Dr Meredith Tavener

Diet quality indices (DQIs) can be useful predictors of diet¿disease relationships, includ-ing non-communicable disease (NCD) multimorbidity. We aimed to investigate whether overall diet quality (DQ) predicted NCD, multimorbidity, and all-cause mortality. Women from the 1945¿ 51 cohort of the Australia Longitudinal Study on Women¿s Health (ALSWH) were included if they: responded to S3 in 2001 and at least one survey between 2004 (S4) and 2016 (S8), and had no NCD history and complete dietary data at S3. DQ was summarized by the Healthy Eating Index for Australian Adults-2013 (HEIFA-2013), Mediterranean Diet Score (MDS), and Alternative Healthy Eating Index-2010 (AHEI-2010). Outcomes included each NCD (diabetes mellitus (DM), coronary heart disease (CHD), hypertension (HT), asthma, cancer (except skin cancer), depression and/or anxiety) independently, multimorbidity, and all-cause mortality. Repeated multivariate logistic regressions were used to test associations between DQIs and NCD outcomes across the 15 years of follow-up. The mean (±sd) of DQIs of participants (n = 5350) were 57.15 ± 8.16 (HEIFA-2013); 4.35 ± 1.75 (MDS), and 56.01 ± 10.32 (AHEI-2010). Multivariate regressions indicated that women reporting the highest quintile of AHEI-2010 had lower odds of DM (42¿56% (S5¿S8)), HT (26% (S8)), asthma (35¿37% (S7, S8)), and multimorbidity (30¿35% (S7, S8)). The highest quintile of HEIFA-2013 and MDS had lower odds of HT (26¿35% (S7, S8); 24¿27% (S6¿S8), respectively) and depression and/or anxiety (30% (S6): 30¿34% (S7, S8)). Our findings support evidence that DQ is an important predictor of some NCDs and a target for prevention in middle-aged women.

Distilling the complexity of overall diet into a simple measure or summative score by data reduction methods has become a common practice in nutritional epidemiology. Recent reviews on diet quality indices (DQI) have highlighted the importance of sound construction criteria and validation. The aim of this current review was to identify and critically appraise all DQI used within Australian and New Zealand adult populations. Twenty-five existing DQI were identified by electronic searching in Medline and hand searching of reference lists. DQI were constructed based on the respective national dietary guidelines and condition-specific recommendations. For preferable features of DQI, six captured the dimensions of adequacy, moderation and balance; five had a nested structure; 12 consisted of foods, food groups and nutrients; 11 used metric scoring systems and most of those with metric scales used normative cutoff points. Food frequency questionnaires, either alone or with other methods, were the most common dietary assessment method used in 20 DQI. For evaluation of DQI, construct validity and relative validity are reported. Based on our critical appraisal, Dietary Guideline Index (DGI), Dietary Guideline Index-2013 (DGI- 2013), Total Diet Score (TDS), Healthy Eating Index for Australian Adults-2013 (HEIFA-2013), and Aussie-Diet Quality Index (Aussie-DQI) were the preferred DQI used in Australian adults according to dimension, indicator selection, scoring criteria and evaluation. Further work is needed to enhance the construction of all Australian and New Zealand DQI, especially in terms of dimension and structure, for alignment with recommended construction criteria.

Purpose: Multiple health behaviours (not smoking, minimal alcohol consumption, and maintaining a healthy weight by having a healthy diet and regular physical activity) improve quality of life and longevity of cancer survivors. Despite international guidelines, there are no existing reviews that synthesise cancer survivors¿ adherence to healthy lifestyle recommendations. Method: Five databases (Embase, MEDLINE, PsycINFO, Web of Science, and Google Scholar) were searched for relevant articles published from 2007 until January 2018. Studies reporting adult cancer survivors¿ adherence to at least two lifestyle behaviours (body mass index, physical activity, smoking, fruit and vegetable intake, fiber intake, red meat intake, caloric intake, sodium intake, and alcohol consumption) based on the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) recommendations were included in the review. The pooled prevalence of adherence to single and multiple behaviours was calculated using a random-effects model. Subgroup analysis (mean years of survival and publication year) was undertaken. Results: A total of 3322 articles were identified. Of these, 51 studies matched the inclusion criteria, presenting data from 2,620,586 adult cancer survivors. Adherence to single behaviours, which was estimated from studies that assessed at least two health behaviours, was highest for not smoking (PE 87%; 95% CI, 85%, 88%) and low or no alcohol intake (PE 83%; 95% CI, 81%, 86%), and lowest for fiber intake (PE 31%; 95% CI, 21%, 40%). Adherence to multiple healthy behaviours (13 studies), ranged from 7 to 40% (pooled estimate (PE) 23%; 95% CI, 17%, 30%). Recent survivors (<¿5-year survival time) had relatively better adherence to multiple behaviours (PE 31%; 95% CI, 27%, 35%) than long-term (> 5¿years) survivors (PE 25%; 95% CI, 14%, 36%). Adherence to multiple behaviours improved over time since 2007. Conclusion: Adherence to physical activity, dietary, and multiple lifestyle behaviours recommendations was low amongst cancer survivors. Recent cancer survivors were relatively more adherent to WCRF/AICR recommendations compared to long-term survivors. Implications for Cancer Survivors: Health promotion programs help support healthy lifestyle behaviours of cancer survivors. PROSPERO registration number: CRD42018091663

Objective: To assess which older Australian women had Medicare subsidized health assessments between 1999 and 2013. Methods: This study used prospective, longitudinal survey data from the 1921 to 1926 birth cohort of Australian Longitudinal Study on Women¿s Health (ALSWH) linked with Medicare Australia data on health services use. Over 11,000 Australian women were included in the study. Latent class analysis was used to identify assessment patterns over time, accounting for death, and based on three categories (¿no assessment¿; ¿assessment; ¿deceased¿) for each year between 1999 and 2013. Further analysis explored the impact of health and sociodemographic characteristics on class membership. Results: Of the women included in the latent class analysis, 37% never had any assessment and the remainder had had at least one assessment. After a steady uptake from 1999 to 2003, there was decline in uptake from 2003 onwards. A six-class model with sufficient homogeneity and reliable estimation was selected to represent assessment patterns and mortality risk, labelled as: ¿high mortality¿ rate with little chance for assessment (12.4%), ¿intermediate mortality, low assessment¿ (14.1%), ¿later mortality/low assessment¿ (13.1%), ¿later mortality, high assessment¿ (7.0%), ¿low mortality, low assessment¿ (31.8%), ¿low mortality, high assessment¿ (21.6%). Older women with certain conditions (such as diabetes, depression, heart disease) were more likely to be in the low assessment groups, and women with difficulty managing on income were more likely to be in low assessment groups. Conclusion: Distinct assessment and mortality patterns were seen, with many women not having assessment, in particular those who had certain health conditions, were taking 3+ medications, had difficulty in managing on income, needed help or were in respite care, and had caring responsibilities. The findings point to a need to promote these assessments among older women, and to reduce financial barriers, even within the context of a heavily subsidized health care system.

Purpose: Postural Orthostatic Tachycardia Syndrome is most commonly seen in women of child bearing age, however little is known about its effects in pregnancy. Method: A systematic review was conducted in March 2015 and updated in February 2018. Medline, Embase, PsychInfo, CINHAL, and the Cochrane Library were searched from database inception. The ClinicalTrials.gov site and bibliographies were searched. MeSH and Emtree headings and keywords included; Postural Orthostatic Tachycardia Syndrome, Postural Tachycardia Syndrome, and were combined with pregnancy and pregnancy related subject headings and keywords. Searches were limited to English. Eligible articles contained key words within the title and or abstract. Articles were excluded if Postural Orthostatic Tachycardia Syndrome was not pre-existing. Results: Eleven articles were identified as eligible for inclusion. Studies were appraised using the PRISMA 2009 guidelines. The overall quality of evidence was poor using the NHMRC Evidence Grading Matrix, which was attributed to small sample sizes and mostly observational studies, emphasizing the need for future high quality research. Findings in this review must be used with caution due to the poor quality of the literature available. Conclusions: Postural Orthostatic Tachycardia Syndrome should not be a contraindication to pregnancy. Symptom course is variable during pregnancy and the post-partum period. Continuing pre-conception medication may help symptoms, with no significant risks reported. Obstetric complications, not Postural Orthostatic Tachycardia Syndrome, should dictate mode of delivery. Postural Orthostatic Tachycardia Syndrome did not appear to affect the rate of adverse events. These results are important in determining appropriate management and care in this population.

Objective The aim of the present study was to examine non-communicable disease (NCD) policy formation and implementation in Indonesia. Methods Interviews were conducted with 13 Indonesian health policy workers. The processes and issues relating to NCD policy formation were mapped, exploring the interactions between policy makers, technical/implementation bodies, alliances across various levels and the mobilisation of non-policy actors. Results Problems in NCD policy formation include insufficient political interest in NCD control, disconnected policies and difficulty in multisectoral coordination. These problems are well illustrated in relation to tobacco control, but also apply to other control efforts. Nevertheless, participants were optimistic that there are plentiful opportunities for improving NCD control policies given growing global attention to NCD, increases in the national health budget and the growing body of Indonesia-relevant NCD-related research. Conclusion Indonesia's success in the creation and implementation of NCD policy will be dependent on high-level governmental leadership, including support from the President, the Health Minister and coordinating ministries. What is known about the topic? The burden of NCD in Indonesia has increased gradually. Nationally, NCD-related mortality accounted for 65% of deaths in 2010. Indonesia is also a country with the highest burden of tobacco smoking in the world. However, the government has not instituted sufficient policy action to tackle NCDs, including tobacco control. What does this paper add? This paper deepens our understanding of current NCD control policy formation in Indonesia, including the possible underlying reason why Indonesia has weak tobacco control policies. It describes the gaps in the current policies, the actors involved in policy formation, the challenges in policy formation and implementation and potential opportunities for improving NCD control. What are the implications for practitioners? An effective NCD control program requires strong collaboration, including between government and health professionals. Health professionals can actively engage in policy formation, for example through knowledge production.

We examined women's access to health insurance in Indonesia. We analyzed IFLS-4 data of 1,400 adult women residing in four major cities. Among this population, the health insurance coverage was 24%. Women who were older, involved in paid work, and with higher education had greater access to health insurance (p¿<.05). We also found there were disparities in the probability of having health insurance across community levels (Median Odds Ratios¿=¿3.40). Given the importance of health insurance for women's health, strategies should be developed to expand health insurance coverage among women in Indonesia, including the disparities across community levels. Such problems might also be encountered in other developing countries with low health insurance coverage.

Big cities can offer great opportunities for women to have a better life. At the same time, however, the physical and social environment in cities can negatively affect their health. We conducted focus groups with 24 women (aged 18¿72 years) living in Jakarta, Indonesia from October to November 2014. Our aim was to elicit women¿s experiences of living in Jakarta, including their health and accessing health care. The most frequent health problems reported by women in this study were hypertension and arthritis. Women often gave priority to their family, particularly their children, over themselves and their own health. Discussants also thought that the city¿s physical and social conditions could affect their health, and that women were more prone to feel stress than men. The results of this study highlight the importance of addressing social determinants of health across the life course, including gender, to improve women¿s health status. Moreover, multi-sectoral collaboration at the municipal and national level is needed for urban planning to create better living conditions for women in the cities.

© 2016 AJA Inc. Aim: To explore the implementation of poslansia, a community-based integrated health service implemented across Indonesia to improve the health status of older people through health promotion and disease prevention. Methods: Data analysis of 307 poslansia surveyed in the 4th wave of Indonesia Family Life Survey (IFLS-4). We examined the services provided in the programme, resources and perceived problems. Results: The services provided by poslansia focused mostly on risk factor screening and treatment for minor illness, and less on health promotion activities. Lack of support from community health centres, no permanent place for holding poslansia and lack of participant interest in joining the programme were associated with fewer services provided in the programme (P < 0.05). Conclusion: The findings indicate existing support from the community, community health centres and related institutions for poslansia is not adequate for optimal service function. Health awareness among the older population should also be increased for programme sustainability.

Objectives: To examine the relationships of retirement and reasons for retirement with psychological distress in men and women at the age of 45-79 years. Method: Data from 202,584 Australians participating in the large-scale 45 and Up Study was used. Psychological distress was measured by the Kessler psychological distress scale. Associations between different work status and reasons for retirement with psychological distress were assessed for men and women at different ages using logistic regression. Results: Being fully retired or unemployed was associated with the high levels of psychological distress compared to being in paid work for men and women aged 45-64 (p < 0.0001), and for men aged 65-74 years (p = 0.0014). At the age of 75-79 years, there was no difference in psychological distress between different work statuses. Among retirees, retirement due to ill health, being made redundant or caring duty was associated with the high level of psychological distress. Conclusion: The association between work and mental health underscores the importance of policies and strategies to encourage and enable people to continue in the workforce after age 55, particularly for men. Important reasons for retirement with worse mental health outcomes include redundancy, ill health and needing to care for family or a friend. These circumstances will affect whether a person can continue working and their risk of poor mental health, and both considerations should be addressed in developing approaches for maintaining older workers or assisting them with their retirement transition.

Objectives: To examine bias arising from loss to follow-up due to lack of contact. Study Design and Setting: The 1973-1978 cohort of Australian Longitudinal Study on Women's Health was first surveyed in 1996 and followed up in 2000, 2003, 2006, and 2009. At the 2000 survey, 9,688 women responded (responders), 2,972 could not be contacted, of whom 1,515 responded subsequently (temporary no contact) and 1,457 did not (permanent no contact). Characteristics were compared for these groups at baseline and follow-up in 2003, 2006, or 2009. Relative risk ratios were used to estimate bias. Results: No-contacts were younger, more likely to live in cities, to be less educated and stressed about money than responders. No-contacts were more likely to be in de facto relationships, separated, divorced, or widowed, to have experienced partner violence and be smokers. Compared with temporary no contact, permanent no contact were less educated, less likely to be studying or employed. Despite differences in prevalence estimates, relative odds ratios were close to one and had confidence intervals that included one, indicating little effect of bias. Conclusion: Although various characteristics were related to loss to follow-up, the relative risks estimates did not indicate serious bias due to loss to follow-up in this cohort of young women.

Although hypertension has been recognized as one of the major public health problems, few studies address economic inequality of hypertension among urban women in developing countries. To assess this issue, we analysed data for 1400 women from four of Indonesia's major cities: Jakarta, Surabaya, Medan and Bandung. Women were aged =15 years (mean age 35.4 years), and were participants in the 2007/2008 Indonesia Family Life Survey. The prevalence of hypertension measured by digital sphygmomanometer among this population was 31%. Using a multivariable logistic regression model, socioeconomic disadvantage (based on household assets and characteristics) as well as age, body mass index and economic conditions were significantly associated with hypertension (P<0.05). Applying the Fairlie decomposition model, results showed that 14% of the inequality between less and more economically advantaged groups could be accounted for by the distribution of socioeconomic characteristics. Education was the strongest contributor to inequality, with lower education levels increasing the predicted probability of hypertension among less economically advantaged groups. This work highlights the importance of socioeconomic inequality in the development of hypertension, and particularly the effects of education level.

Aim: This paper explored how gerontology experts described baby boomers, whether they challenged the popular image, and if they provided alternatives to the popularly reported baby boomer behaviours and characteristics. Methods: Qualitative interviews were conducted with ten experts from different areas across Australia. The interviews were semi-structured and guided by a 'sense-making' approach to explore the baby boomer construct and identify expert narratives that differed from the popularly tendered image. Results: The majority of experts were identified as baby boomers and made use of phrases associated with the popular baby boomer image, such as 'cashed up', 'reinventing retirement' and 'sea change'. Lifestyle and wealth were recognised as staple features of the popular image. To a lesser degree, the experts also recognised alternative characteristics and behaviours, including people with disabilities and those who struggle financially. Conclusions: Experts appeared to identify with the popular baby boomer label, but not necessarily the accompanying stereotypes.