Delivering Enhanced heaLthcare at home through optImising Virtual tools for oldEr people in Rural and regional Australia) Project. Funded by Australia's Medical Research Future Fund, DELIVER involves a collaboration with public health services of Western Victoria, Australia., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Needham et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
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- 2023
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40. Dietary patterns in rural and metropolitan Australia: a cross-sectional study exploring dietary patterns, inflammation and association with cardiovascular disease risk factors.
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Alston L, Nichols M, Allender S, Versace V, Brown LJ, Schumacher T, Howard G, Shikany JM, Bolton KA, Livingstone K, Zorbas C, and Judd SE
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- Adult, Humans, Middle Aged, Risk Factors, Cross-Sectional Studies, Australia epidemiology, Inflammation epidemiology, Rural Population, Cardiovascular Diseases epidemiology, Cardiovascular Diseases etiology
- Abstract
Objectives: This study sought first to empirically define dietary patterns and to apply the novel Dietary Inflammation Score (DIS) in data from rural and metropolitan populations in Australia, and second to investigate associations with cardiovascular disease (CVD) risk factors., Design: Cross-sectional study., Setting: Rural and metropolitan Australia., Participants: Adults over the age of 18 years living in rural or metropolitan Australia who participated in the Australian Health survey., Primary Outcomes: A posteriori dietary patterns for participants separated into rural and metropolitan populations using principal component analysis., Secondary Outcomes: association of each dietary pattern and DIS with CVD risk factors was explored using logistic regression., Results: The sample included 713 rural and 1185 metropolitan participants. The rural sample was significantly older (mean age 52.7 compared with 48.6 years) and had a higher prevalence of CVD risk factors. Two primary dietary patterns were derived from each population (four in total), and dietary patterns were different between the rural and metropolitan areas. None of the identified patterns were associated with CVD risk factors in metropolitan or rural areas, aside diet pattern 2 being strongly associated with from self-reported ischaemic heart disease (OR 13.90 95% CI 2.29 to 84.3) in rural areas. There were no significant differences between the DIS and CVD risk factors across the two populations, except for a higher DIS being associated with overweight/obesity in rural areas., Conclusion: Exploration of dietary patterns between rural and metropolitan Australia shows differences between the two populations, possibly reflective of distinct cultures, socioeconomic factors, geography, food access and/or food environments in the different areas. Our study provides evidence that action targeting healthier dietary intakes needs to be tailored to rurality in the Australian context., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2023
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41. Understanding weight status and dietary intakes among Australian school children by remoteness: a cross-sectional study.
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Jacobs J, Strugnell C, Becker D, Whelan J, Hayward J, Nichols M, Brown A, Brown V, Allender S, Bell C, Sanigorski A, Orellana L, and Alston L
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- Humans, Child, Cross-Sectional Studies, Eating, Victoria, Pediatric Obesity epidemiology
- Abstract
Objective: To determine whether primary school children's weight status and dietary behaviours vary by remoteness as defined by the Australian Modified Monash Model (MMM)., Design: A cross-sectional study design was used to conduct secondary analysis of baseline data from primary school students participating in a community-based childhood obesity trial. Logistic mixed models estimated associations between remoteness, measured weight status and self-reported dietary intake., Setting: Twelve regional and rural Local Government Areas in North-East Victoria, Australia., Participants: Data were collected from 2456 grade 4 (approximately 9-10 years) and grade 6 (approximately 11-12 years) students., Results: The final sample included students living in regional centres (17·4 %), large rural towns (25·6 %), medium rural towns (15·1 %) and small rural towns (41·9 %). Weight status did not vary by remoteness. Compared to children in regional centres, those in small rural towns were more likely to meet fruit consumption guidelines (OR: 1·75, 95 % CI (1·24, 2·47)) and had higher odds of consuming fewer takeaway meals (OR: 1·37, 95 % CI (1·08, 1·74)) and unhealthy snacks (OR = 1·58, 95 % CI (1·15, 2·16))., Conclusions: Living further from regional centres was associated with some healthier self-reported dietary behaviours. This study improves understanding of how dietary behaviours may differ across remoteness levels and highlights that public health initiatives may need to take into account heterogeneity across communities.
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- 2023
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42. The application of spatial measures to analyse health service accessibility in Australia: a systematic review and recommendations for future practice.
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Wood SM, Alston L, Beks H, Mc Namara K, Coffee NT, Clark RA, Wong Shee A, and Versace VL
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- Humans, Australia, Databases, Factual, Travel, Health Services Accessibility, Rural Health Services
- Abstract
Background: Australia's inequitable distribution of health services is well documented. Spatial access relates to the geographic limitations affecting the availability and accessibility of healthcare practitioners and services. Issues associated with spatial access are often influenced by Australia's vast landmass, challenging environments, uneven population concentration, and sparsely distributed populations in rural and remote areas. Measuring access contributes to a broader understanding of the performance of health systems, particularly in rural/remote areas. This systematic review synthesises the evidence identifying what spatial measures and geographic classifications are used and how they are applied in the Australian peer-reviewed literature., Methods: A systematic search of peer-reviewed literature published between 2002 and 2022 was undertaken using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Search terms were derived from three major topics, including: [1] Australian population; [2] spatial analysis of health service accessibility; and [3] objective physical access measures., Results: Database searches retrieved 1,381 unique records. Records were screened for eligibility, resulting in 82 articles for inclusion. Most articles analysed access to primary health services (n = 50; 61%), followed by specialist care (n = 17; 21%), hospital services (n = 12; 15%), and health promotion and prevention (n = 3; 4%). The geographic scope of the 82 articles included national (n = 33; 40%), state (n = 27; 33%), metropolitan (n = 18; 22%), and specified regional / rural /remote area (n = 4; 5%). Most articles used distance-based physical access measures, including travel time (n = 30; 37%) and travel distance along a road network (n = 21; 26%), and Euclidean distance (n = 24; 29%)., Conclusion: This review is the first comprehensive systematic review to synthesise the evidence on how spatial measures have been applied to measure health service accessibility in the Australian context over the past two decades. Objective and transparent access measures that are fit for purpose are imperative to address persistent health inequities and inform equitable resource distribution and evidence-based policymaking., (© 2023. The Author(s).)
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- 2023
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43. Design and implementation characteristics of research training for rural health professionals: a qualitative descriptive study.
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Quilliam C, Wong Shee A, Corboy D, Glenister K, King O, Mc Namara K, Alston L, Aras D, Beauchamp A, and McKinstry C
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- Humans, Health Personnel, Australia, Educational Status, Qualitative Research, Rural Health, Rural Health Services
- Abstract
Background: Research capacity and capability of rural health professionals is essential to the delivery of evidence-based care and for informing strategies to address rural health inequities. Effective implementation of research education and training is fundamental to building rural health professional research capacity and capability. A lack of overarching guidance to inform the delivery of research education and training in rural health services can contribute to gaps in capacity-building approaches. The aim of this study was to identify characteristics of the design and implementation of current research training for rural health professionals in Victoria, Australia, to inform a future model for rural health professional research capacity and capability building., Methods: A qualitative descriptive study was undertaken. Key informants, with extensive knowledge of research education and training in rural health services in Victoria, were invited to participate in semi-structured telephone interviews via snowballing recruitment methods. Interview transcripts were analysed inductively, with themes and codes mapped to the domains of the Consolidated Framework for Implementation Research., Results: Of the 40 key informants approached, 20 agreed to participate including 11 regional health service managers, five rural health academics and four university managers. Participants suggested that research training varied in quality and relevance to rural health professionals. Training costs and lack of tailoring to the rural context were key barriers, whereas experiential learning and flexible modes of delivery enabled training uptake. Health service and government policies, structures, and processes both enabled or stifled implementation opportunities, with rural health professional networks from different regions offering capacity for research training development, and government departmental structures hampering training coordination. Tension between research activities and clinical practice, and health professional knowledge and beliefs, shaped the delivery of training programs. Strategically planned and evaluated research training programs and education via co-design with rural health professionals and use of research champions were strongly recommended by participants., Conclusions: To optimise research training for rural health professionals and increase the quality and quantity of relevant rural health research, a systematically planned, implemented, and resourced region-wide research training model is required., (© 2023. The Author(s).)
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- 2023
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44. Digital behaviour change interventions to increase vegetable intake in adults: a systematic review.
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Livingstone KM, Rawstorn JC, Partridge SR, Godrich SL, McNaughton SA, Hendrie GA, Blekkenhorst LC, Maddison R, Zhang Y, Barnett S, Mathers JC, Packard M, and Alston L
- Subjects
- Adult, Humans, Feeding Behavior, Reward, Vegetables, Fruit
- Abstract
Background: Digital interventions may help address low vegetable intake in adults, however there is limited understanding of the features that make them effective. We systematically reviewed digital interventions to increase vegetable intake to 1) describe the effectiveness of the interventions; 2) examine links between effectiveness and use of co-design, personalisation, behavioural theories, and/or a policy framework; and 3) identify other features that contribute to effectiveness., Methods: A systematic search strategy was used to identify eligible studies from MEDLINE, Embase, PsycINFO, Scopus, CINAHL, Cochrane Library, INFORMIT, IEEE Xplore and Clinical Trial Registries, published between January 2000 and August 2022. Digital interventions to increase vegetable intake were included, with effective interventions identified based on statistically significant improvement in vegetable intake. To identify policy-action gaps, studies were mapped across the three domains of the NOURISHING framework (i.e., behaviour change communication, food environment, and food system). Risk of bias was assessed using Cochrane tools for randomized, cluster randomized and non-randomized trials., Results: Of the 1,347 records identified, 30 studies were included. Risk of bias was high or serious in most studies (n = 25/30; 83%). Approximately one quarter of the included interventions (n = 8) were effective at improving vegetable intake. While the features of effective and ineffective interventions were similar, embedding of behaviour change theories (89% vs 61%) and inclusion of stakeholders in the design of the intervention (50% vs 38%) were more common among effective interventions. Only one (ineffective) intervention used true co-design. Although fewer effective interventions included personalisation (67% vs 81%), the degree of personalisation varied considerably between studies. All interventions mapped across the NOURISHING framework behaviour change communication domain, with one ineffective intervention also mapping across the food environment domain., Conclusion: Few digital interventions identified in this review were effective for increasing vegetable intake. Embedding behaviour change theories and involving stakeholders in intervention design may increase the likelihood of success. The under-utilisation of comprehensive co-design methods presents an opportunity to ensure that personalisation approaches better meet the needs of target populations. Moreover, future digital interventions should address both behaviour change and food environment influences on vegetable intake., (© 2023. The Author(s).)
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- 2023
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45. Place-based research in small rural hospitals: an overlooked opportunity for action to reduce health inequities in Australia?
- Author
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Alston L and Versace VL
- Abstract
Competing Interests: This paper did not receive specific funding. Professor Vincent Versace is supported by the Rural Health Multidisciplinary Training (RHMT) program funded by the 10.13039/501100003921Australian Government Department of Health and Aged Care. Dr Laura Alston is supported by a 10.13039/501100001030National Heart Foundation Post-Doctoral Fellowship (ID: LA is supported by a 10.13039/501100001030National Heart Foundation fellowship (ID: Grant/Award Number: 102530).
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- 2023
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46. Healthy weight, health behaviours and quality of life among Aboriginal children living in regional Victoria.
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Browne J, Becker D, Orellana L, Ryan J, Walker T, Whelan J, Alston L, Egan M, Johnson B, Rossignoli A, Crooks N, Brown AD, Bolton KA, Fraser P, Le H, Bell C, Hayward J, Sanigorski A, Backholer K, Allender S, and Strugnell C
- Subjects
- Adolescent, Child, Cross-Sectional Studies, Exercise, Health Behavior, Humans, Randomized Controlled Trials as Topic, Health Status, Quality of Life
- Abstract
Objective: To report the prevalence of healthy weight and related behaviours among Victorian Aboriginal and non-Aboriginal children and explore associations between these factors and health-related quality of life (HRQoL)., Methods: Analysis of cross-sectional data from two cluster randomised controlled trials using logistic and linear mixed models. The sample included Aboriginal (n=303) and non-Aboriginal (n=3,026) children aged 8-13 years., Results: More than two-thirds of Aboriginal children met guidelines for fruit (75.9%), sweetened drinks (66.7%), sleep (73.1%), screen time (67.7%) and objectively measured physical activity (83.6%); and 79.1% reported consuming take-away foods less than once per week. Aboriginal children were more likely to meet vegetable consumption guidelines (OR=1.42, 95%CI: 1.05, 1.93), but less likely to have a healthy weight (OR=0.66, 95%CI: 0.52, 0.85) than non-Aboriginal children. Mean HRQoL scores were significantly higher among non-Aboriginal children and both Aboriginal and non-Aboriginal children meeting health guidelines., Conclusions: Most Aboriginal children in this study met guidelines for fruit, physical activity, screen time and sleep, and those meeting these guidelines had significantly higher HRQoL., Implications for Public Health: Promoting nutrition, physical activity and sleep is likely to benefit all children. Aboriginal community-controlled organisations can use these data to design culturally-specific programs that may improve disparities in healthy weight and HRQoL., (© 2022 The Authors.)
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- 2022
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47. Prevalence of chronic non-communicable diseases in Ethiopia: A systematic review and meta-analysis of evidence.
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Tesfay FH, Zorbas C, Alston L, Backholer K, Bowe SJ, and Bennett CM
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- Ethiopia epidemiology, Humans, Income, Prevalence, Diabetes Mellitus epidemiology, Noncommunicable Diseases epidemiology
- Abstract
Background: Non-communicable diseases (NCDs) are a growing global health challenge disproportionately impacting low- and middle-income settings, including Ethiopia. Currently, the body of evidence describing the burden of NCDs is fragmented, inconsistent, health facility- or institution-based, and out-dated in Ethiopia. We conducted a systematic review of the literature and meta-analysis of the prevalence of NCDs in community settings in Ethiopia., Review Methodology: Community-based quantitative studies published in English between January 1st, 2012, and June 30th, 2022, that reported on the prevalence of NCDs in Ethiopia were included. A systematic search of Medline, Embase, Scopus, CINAHL, and Global Health using pretested search terms related to NCDs was conducted, and data were extracted using a piloted data extraction proforma adapted from the Joanna Briggs Institute tool. Meta-analysis was performed using Stata 16. While the pooled prevalence of Diabetes Mellitus (DM) and undiagnosed (DM) was computed and presented using forest plots, then overall prevalence of NCDs and other various types of NCDs were narratively synthesized. I
2 was used to assess heterogeneity. Studies that did not fulfill the criteria (used similar tool to measure the types of NCDs) for meta-analysis were narratively synthesized., Results: Twenty-two studies met the inclusion criteria. Five studies measured the prevalence of NCDs (all NCDs together), ranging from 29 to 35% (prevalence estimates not pooled). The pooled prevalence of Diabetes Mellitus (DM) across ten studies was 5% (95% CI: 4-7%). Three studies each reported on the prevalence of undiagnosed DM (pooled prevalence 5%, 95% CI: 4-7%) and pre-DM (pooled prevalence 7%, 95% CI: 3-14%%). In a narrative analysis the prevalence of cardiovascular conditions ranged from 13.4 to 32.2% ( n = 3 studies), cancer mortality ranged from 4 to 18% ( n = 3 studies) and respiratory conditions ranged from 1 to 18% ( n = 3 studies). Some studies have determined more than one NCDs and that is why the total number of studies are exceeding more than twenty studies., Conclusion and Recommendations: Our analysis found that approximately one-third of Ethiopians have an NCD, with cardiovascular diseases the most common of all NCDs. The prevalence of respiratory conditions also appears high, but there are insufficient data for a pooled estimate. Whilst the prevalence of DM appears relatively low, there is evidence that the magnitude is increasing. Public health actions to address the high burden of cardiovascular and respiratory diseases, as well as the increasing magnitude of DM in Ethiopia, must be prioritized., Systematic Review Registration: PROSPERO [CRD42020196815]., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Tesfay, Zorbas, Alston, Backholer, Bowe and Bennett.)- Published
- 2022
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48. The impact of coalition characteristics on outcomes in community-based initiatives targeting the social determinants of health: a systematic review.
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Nagorcka-Smith P, Bolton KA, Dam J, Nichols M, Alston L, Johnstone M, and Allender S
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- Adolescent, Child, Cross-Sectional Studies, Data Collection, Humans, Residence Characteristics, Health Promotion methods, Social Determinants of Health
- Abstract
Background: Coalitions are a popular mechanism for delivering community-based health promotion. The aim of this systematic review was to synthesize research that has quantitatively analyzed the association between coalition characteristics and outcomes in community-based initiatives targeting the social determinants of health. Coalition characteristics described elements of their structure or functioning, and outcomes referred to both proximal and distal community changes., Methods: Authors searched six electronic databases to identify peer reviewed, published studies that analyzed the relationship between coalition characteristics and outcomes in community-based initiatives between 1980 and 2021. Studies were included if they were published in English and quantitatively analyzed the link between coalition characteristics and outcomes. Included studies were assessed for quality using the Joanna Briggs Institute analytical cross-sectional studies assessment tool., Results: The search returned 10,030 unique records. After screening, 26 studies were included from six countries. Initiatives targeted drug use, health equity, nutrition, physical activity, child and youth development, crime, domestic violence, and neighbourhood improvement. Community outcomes measured included perceived effectiveness (n=10), policy, systems or environment change (n=9), and community readiness or capacity (n=7). Analyses included regression or correlation analysis (n=16) and structural equation or pathway modelling (n=10). Studies varied in quality, with a lack of data collection tool validation presenting the most prominent limitation to study quality. Statistically significant associations were noted between community outcomes and wide range of coalition characteristics, including community context, resourcing, coalition structure, member characteristics, engagement, satisfaction, group facilitation, communication, group dynamics, relationships, community partnership, and health promotion planning and implementation., Conclusion: Existing literature demonstrates that coalition characteristics, including best practice health promotion planning and evaluation, influence community outcomes. The field of coalition research would benefit from more consistent description and measurement of coalition characteristics and outcomes, and efforts to evaluate coalitions in a wider range of countries around the world. Further research using empirical community outcome indicators, and methods that consider the interrelationship of variables, is warranted., Trial Registration: A protocol for this review was registered with PROSPERO ( CRD42020205988 )., (© 2022. The Author(s).)
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- 2022
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49. The Magnitude of NCD Risk Factors in Ethiopia: Meta-Analysis and Systematic Review of Evidence.
- Author
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Tesfay FH, Backholer K, Zorbas C, Bowe SJ, Alston L, and Bennett CM
- Subjects
- Ethiopia epidemiology, Humans, Obesity epidemiology, Overweight epidemiology, Prevalence, Risk Factors, Noncommunicable Diseases epidemiology
- Abstract
Background: Non-communicable Diseases (NCDs) and their risk factors are the leading contributors to morbidity and mortality globally, particularly in low- and middle-income countries including Ethiopia. To date, there has been no synthesis of the literature on the relative prevalence of NCD risk factors in Ethiopia., Methodology: We conducted a systematic review and meta-analysis of primary studies reporting on the prevalence of NCD risk factors in Ethiopia published in English from 2012 to July 2020. Pre-tested NCD search terms were applied to Medline, Embase, Scopus, CINAHL, and Global Health. Three reviewers screened and appraised the quality of the identified papers. Data extraction was conducted using a pilot tested proforma. Meta-analysis was conducted using Stata 16 and pooled prevalence estimated with associated 95% confidence intervals. Clinically heterogeneous studies that did not fulfil the eligibility criteria for meta-analysis were narratively synthesised. I
2 was used to assess statistical heterogeneity., Results: 47 studies fulfilled the inclusion criteria and contributed 68 NCD risk factor prevalence estimates. Hypertension was the most frequently examined NCD risk factor, with a pooled prevalence of 21% ( n = 27 studies). The pooled prevalence percentages for overweight and obesity were 19.2% and 10.3%, respectively ( n = 7 studies each), with a combined prevalence of 26.8% ( n = 1 study). It was not possible to pool the prevalence of alcohol consumption, smoking, metabolic disorders, or fruit consumption because of heterogeneity across studies. The prevalence of alcohol use, as reported from the included individual studies, ranged from 12.4% to 13.5% ( n = 7 studies). More than 90% of participants met the WHO-recommended level of physical activity ( n = 5 studies). The prevalence of smoking was highly variable, ranging between 0.8% and 38.6%, as was the prevalence of heavy alcohol drinking (12.4% to 21.1%, n = 6 studies) and metabolic syndrome (4.8% to 9.6%, n = 5 studies). Fruit consumption ranged from 1.5% up to the recommended level, but varied across geographic areas ( n = 3 studies)., Conclusion and Recommendations: The prevalence of NCD risk factors in Ethiopia is relatively high. National NCD risk factor surveillance is required to inform the prioritisation of policies and interventions to reduce the NCD burden in Ethiopia.- Published
- 2022
- Full Text
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50. The Impact of the COVID-19 Pandemic on Rural Food Security in High Income Countries: A Systematic Literature Review.
- Author
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Kent K, Alston L, Murray S, Honeychurch B, and Visentin D
- Subjects
- Developed Countries, Food Security, Humans, Rural Population, COVID-19 epidemiology, Pandemics
- Abstract
Prior to the COVID-19 pandemic, rural-dwelling people in high-income countries were known to have greater challenges accessing healthy food than their urban counterparts. The COVID-19 pandemic has impacted food supplies across the world, and public health restrictions have changed the way people shop for food, potentially exacerbating food insecurity. This systematic literature review aimed to synthesize the available evidence on the impact of the COVID-19 pandemic on aspects of food insecurity in rural populations residing in high-income countries. Five electronic databases were searched, identifying 22 articles that assessed food insecurity prevalence or data on food availability, access, utilization and the stability of the food supply in rural populations during the COVID-19 pandemic. Ten studies examined the prevalence of food insecurity in rural populations, with the reported prevalence ranging from 15% to 95%. Where rural/urban comparisons were presented, most studies ( n = 5; 71%) reported that food insecurity was significantly higher in rural regions. Five studies examined the availability of food and eight studies examined access to food, identifying that rural populations often had lower food availability and access to food during the pandemic. In contrast, two studies identified positive effects such as more gardening and increased online access to food. Rural populations experienced multiple changes to food utilization, such as reduced diet quality and food safety observed in eight studies, but this was not shown to be different from urban populations. Additionally, the food supply in rural regions was perceived to be affected in two studies. The results of this review may be used to inform region-specific mitigation strategies to decrease the impact of the current COVID-19 pandemic and future global events on food security. However, the lack of consistency in study outcomes in research on rural populations limits the identification of priority areas for intervention at a global-scale.
- Published
- 2022
- Full Text
- View/download PDF
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