The Australian system of government was founded on the Westminster tradition, which relies on the binary relationship between Ministers and the Australian Public Service (APS). However, the ...increasing number of ministerial advisers over the past 40 years has changed the balance of power in the Australian executive. While public servants are able to work in a Minister's office, this article considers whether the movement of public servants between the public service and ministerial offices has the effect of politicising the role of the APS. Based on 22 interviews with current and former Commonwealth Ministers, public servants and ministerial advisers, the authors argue that public servants gaining experience in ministerial offices is beneficial to both the APS and the Minister's office. This is because public servants are exposed to the political side of government which helps improve the output of the department, while the Minister's office gains technical expertise. Despite these benefits, there appears to be fewer public servants working in ministerial offices over recent years. This article considers the benefits of public servants working in a ministerial office, why the movement has reduced, and explores ways in which this can be changed to support the executive governance of Australia.
Abstract
Undernutrition among children is a significant issue in rural areas in Cameroon, with diarrhea being one of the major contributing risk factors. To gain a better understanding of the risk ...factors of diarrhea, the main objective of this epidemiological study was to examine associations between water access and sanitation service with diarrhea, diet diversity, and anemia among infants and toddlers in rural households in Cameroon. The study involved household- and individual-level data of 2,129 rural-dwelling infants and toddlers from the Demographic and Health Survey database. About one-third of infants and toddlers were experiencing diarrhea, with higher odds among those who lived in households with limited water service (p = 0.028). The odds of having diarrhea were 50% higher among infants and toddlers when households did not have sanitation facilities (p = 0.007). The lack of improved water and sanitation was also associated with a low intake of various food groups among older infants and toddlers. The prevalence of anemia was high, but no significant differences were seen by water and sanitation services. The achievement of SDG #6 will help address undernutrition and achieve other SDGs, including improving health and wellbeing.
Over the past three decades, obesity-related diseases have increased tremendously in China, and are now the leading causes of morbidity and mortality. Patterns of weight change can be used to predict ...risk of obesity-related diseases, increase understanding of etiology of disease risk, identify groups at particularly high risk, and shape prevention strategies.
Latent class trajectory modeling was used to compute weight change trajectories for adults aged 18 to 66 using the China Health and Nutrition Survey (CHNS) data (n = 12,611). Weight change trajectories were computed separately for males and females by age group at baseline due to differential age-related patterns of weight gain in China with urbanization. Generalized linear mixed effects models examined the association between weight change trajectories and baseline characteristics including urbanicity, BMI category, age, and year of study entry.
Trajectory classes were identified for each of six age-sex subgroups corresponding to various degrees of weight loss, maintenance and weight gain. Baseline BMI status was a significant predictor of trajectory membership for all age-sex subgroups. Baseline overweight/obesity increased odds of following 'initial loss with maintenance' trajectories. We found no significant association between baseline urbanization and trajectory membership after controlling for other covariates.
Trajectory analysis identified patterns of weight change for age by gender groups. Lack of association between baseline urbanization status and trajectory membership suggests that living in a rural environment at baseline was not protective. Analyses identified age-specific nuances in weight change patterns, pointing to the importance of subgroup analyses in future research.
Background
Recent longitudinal work suggests that weight change is an important risk factor for inflammation across the full range of BMI. However, few studies have examined whether the risk of ...inflammation differs by patterns of weight gain over time. Using latent class trajectory analysis, we test whether patterns of weight gain are associated with elevated high‐sensitivity C‐reactive protein (hs‐CRP 2–10 mg/L).
Methods and Results
Data come from China Health and Nutrition Survey (CHNS) participants (n=5536), aged 18 at baseline to 66 years in 2009, with measured weight over 18 years. Latent class trajectory analysis was used to identify weight‐change trajectories in 6 age and sex strata. Multivariable general linear mixed‐effects models fit with a logit link were used to assess the risk of elevated hs‐CRP across weight trajectory classes. Models were fit within age and sex strata, controlling for baseline weight, adult height, and smoking, and included random intercepts to account for community‐level correlation. Steeper weight‐gain trajectories were associated with greater risk of elevated hs‐CRP compared to more moderate weight‐gain trajectories in men and women. Initially high weight gain followed by weight loss was associated with lower risk of elevated hs‐CRP in women aged 18 to 40.
Conclusions
Latent class trajectory analysis identified heterogeneity in adult weight change associated with differential risk of inflammation independently of baseline weight and smoking. These results suggest that trajectories of weight gain are an important clinical concern and may identify those at risk for inflammation and the development of cardiometabolic disease.
Reducing the incidence of obesity requires coordination among primary health care providers. Because of their frequent contact with patients, dentists are positioned to recognize patients at risk of ...developing obesity. The authors conducted a study to assess dentists' interest in and barriers to providing obesity counseling to patients.
The authors surveyed a random sample of 8,000 American Dental Association members by mail, stratified according to census region (West, Midwest, South, Northeast) and dentist type (general, pediatric). The authors weighted respondents' data to account for the unequal probability of selection and nonresponse rates among regions and dentist types.
In all, 2,965 dentists responded. Overall, 4.8 percent of respondents offered a form of counseling services and 50.5 percent reported that they were interested in offering obesity-related services. More than one-half of the respondents cited fears of offending patients (53.8 percent) and appearing judgmental (52 percent) as major barriers, followed by a paucity of trained personnel (46.3 percent) and patients' rejection of weight-loss advice (45.7 percent). Eighty-two percent of respondents agreed that dentists would be more willing to intervene if obesity were linked definitively to oral disease.
Given continued increases in obesity in the United States and the willingness of dentists to assist in preventive and interventional efforts, experts in obesity intervention, in conjunction with dental educators, should develop models of intervention within the scope of dental practice.
Educating dentists about obesity and counseling may reduce barriers for those interested in addressing obesity in their practices.
Over the last decade, the Supplemental Nutrition Program for Women, Infants, and Children (WIC) has been transitioning to electronic food-benefits (eWIC). The North Carolina Appalachian Region was ...among the last to implement this transition, yet little is known about how eWIC influenced experiences in rural areas. This study examined potential differences in maternal shopping characteristics (MSC), perceptions, barriers, and dietary intakes by type of food-benefits used (paper food-benefits (PB) versus eWIC) among pregnant women and/or mothers in three rural counties in Western North Carolina. Our findings suggest eWIC has a positive impact on MSC and overall satisfaction in this region.
Abstract Purpose The purpose of our study was to determine the ability of electrocardiographic (ECG) criteria derived from prior angiographic-ECG correlative studies to identify life-threatening ...coronary artery obstructive lesions. Methods We studied 128 consecutive patients referred from the emergency department for emergent coronary angiography for symptoms and ECG changes suggesting an acute coronary event. Using ECG criteria derived from prior studies, we attempted to predict not only the vessel housing the culprit lesion, but whether the lesion was located proximally in that vessel, and then determined the positive and negative predictive values (PPV and NPV) of the criteria used. Results Our criteria correctly identified 7 of 11 patients with left main disease, with a PPV of 100% and an NPV of 97%; 12 of 19 patients with proximal left anterior descending coronary artery disease, with a PPV of 67% and an NPV of 94%; and 25 of 28 patients with proximal right coronary artery disease, with a PPV of 64% and an NPV of 97%. The combined PPV and NPV for predicting patients with either left main coronary artery, proximal left anterior descending coronary artery, or proximal right coronary artery disease were 72% and 81%. Conclusion Our study indicates that the location of life-threatening coronary artery lesions in patients presenting with signs and symptoms of acute coronary syndromes can be predicted from the initial ECG with a high degree of accuracy. Recognizing the ECG criteria for such lesions has the potential for shortening door-to-reperfusion time and improving patient outcomes.
Aims/Hypothesis
Although obesity is a major risk factor for diabetes, little is known about weight gain trajectories across adulthood, and whether they are differentially associated with metabolic ...markers of diabetes.
Methods
We used fasting blood samples and longitudinal weight data for 5,436 adults (5,734 observations, aged 18–66 years) from the China Health and Nutrition Survey (1991–2009). Using latent class trajectory analysis, we identified different weight gain trajectories in six age and sex strata, and used multivariable general linear mixed effects models to assess elevated metabolic markers of diabetes (fasting glucose, HbA
1c
, HOMA-IR, insulin) across weight trajectory classes. Models were fitted within age and sex strata, and controlled for baseline weight (or baseline weight by weight trajectory interaction terms), height, and smoking habit, with random intercepts to control for community-level correlations.
Results
Compared with weight gain, classes with weight maintenance, weight loss, or a switch from weight gain to loss had lower values for metabolic markers of diabetes. These associations were stronger among younger women (aged 18–29 and 30–39 years) and men (18–29 years) than in older (40–66 years) men and women. An exception was HOMA-IR, which showed class differences across all ages (at least
p
< 0.004).
Conclusion
Trajectory analysis identified heterogeneity in adult weight gain associated with diabetes-related metabolic markers, independent of baseline weight. Our findings suggest that variation in metabolic markers of diabetes across patterns of weight gain is masked by a homogeneous classification of weight gain.
Purpose To study associations between serum and aqueous vascular endothelial growth factor (VEGF) and insulin-like growth factor 1 (IGF-1) and macular edema measured with optical coherence tomography ...(OCT) following phacoemulsification in diabetic patients. Design Cohort study. Methods A pilot study of 36 consecutive diabetic patients undergoing planned phacoemulsification with IOL in 1 eye by one surgeon at the University of North Carolina consented to preoperative and postoperative OCT central subfield (CSF) thickness measurements and aqueous and blood samples for VEGF and IGF-1. Four patients with clinically significant macular edema (CSME) received laser preoperatively. Spearman-rank correlations were performed between growth factors and mean CSF or a clinically meaningful percent change in CSF (>11% of preoperative measurement) at 1 and 6 months postoperatively. Results There were no surgical complications or new cases of CSME following surgery. Mean aqueous VEGF in patients with retinopathy, determined preoperatively, increased with increasing level of severity. Patients with preoperative CSME also had severe or worse retinopathy and the greatest mean aqueous VEGF. Significant preoperative correlations existed between aqueous VEGF and more severe retinopathy whether CSME was present or absent ( r = 0.49; P = .007), and between aqueous VEGF and CSME ( r = 0.41; P = .029). At 1 month postoperative, aqueous VEGF was positively correlated with >11% change from preoperative CSF regardless of CSME status ( r = 0.47; P = .027). No noteworthy associations existed between CSF and IGF-1 values. Conclusions Aqueous VEGF was significantly positively associated with a clinically meaningful change in CSF in diabetic patients 1 month following cataract surgery. Accounting for preoperative CSF was important. Further study is indicated.
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