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Addressing health equity through action on the social determinants of health: a global review of policy outcome evaluation methods
Get PDFPublished by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Background: Epidemiological evidence on the social determinants of health inequity is well-advanced, but considerably less attention has been given to evaluating the impact of public policies addressing those social determinants. Methodological challenges to produce evidence on policy outcomes present a significant barrier to mobilising policy actions for health equities. This review aims to examine methodological approaches to policy evaluation of health equity outcomes and identify promising approaches for future research.
Methods: We conducted a systematic narrative review of literature critically evaluating policy impact on health equity, synthesizing information on the methodological approaches used. We searched and screened records from five electronic databases, using pre-defined protocols resulting in a total of 50 studies included for review. We coded the studies according to (1) type of policy analysed; (2) research design; (3) analytical techniques; (4) health outcomes; and (5) equity dimensions evaluated.
Results: We found a growing number of a wide range of policies being evaluated for health equity outcomes using a variety of research designs. The majority of studies employed an observational research design, most of which were cross-sectional, however, other approaches included experimental designs, simulation modelling, and meta-analysis. Regression techniques dominated the analytical approaches, although a number of novel techniques were used which may offer advantages over traditional regression analysis for the study of distributional impacts of policy. Few studies made intra-national or cross-national comparisons or collected primary data. Despite longstanding challenges of attribution in policy outcome evaluation, the majority of the studies attributed change in physical or mental health outcomes to the policy being evaluated.
Conclusion: Our review provides an overview of methodological approaches to health equity policy outcome evaluation, demonstrating what is most commonplace and opportunities from novel approaches. We found the number of studies evaluating the impacts of public policies on health equity are on the rise, but this area of policy evaluation still requires more attention given growing inequities.This work was supported by the NHMRC Centre of Research
Excellence on the Social Determinants of Health Equity:
Policy research on the social determinants of health equity
(APP1078046)
Cross-Species Meta-Analysis of Transcriptomic Data in Combination With Supervised Machine Learning Models Identifies the Common Gene Signature of Lactation Process
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Bioinformatics and Computational
Biology,
a section of the journal
Frontiers in Genetics. This is an
open-access article distributed under the terms of the Creative Commons Attribution
License (CC BY). The use, distribution or reproduction in other forums is permitted,
provided the original author(s) and the copyright owner(s) are credited and that the
original publication in this journal is cited, in accordance with accepted academic
practice. No use, distribution or reproduction is permitted which does not comply
with these terms.Lactation, a physiologically complex process, takes place in mammary gland after
parturition. The expression profile of the effective genes in lactation has not
comprehensively been elucidated. Herein, meta-analysis, using publicly available
microarray data, was conducted identify the differentially expressed genes (DEGs)
between pre- and post-peak milk production. Three microarray datasets of Rat, Bos
Taurus, and Tammar wallaby were used. Samples related to pre-peak (n = 85) and
post-peak (n = 24) milk production were selected. Meta-analysis revealed 31 DEGs
across the studied species. Interestingly, 10 genes, including MRPS18B, SF1, UQCRC1,
NUCB1, RNF126, ADSL, TNNC1, FIS1, HES5 and THTPA, were not detected in
original studies that highlights meta-analysis power in biosignature discovery. Common
target and regulator analysis highlighted the high connectivity of CTNNB1, CDD4 and
LPL as gene network hubs. As data originally came from three different species, to
check the effects of heterogeneous data sources on DEGs, 10 attribute weighting
(machine learning) algorithms were applied. Attribute weighting results showed that
the type of organism had no or little effect on the selected gene list. Systems biology
analysis suggested that these DEGs affect the milk production by improving the immune
system performance and mammary cell growth. This is the first study employing
both meta-analysis and machine learning approaches for comparative analysis of
gene expression pattern of mammary glands in two important time points of lactation
process. The finding may pave the way to use of publically available to elucidate the
underlying molecular mechanisms of physiologically complex traits such as lactation in
mammals.This study is supported by University of Tabriz
Microbiological Values of Rainwater Harvested in Adelaide
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article distributed under the terms and conditions of the Creative Commons Attribution
(CC BY) license (http://creativecommons.org/licenses/by/4.0/).In Australia, rainwater is an important source of water for many households. Unlike
municipal water, rainwater is often consumed untreated. This study investigated the potential
contamination of rainwater by microorganisms. Samples from 53 rainwater tanks across the Adelaide
region were collected and tested using Colilert™ IDEXX Quanti-Tray*/2000. Twenty-eight out of
the 53 tanks (53%) contained Escherichia coli. Samples collected from ten tanks contained E. coli at
concentrations exceeding the limit of 150 MPN/100 mL for recreational water quality. A decline in
E. coli was observed in samples collected after prolonged dry periods. Rainwater microbiological
values depended on the harvesting environment conditions. A relationship was found between
mounted TV antenna on rooftops and hanging canopies; and E. coli abundance. Conversely, there
was no relationship between seasonality and E. coli or roof and tank structure materials and E. coli.
In several tanks used for drinking water, samples collected prior to and after filtration showed that
the filtration systems were not always successful at completely removing E. coli. These results differed
from a study undertaken in the laboratory that found that a commercially available in-bench 0.45 m
filter cartridge successfully reduced E. coli in rainwater to 0 MPN/100 mL. After running a total of
265 L of rainwater which contained high levels of E. coli through the filter (half of the advertised filter
lifespan), the filter cartridge became blocked, although E. coli remained undetected in filtered water.
The difference between the laboratory study and field samples could be due to improper maintenance
or installation of filters or recontamination of the faucet after filtration. The presence of E. coli in
water that is currently used for drinking poses a potential health concern and indicates the potential
for contamination with other waterborne pathogens.This project was funded by the Australian Government Research Training Program
Scholarship (AGRTPS) and supported by the Environmental Health Group, College of Sciences and Engineering,
Flinders University
Corrigendum to “Palaeohydrogeology and Transport Parameters Derived from 4He and Cl Profiles in Aquitard Pore Waters in a Large Multilayer Aquifer System, Central Australia”
Get PDFThis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.In the article titled “Palaeohydrogeology and Transport
Parameters Derived from 4
He and Cl Profiles in Aquitard
Pore Waters in a Large Multilayer Aquifer System, Central
Australia” [1], Mr. Stanley D. Smith was missing from the
authors’ list. Mr. Stanley made a significant contribution in
helping with the core sampling protocol, canister leak testing,
and discussing modelling methods. The corrected authors’
list is shown above
Expansion of Sphingosine Kinase and Sphingosine-1-Phosphate Receptor Function in Normal and Cancer Cells: From Membrane Restructuring to Mediation of Estrogen Signaling and Stem Cell Programming
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article distributed under the terms and conditions of the Creative Commons Attribution
(CC BY) license (http://creativecommons.org/licenses/by/4.0/).Sphingolipids, sphingolipid metabolizing enzymes, and their receptors network are being
recognized as part of the signaling mechanisms, which govern breast cancer cell growth, migration,
and survival during chemotherapy treatment. Approximately 70% of breast cancers are estrogen
receptor (ER) positive and, thus, rely on estrogen signaling. Estrogen activates an intracellular
network composed of many cytoplasmic and nuclear mediators. Some estrogen effects can be
mediated by sphingolipids. Estrogen activates sphingosine kinase 1 (SphK1) and amplifies the
intracellular concentration of sphingosine-1-phosphate (S1P) in breast cancer cells during stimulation
of proliferation and survival. Specifically, Estrogen activates S1P receptors (S1PR) and induces
growth factor receptor transactivation. SphK, S1P, and S1PR expression are causally associated with
endocrine resistance and progression to advanced tumor stages in ER-positive breast cancers in vivo.
Recently, the network of SphK/S1PR was shown to promote the development of ER-negative cancers
and breast cancer stem cells, as well as stimulating angiogenesis. Novel findings confirm and broaden
our knowledge about the cross-talk between sphingolipids and estrogen network in normal and
malignant cells. Current S1PRs therapeutic inhibition was indicated as a promising chemotherapy
approach in non-responsive and advanced malignancies. Considering that sphingolipid signaling has
a prominent role in terminally differentiated cells, the impact should be considered when designing
specific SphK/S1PR inhibitors. This study analyzes the dynamic of the transformation of sphingolipid
axis during a transition from normal to pathological condition on the level of the whole organism.
The sphingolipid-based mediation and facilitation of global effects of estrogen were critically accented
as a bridging mechanism that should be explored in cancer prevention.This work was supported by grants from C.M.E. Kelly Cancer Research Foundation
and Lyn Wrigley Breast Cancer Research and Development Fund (Flinders Medical Centre, Australia)
(to Olga A. Sukocheva)
TiO2 nanofiber photoelectrochemical cells loaded with sub-12 nm AuNPs: Size dependent performance evaluation
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(http://creativecommons.org/licenses/by/4.0/), which permits use, distribution and reproduction in any medium, provided the original work is properly cited.Incorporation of gold nanoparticles (AuNPs) into titanium dioxide (TiO2) photoelectrodes has been used traditionally to increase the performance of photoelectrochemical cells (PECs) through their tailored optical properties. In contrast to larger AuNPs, previous studies have suggested that smaller AuNPs are the most catalytic or effective at increasing the photovoltaic (PV) performance of TiO2 photoelectrodes based on PECs. Despite this, AuNPs are often only compared between sizes of 12–300 nm in diameter due to the most common synthesis, the Turkevich method, being best controlled in this region. However, the optimum radius for citrate-capped AuNPs sized between 5 and 12 nm, and their influence on the PV performances has not yet been investigated. In addition to using AuNPs in the photoelectrodes, replacing traditional TiO2 NPs with one-dimensional nanofibers (NFs) is a promising strategy to enhance the PV efficiency of the PECs due their capability to provide a direct pathway for charge transport. Herein, we exploit the advantages of two different nanostructured materials, TiO2 NFs and sub-12 nm AuNPs (5, 8, 10, and 12 nm), and fabricate composite based photoelectrodes to conduct a size dependent performance evaluation. The PECs assembled with 8 nm AuNPs showed ∼20% improvement in the average power conversion efficiency compared to the control PECs without AuNPs. The highest performing PEC achieved a power conversion efficiency of 8%, which to the best of our knowledge, is among the highest reported for scattering layers based on pure anatase TiO2 NFs. On the basis of our comprehensive investigations, we attribute this enhanced device performance using 8 nm AuNPs in the TiO2 NF photoelectrodes to the improved spectral absorption, decreased series resistance, and an increase in electron transport and injection rate leading to an increase in current density and fill factor.TJM would like to thank the Ramsay Memorial Trust for their
financial assistance. T.J.M and I.P.P would like to acknowledge the
EPSRC for financial support (EP/M015157/1)
Factors influencing early and late readmissions in Australian hospitalised patients and investigating role of admission nutrition status as a predictor of hospital readmissions: a cohort study
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Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which
permits others to distribute, remix, adapt, build upon this work non-commercially,
and license their derivative works on different terms, provided the original work is
properly cited and the use is non-commercial. See: http:// creativecommons. org/
licenses/ by- nc/ 4. 0/Objectives Limited studies have identified predictors of early and late hospital readmissions in Australian healthcare settings. Some of these predictors may be modifiable through targeted interventions. A recent study has identified malnutrition as a predictor of readmissions in older patients but this has not been verified in a larger population. This study investigated what predictors are associated with early and late readmissions and determined whether nutrition status during index hospitalisation can be used as a modifiable predictor of unplanned hospital readmissions.
Design A retrospective cohort study.
Setting Two tertiary-level hospitals in Australia.
Participants All medical admissions ≥18 years over a period of 1 year.
Outcomes Primary objective was to determine predictors of early (0–7 days) and late (8–180 days) readmissions. Secondary objective was to determine whether nutrition status as determined by malnutrition universal screening tool (MUST) can be used to predict readmissions.
Results There were 11 750 (44.8%) readmissions within 6 months, with 2897 (11%) early and 8853 (33.8%) late readmissions. MUST was completed in 16.2% patients and prevalence of malnutrition during index admission was 31%. Malnourished patients had a higher risk of both early (OR 1.39, 95% CI 1.12 to 1.73) and late readmissions (OR 1.23, 95% CI 1.06 to 128). Weekend discharges were less likely to be associated with both early (OR 0.81, 95% CI 0.74 to 0.91) and late readmissions (OR 0.91, 95% CI 0.84 to 0.97). Indigenous Australians had a higher risk of early readmissions while those living alone had a higher risk of late readmissions. Patients ≥80 years had a lower risk of early readmissions while admission to intensive care unit was associated with a lower risk of late readmissions.
Conclusions Malnutrition is a strong predictor of unplanned readmissions while weekend discharges are less likely to be associated with readmissions. Targeted nutrition intervention may prevent unplanned hospital readmissions.This work was supported by Flinders Centre for Clinical Change and
Health Care Research (FCCCHCR) collaboration grant from Flinders University, South
Australia (grant number: 36373)
Dietary inclusion of Acti-Meal improves growth and feed utilisation of greenlip abalone (Haliotis laevigata)
Get PDFThis author accepted manuscript is made available following 24 month embargo from date of publication (August 2018) in accordance with the publisher’s archiving policy
This manuscript version is made
available under the CC-BY-NC-ND 4.0 license:
http://creativecommons.org/licenses/by-nc-nd/4.0/ which permits use, distribution and reproduction in any medium, provided the original work is properly cited.Acti-Meal is a co-product of the wine industry, consisting of a steam distilled, milled and dried grape marc meal rich in carbohydrates (55–65%). In this 90-day study, growth and feed utilisation of juvenile (1.82 g) greenlip abalone (Haliotis laevigata) fed diets containing graded dietary inclusion levels of Acti-Meal (0 basal, 5, 10, 15 and 20%) were examined. Four replicates were allocated per treatment with 15 abalone per tank and abalone were fed to excess daily. All experimental diets were formulated to contain 35% crude protein, 5% crude lipid and 17.5 MJ kg−1 gross energy. In addition, a commercial diet was also fed to abalone and compared with the 0% diet. Growth and feed utilisation of greenlip abalone fed the commercial diet and the 0% basal diet were similar. Greenlip abalone fed any Acti-Meal inclusion level (5, 10, 15 and 20%) exhibited significantly superior growth to abalone fed the 0% basal diet. Notably, in comparison to the basal diet, specific growth rate and biomass gain were improved by 5 to 6% and 10 to 12% respectively. The improvements were achieved despite greenlip abalone consuming significantly less feed (~9%) when fed the Acti-Meal diets. Greenlip abalone fed diets with Acti-Meal also exhibited superior apparent feed conversion ratios compared to those fed the 0% basal diet, on average FCRs were reduced by 13%. We recommend dietary inclusions of up to 20% Acti-Meal to improve greenlip abalone growth. We also recommend an on-farm growth trial to validate this product.This study was funded by the South Australian Government Functional Food Focus Program, Thriving Abalone Project (6251)
Early life determinants of cardiovascular health in adulthood. The Australian Aboriginal Birth Cohort study
Get PDFThis manuscript version is made available under the CC-BY-NC-ND 4.0 license:
http://creativecommons.org/licenses/by-nc-nd/4.0/ This author accepted manuscript is made available following 12 month embargo from date of publication (June 2018) in accordance with the publisher’s archiving policyBackground
In 2010, The American Heart Association (AHA) set seven impact goals for ideal cardiovascular health (CVH): ideal blood pressure (BP), glucose, cholesterol levels and body mass index (BMI), physical activity on recommended levels, non-smoking and a healthy diet. We explored the prevalence of ideal CVH and the relationship between early life determinants and later CVH in an Aboriginal Birth Cohort in Australia.
Methods
The sample comprised 686 Aboriginal babies born in Darwin between 1987 and 1990. At birth, birthweight was measured and data was gathered about the families. A follow-up was conducted in adulthood. Prevalences of CVH metrics were assessed and each participant received an AHA score between 0 and 7. The relationship between socioeconomic factors at birth and later CVH was analysed.
Results
Ideal CVH was rare. Females had higher levels of ideal blood pressure (OR 5.87, P < 0.0001) and lower levels of ideal physical activity (OR 0.19, P < 0.0001). Low areal disadvantage was inversely associated with ideal levels of physical activity (OR 0.13, P = 0.04) and ideal BP (OR 0.06, P = 0.04). Participants living in urban environments had lower levels of ideal BP (OR 0.11, P = 0.03). Living in large households was inversely associated with non-smoking (OR 0.22, P = 0.02). High maternal BMI was inversely associated with ideal cholesterol (OR 0.13, P = 0.004) and ideal BP (OR 0.20, P = 0.04).
Conclusions
Several early life factors affect later CVH in this cohort. These factors could be of significance in reducing the gap in cardiovascular mortality and morbidity between the Aboriginal and the non-Aboriginal populations in Australia
Age and quality stratification of groundwater in the Triassic Sherwood Sandstone aquifer of South Yorkshire and the East Midlands, UK
Get PDFThis manuscript version is made available under the CC-BY-NC-ND 4.0 license:
http://creativecommons.org/licenses/by-nc-nd/4.0/ This author accepted manuscript is made available following 24 month embargo from date of publication (August 2018) in accordance with the publisher’s archiving policyGroundwater from the Triassic Sherwood Sandstone aquifer of the English East Midlands shows a well-documented evolution in chemistry and residence time as it flows downgradient from shallow unconfined conditions to greater depths, confined by Mercia Mudstone. The flow path covers a lateral distance of some 40 km and depths approaching 800 m. The presence of fresh groundwater (Cl = 15 mg/L, Na = 17 mg/L, SO4 = 144 mg/L, TDS = 500 mg/L) of likely Pleistocene age can be demonstrated down to about 500 m depth in the aquifer, some 10 km downgradient of its confined/unconfined interface. This is amongst the deepest fresh groundwater identified in the UK. Beyond that zone, salinity increases in response to dissolution of gypsum or anhydrite, giving Ca-SO4 groundwater. Further downgradient still, saline groundwater (TDS = 10 g/L) is encountered in the deepest part of the confined aquifer. Downgradient geochemical evolution and increasing residence time are also observed in the South Yorkshire section of the aquifer, to the north of the East Midlands flow path. Here, analogous sequential geochemical changes are observed, controlled by carbonate and sulphate mineral reactions, redox changes and silicate hydrolysis, with evidence of increased inputs of e.g. Na, Cl and SO4 from modern pollution at shallow depths in the unconfined aquifer. Redox conditions are more variable in the western part of the South Yorkshire aquifer, due to local confinement or semi-confinement by fine-grained Quaternary deposits overlying the Sherwood Sandstone. Ratios of δ13C in this section of aquifer increase from −14‰ at outcrop to −11‰ in Mercia-Mudstone-confined conditions as a result of gradual equilibration with aquifer carbonate under closed-system conditions. Ratios of δ18O and δ2H become more depleted, reaching −9‰ and −61‰ respectively, suggesting recharge under climatic conditions significantly cooler than the modern era. Increasing residence time is also indicated by increasing concentrations of a number of trace elements (e.g. Li, Rb, Sr, Mo). These transitions are also observed vertically within investigated boreholes in unconfined and semi-confined sections of the aquifer. Deep groundwater (160–170 m depth) from a borehole within the unconfined aquifer of South Yorkshire has δ18O and δ2H ratios as depleted as −9.2‰ and −67‰ respectively. Such depth stratification indicates that good-quality palaeowater, likely of Pleistocene age, can exist at depth even in the unconfined Sherwood Sandstone aquifer, and that vertical hydraulic conductivity is much lower than lateral. A paucity of boreholes in the Mercia-Mudstone-confined section of the South Yorkshire aquifer makes estimation of the lateral extent of fresh groundwater there more problematic, though brackish groundwater (Cl = 1300 mg/L, TDS = 5.5 g/L) has been identified 12 km east of the aquifer's confined margin.The study results from findings of a number of previous projects funded variously by Yorkshire Water, Anglian Water, the Environment Agency and the Natural Environment Research Council (NERC). The recent investigations have been carried out through NERC funding. Open access has been provided through a NERC block grant