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The health of young offenders supervised in the community has not been studied previously. This paper describes the prevalence of overweight, obesity and obesity-associated cardiovascular and hepatic risk factors in a sample of young offenders supervised in the community in New South Wales, Australia. During 2003-05, 800 (85% male) young offenders took part in a comprehensive health survey that included direct measurement of height and weight as well as blood sampling. The prevalence of combined overweight and obesity was 33.7% in boys and 35.3% in girls; both rates were higher than those of a comparable community sample. Cardiovascular risk factor prevalence was extremely high compared with other published studies, with over 40% of boys and over 20% of girls having low levels of high density lipoprotein (HDL) cholesterol, and over 10% of both boys and girls having elevated low density lipoprotein (LDL) cholesterol. Risk factors for fatty liver disease were also prevalent, with almost 15% of boys, and 30% of girls having raised alanine aminotransferase (ALT), suggesting hepatic cell injury. Cardiovascular and fatty liver disease risk factors were significantly associated with overweight and obesity among boys but not girls in this sample. Young people of Aboriginal or Torres Strait Islander decent were at no greater risk than the rest of the population. Young offenders are among the most disadvantaged people in Australian society and are particularly vulnerable to a range of health problems. The high prevalence of risk factors represents a substantial health burden for these young people in early adulthood. Timely intervention is required to address the complex health needs of this under-served population. [ABSTRACT FROM AUTHOR]

Unlike other aspects of welfare (e.g. income), health has been relatively neglected when it comes to defining and measuring aspects of poverty. The aim of the paper is twofold: first we elaborate how the concept of 'health poverty' can be defined and measured, and second we apply the methodology to study health poverty in a variety of cases. The measurement of health poverty allows us to gain insights into different sorts of health deprivation in society as a whole, and in specific subgroups. We measure poverty by means of the widely adopted Foster-Greer-Thorbecke (FGT) class of indicators and apply this to three different health variables: cardiovascular risk, health status and life expectancy. Moreover, the FGT class is additively decomposable, making it possible to gauge the contribution of specific subgroups to overall poverty. We provide two applications of these methods. Firstly, we examine changes in the risk of cardiovascular disease (CVD) in the United States using two waves of the NHANES survey from 2005-06 and 2013-14 (n = 3,014 and 4,001 respectively) and use a threshold of 20% 10 year CVD risk to define health poverty. Overall our results indicate a slight decline in the proportion at high CVD risk between these periods. Secondly, we apply poverty measures to health status as measured by the SF-6D index and to empirically derived predictions of life expectancy and estimated using 24,820 individuals from the first 15 waves of the Australian HILDA survey. Trends in poverty over time are compared using several thresholds and decomposed by a variety of sub-groups. Measures of health poverty can be an important instrument for focusing the attention on those with the worst health, or highest risk, in a society and should be used more widely. • Health poverty measures are useful to monitor deprivation in the domain of health. • Health poverty measures accord closely with threshold-based practices in medicine. • Poverty measures can be applied to disease risk, life expectancy and quality of life. [ABSTRACT FROM AUTHOR]

Background Cardiovascular disease (CVD) is the leading cause of death and disability worldwide. Despite the widespread availability of evidence-based clinical guidelines and validated risk predication equations for prevention and management of CVD, their translation into routine practice is limited. We developed a multifaceted quality improvement intervention for CVD risk management which incorporates electronic decision support, patient risk communication tools, computerised audit and feedback tools, and monthly, peer-ranked performance feedback via a web portal. The intervention was implemented in a cluster randomised controlled trial in 60 primary healthcare services in Australia. Overall, there were improvements in risk factor recording and in prescribing of recommended treatments among under-treated individuals, but it is unclear how this intervention was used in practice and what factors promoted or hindered its use. This information is necessary to optimise intervention impact and maximally implement it in a post-trial context. In this study protocol, we outline our methods to conduct a theory-based, process evaluation of the intervention. Our aims are to understand how, why, and for whom the intervention produced the observed outcomes and to develop effective strategies for translation and dissemination. Methods/design We will conduct four discrete but inter-related studies taking a mixed methods approach. Our quantitative studies will examine (1) the longer term effectiveness of the intervention posttrial, (2) patient and health service level correlates with trial outcomes, and (3) the health economic impact of implementing the intervention at scale. The qualitative studies will (1) identify healthcare provider perspectives on implementation barriers and enablers and (2) use video ethnography and patient semi-structured interviews to understand how cardiovascular risk is communicated in the doctor/patient interaction both with and without the use of intervention. We will also assess the costs of implementing the intervention in Australian primary healthcare settings which will inform scale-up considerations. Discussion This mixed methods evaluation will provide a detailed understanding of the process of implementing a quality improvement intervention and identify the factors that might influence scalability and sustainability. Trials registration 12611000478910. [ABSTRACT FROM AUTHOR]

Background In rural and remote Australia, cardiovascular mortality and morbidity rates are higher than metropolitan rates. This study analysed cardiovascular and other chronic disease risk factors and related health behaviours by occupational status, to determine whether agricultural workers have higher cardiovascular disease (CVD) risk than other rural workers. Methods Cross-sectional surveys in three rural regions of South Eastern Australia (2004-2006). A stratified random sample of 1001 men and women aged 25-74 from electoral rolls were categorised by occupation into agricultural workers (men = 214, women = 79), technicians (men = 123), managers (men = 148, women = 272) and 'home duties (women = 165). Data were collected from self-administered questionnaire, physical measurements and laboratory tests. Cardiovascular disease (CVD) and coronary heart disease (CHD) risk were assessed by Framingham 5 years risk calculation. Results Amongst men, agricultural workers had higher occupational physical activity levels, healthier more traditional diet, lower alcohol consumption, lower fasting plasma glucose, the lowest proportion of daily smokers and lower age-adjusted 5 year CVD and CHD risk scores. Amongst women, managers were younger with higher HDL cholesterol, lower systolic blood pressure, less hypertension, lower waist circumference, less self-reported diabetes and better 5 year CVD and CHD risk scores. Agricultural workers did not have higher cardiovascular disease risk than other occupational groups. Conclusions Previous studies have suggested that farmers have higher risks of cardiovascular disease but this is because the risk has been compared with non-rural populations. In this study, the comparison has been made with other rural occupations. Cardiovascular risk reduction programs are justified for all. Programs tailored only for agricultural workers are unwarranted. [ABSTRACT FROM AUTHOR]

Objective: To investigate the change of cardiovascular risk factor from 2000 to 2002 in general practice patients with type 2 diabetes in urban and rural areas, and the association between cardiovascular risk (both single risk factors and coronary heart disease absolute risk (CHDAR)) and rurality in three years. Methods: In total, 6305 patients were extracted from 16 Divisions (250 practices). Multivariate regression at Division, practice and patient levels was conducted with adjustment for age and gender. Results: In each of the three years, most single individual risk factors and CHDAR were high. Comparing 2002 with 2000: for urban patients in 2002 total cholesterol (OR 0.85) and low-density lipoprotein (OR 0.81) significantly decreased, and high-density lipoprotein (HDL) (OR 1.16) significantly increased; for rural patients in 2002 HbA1c (OR 0.85) significantly decreased and HDL (OR 1.22) significantly increased; and CHDAR significantly improved only in urban patients (OR 0.93) in 2002. In 2002 rural patients were still more likely to be overweight/obese (OR 1.16), be current smokers (OR 1.36), and have worse HDL (OR 0.84) and triglycerides (OR 1.23) than their urban counterparts. Conclusion: Some key individual risk factors and CHDAR did not improve in rural patients with type 2 diabetes despite a number of programs designed to provide comprehensive care to rural patients with diabetes. More emphasis is needed on supporting access to lifestyle changes (such as smoking, diet and physical activity) in rural primary health care. [ABSTRACT FROM AUTHOR]