Is educational inequality protective?
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Educational Status↗
Biomedical subjects
Mark Daniel
Publications and source records attributed to Mark Daniel.
Mastery, perceived stress and health-related behaviour in northeast Arnhem Land: a cross-sectional study.
BACKGROUND: Indigenous peoples in Australia are disadvantaged on all markers of health and social status across the life course. Psychosocial factors are implicated in the aetiology of chronic diseases and in pathways underpinning social health disparities. Minimal research has investigated psychosocial factors and health in Indigenous peoples. This study evaluated associations between mastery, perceived stress, and health-related behaviour for a remote Indigenous population in Australia. METHODS: Complete data on mastery (the degree to which individuals feel in control of their lives), perceived stress, physical activity, and fruit and vegetable consumption were obtained for 177 participants in a community-based chronic disease risk factor survey. Psychosocial questionnaires were completed as an option during community screening (response rate = 61.9%). Extensive consultation facilitated the cross-cultural adaptation of measures. RESULTS: Mastery was inversely correlated with perceived stress measures (p < 0.009): recent stress, r = -0.47; chronic stress, r = -0.41; and youth stress, r = -0.30. Relationships between mastery and behaviour varied according to age group (<25 or > or =25 years) for physical activity (p = 0.001) and vegetable consumption (p = 0.005). Individuals aged > or =25 years engaging in < or =2 bouts of physical activity/week had lower mastery than individuals engaging in > or =3 bouts/week, with means (95% CI) of 14.8 (13.7-15.8) and 17.1 (15.3-19.0), respectively (p = 0.026). Individuals aged > or =25 years eating vegetables < or =3 times/week had lower mastery than those eating vegetables > or =4 times/week (p = 0.009) [means 14.7 (13.8-15.5) and 17.3 (15.5-19.1), respectively]. Individuals <25 years engaging in < or =2 bouts of physical activity/week had greater mastery than individuals engaging in > or =3 bouts/week (p = 0.022) [means 17.2 (15.2-19.2) and 13.8 (11.9-15.7), respectively]. For men > or =25 years and women > or =15 years, mastery was inversely related to age (p < 0.002). Men <25 years had less mastery than women of equivalent age (p = 0.001) [means 13.4 (12.1-14.7) and 17.5 (15.3-19.8), respectively]. CONCLUSION: Consistent with previous research, this study provides additional support for a link between mastery and health-related behaviour, and extends evidence of this association to a remote Indigenous population. Mastery's association with perceived stress, its age-specific association with health behaviour, and findings of low mastery amongst young men, highlights a need for life course research accounting for contextual factors affecting Indigenous peoples.
Journal Article↗
Aboriginal status is a prognostic factor for mortality among antiretroviral naïve HIV-positive individuals first initiating HAART.
BACKGROUND: Although the impact of Aboriginal status on HIV incidence, HIV disease progression, and access to treatment has been investigated previously, little is known about the relationship between Aboriginal ethnicity and outcomes associated with highly active antiretroviral therapy (HAART). We undertook the present analysis to determine if Aboriginal and non-Aboriginal persons respond differently to HAART by measuring HIV plasma viral load response, CD4 cell response and time to all-cause mortality. METHODS: A population-based analysis of a cohort of antiretroviral therapy naïve HIV-positive Aboriginal men and women 18 years or older in British Columbia, Canada. Participants were antiretroviral therapy naïve, initiated triple combination therapy between August 1, 1996 and September 30, 1999. Participants had to complete a baseline questionnaire as well as have at least two follow-up CD4 and HIV plasma viral load measures. The primary endpoints were CD4 and HIV plasma viral load response and all cause mortality. Cox proportional hazards models were used to determine the association between Aboriginal status and CD4 cell response, HIV plasma viral load response and all-cause mortality while controlling for several confounder variables. RESULTS: A total of 622 participants met the study criteria. Aboriginal status was significantly associated with no AIDS diagnosis at baseline (p = 0.0296), having protease inhibitor in the first therapy (p = 0.0209), lower baseline HIV plasma viral load (p < 0.001), less experienced HIV physicians (P = 0.0133), history of IDU (p < 0.001), not completing high school (p = 0.0046), and an income of less than $10,000 per year (p = 0.0115). Cox proportional hazards models controlling for clinical characteristics found that Aboriginal status had an increased hazard of mortality (HR = 3.12, 95% CI: 1.77-5.48) but did not with HIV plasma viral load response (HR = 1.15, 95% CI: 0.89-1.48) or CD4 cell response (HR = 0.95, 95% CI: 0.73-1.23). CONCLUSION: Our study demonstrates that HIV-infected Aboriginal persons accessing HAART had similar HIV treatment response as non-Aboriginal persons but have a shorter survival. This study highlights the need for continued research on medical interventions and behavioural changes among HIV-infected Aboriginal and other marginalized populations.
Journal Article↗
Associations among education, cortisol rhythm, and BMI in blue-collar women.
OBJECTIVE: This study sought to test whether a biological measure of chronic stress, Delta cortisol, was related to BMI and whether the relationship between Delta cortisol and BMI varied according to education and positive affect. RESEARCH METHODS AND PROCEDURES: One hundred fifty-four women from a blue-collar women's health project in 11 industrial sites in rural North Carolina provided saliva for cortisol assays for a substudy on "stress." Delta Cortisol, the difference between awakening and midday cortisol measures representing diurnal decline, was calculated (lower values = greater stress). BMI was regressed on Delta cortisol, education, and positive affect. Analyses were controlled for age, race, and worksite. Standardized beta-coefficients were calculated. RESULTS: For participants with complete data (n = 129), BMI was greater (beta; 95% confidence interval) for women with less than high school education (0.56; 0.18, 0.94) and those who completed high school (0.26; -0.05, 0.57) relative to women with greater than a high school education (p = 0.009). Delta Cortisol was inversely related to BMI (-0.32; -0.59, -0.05; p = 0.022). Education positively modified the inverse relationship between Delta cortisol and BMI (p = 0.047). Positive affect was negatively associated with BMI (-0.44; -0.82, -0.06; p = 0.026) and positively modified the inverse association between Delta cortisol and BMI (0.33; -0.03, 0.69; p = 0.074). DISCUSSION: Education and Delta cortisol were inversely related to BMI, and the magnitude of the association between Delta cortisol and BMI was buffered by higher education. Positive affect was inversely related to BMI. Chronic stress is associated with higher BMI, with this relation attenuated by higher education and, possibly, a positive affect.
Adult↗
Test agreement for classifying diabetes in indigenous Australians.
OBJECTIVE: To evaluate for Indigenous Australians the agreement between a fasting plasma glucose (FPG) criterion of 7.0 mmol/L and diabetes test results using a two-hour oral glucose tolerance test (OGTT), comparing relationships between test agreement and prevalence to similar studies. METHODS: Screening was undertaken in 25 remote settlements. Agreement between FPG and OGTT results was evaluated using the kappa coefficient (chance-corrected agreement). RESULTS: Participants (n=3,249) ranged from 15-94 years. Kappa ranged from 0.70-0.77 for diabetes prevalence of 5-30%, with overall agreement of 0.76. In comparison studies, the relationship between kappa and diabetes prevalence was similar, but with kappa 0.21-0.48. CONCLUSIONS AND IMPLICATIONS: A FPG test with a 7.0 mmol/L cut-off is a reliable screening method, relative to the OGTT, for remote Indigenous settlements. The level of agreement between the FPG test and the OGTT for the Indigenous population surveyed is superior by far to agreement reported for non-Indigenous samples.
Adult↗
High rates of HIV testing despite low perceived HIV risk among African-American sexually transmitted disease patients.
PURPOSE: In the current diagnosis-based, human immunodeficiency virus (HIV) prevention climate, previous testing among persons at elevated HIV risk has cost and efficacy implications, as it signals continued behavioral risk, limited HIV knowledge or overuse of services. This study sought to determine the proportion of African Americans newly seeking sexually transmitted disease (STD) diagnosis who previously had obtained HIV counseling and testing. METHODS: This was a clinic-based, cross-sectional survey of African-American adults (N=408) seeking STO diagnosis at a public STD clinic located in a high-HIV and STD prevalence city in the U.S. south. MAIN FINDINGS: Eighty-four percent of respondents had previously obtained HIV counseling and testing: 68% had previously obtained care at the clinic. Sixty-five percent of respondents perceived themselves as having low or no HIV risk. Seventy-two percent correctly answered > or = 3 of 4 HIV knowledge items. CONCLUSIONS: Although diagnosis-based HIV prevention initiatives promote HIV counseling and testing for both primary and secondary HIV prevention, these findings suggest that many African-American STD patients remain at risk following testing. Future research should explore how the counseling portion of standard HIV counseling and testing influences subsequent knowledge, attitudes, risk perceptions and behaviors.
AIDS Serodiagnosis↗
Mediation and modification of the association between hopelessness, hostility, and progression of carotid atherosclerosis.
Hopelessness and hostility are linked to progression of carotid atherosclerosis (PCA). The purpose of this study was to replicate such relations and to evaluate the role of biological pathways involving hyperactivation of the sympathetic nervous system (SNS) and the hypothalamic-pituitary-adrenocortical (HPA) axis. PCA was evaluated by 4-year change in three ultrasound measures of intima-media thickness (IMT) in 1027 men aged 42-60 years at baseline. Effect modification and mediation of relationships between psychosocial factors and PCA were examined for the measures systolic blood pressure (SBP), fibrinogen, and waist-to-hip ratio (WHR), levels of which are indicative of activity along these pathways. Hopelessness and hostility were associated with PCA. Fibrinogen mediated to a moderate extent the association between hopelessness and PCA. SBP significantly modified the relation between hostility and PCA in participants of moderate hostility. The above biological pathways are implicated in the mechanisms connecting hopelessness, hostility, and PCA.
Adult↗
AIDS and "shared sovereignty" in Tanzania from 1987 to 2000: a case study.
After more than 15 years of foreign assistance to support HIV/AIDS prevention in Sub-Saharan Africa, HIV rates in the sub-continent remain high with only a few examples of reduced HIV incidence. This case study used the frame of "shared sovereignty" between nation-states and official development assistance agencies to analyze 13 years of technical assistance for HIV/AIDS programs in Tanzania from 1987 to 2000. The study draws on 21 key informant interviews and a systematic review of key program documents from the National AIDS Control Programme (NACP) and 14 other international agencies. Applying Jamison et al.'s (Lancet 351 (1998) 514) shared sovereignty framework, the analysis focused on fulfilled shared functions in moving Tanzania's NACP from dependence to independence. The analysis revealed an uneven and inconsistent level of technical assistance to the NACP with a rotation of multilateral and bilateral donors over the period of study. The Tanzanian government was often ambivalent toward agencies providing assistance towards its HIV/AIDS programs and toward its own NACP. Results are discussed in terms of implications for future strategic planning to mitigate the effects of HIV/AIDS. Determining roles, shared accountability and responsibility in a shared sovereignty framework remain a challenge in the governance of HIV/AIDS programs in Tanzania.
Acquired Immunodeficiency Syndrome↗
International NGOs and the role of network centrality in humanitarian aid operations: a case study of coordination during the 2000 Mozambique floods.
In February 2000, Mozambique suffered its worst flooding in almost 50 years: 699 people died and hundreds of thousands were displaced. Over 49 countries and 30 international non-governmental organisations provided humanitarian assistance. Coordination of disaster assistance is critical for effective humanitarian aid operations, but limited attention has been directed toward evaluating the system-wide structure of inter-organisational coordination during humanitarian operations. Network analysis methods were used to examine the structure of inter-organisational relations among 65 non-governmental organisations (NGOs) involved in the flood operations in Mozambique. Centrality scores were used to estimate NGO-specific potential for aid coordination and tested against NGO beneficiary numbers. The average number of relief- and recovery-period beneficiaries was significantly greater for NGOs with high relative to low centrality scores (p < 0.05). This report addresses the significance of these findings in the context of the Mozambican 2000 floods and the type of data required to evaluate system-wide coordination.
Altruism↗
Fasting criteria for screening: test properties and agreement with glucose tolerance.
The objective of this study was to characterise test properties and agreement for fasting glucose cut-offs used for screening diabetes in Indigenous Australian communities, across a range of diabetes prevalence. The oral glucose tolerance test (OGTT) was administered to adult volunteers (n=3249) for community-based diabetes screening in isolated settlements (n=25). Two-hour post-load glucose concentration was the 'gold standard' against which test properties were characterised for fasting plasma glucose cut-offs at concentrations of > or = 7.0 mmol/l (ADA criterion) and > or = 7.8 mmol/l (WHO criterion). Test sensitivity (95% CI) was greater for the ADA (72.5%, 67.4-77.1%) versus the WHO criterion (61.5%, 56.1-66.6%). Specificity was high (>98%) using either criterion. The post-test likelihood of diabetes, given a population prevalence of 14.8%, was 89.1% using the ADA criterion, and 94.9% using the WHO criterion. The ADA criterion gave better agreement than did the WHO criterion for diabetes prevalence > or = 8.6%, and the probability of false results was lower using the ADA criterion, when diabetes prevalence was > or = 12.8%. According to the ADA criterion most individuals ascribed false negative results were aged > or = 35 years, overweight/obese, or had impaired fasting glucose. The fasting glucose criterion of 7.0 mmol/l was superior to 7.8 mmol/l in screening for diabetes.
Adolescent↗
Perceptions of disease severity and barriers to self-care predict glycemic control in Aboriginal persons with type 2 diabetes mellitus.
The Health Belief Model (HBM) was evaluated for secondary prevention of type 2 diabetes mellitus in an Aboriginal population in British Columbia. Glycemic markers (glycated hemoglobin [HbA1c]), insulin and post-load glucose), diabetes health beliefs (susceptibility, severity, benefits and barriers), knowledge and behaviour were measured for 16 men and 18 women with diabetes (age [SD]=57.7 [11.6]). Eighteen months later, HbA1c and behaviour were measured for all participants, and health beliefs obtained for 17 of them. Perceived severity and perceived barriers were related to glycemic status at baseline and follow up, and predicted reduction in HbA1c (b[SE] |0.40| [0.18], p <0.05). The results support a therapeutic emphasis on belief in the severity of diabetes complications, and the complementary belief that barriers to therapeutic behaviour can be overcome in efforts to support Aboriginal persons with diabetes to manage their disease. The empirical utility of the HBM in glycemic control was partially upheld.
Adult↗
Waist-to-hip ratio and adipose tissue distribution: contribution of subcutaneous adiposity.
The waist-to-hip ratio (WHR) reflects the relative distribution of adipose tissue in the human body. However, whether this is due to the musculoskeletal structures of the waist and hip or the overlying subcutaneous adipose tissue has been disputed. We measured waist and hip girths in 11 male and 11 female cadavers, aged 55-94 years, before and after complete removal of skin and subcutaneous adipose tissue. Girths measured following removal of subcutaneous adipose tissue were termed "waist gx" and "hip gx", and their ratio "WHRx". Masses of regional adipose tissue segments were obtained by complete dissection, and the adipose mass ratios "trunk/arm-plus-leg", "trunk/leg", "internal/arm-plus-leg", and "internal/leg" were derived. As assessed by analysis of variance, WHR accounted for significant (P < 0.05) portions of the variance in all adipose mass ratios; adjustment for internal adipose mass increased the significance of all these relationships (P < 0.005). The ratio WHRx was not related to any ratio of regional adipose masses. Waist girth was related to trunk (P < 0.001) and internal (P < 0.05) adipose masses, and hip girth was related to arm-plus-leg adipose mass (P < 0.0001) and leg adipose mass (P < 0.0001), but waist gx and hip gx were not related to dependent variables. The results indicate that the ability of WHR and waist and hip girths to reflect the regional distribution of adipose tissue in the body is dependent upon the subcutaneous adipose tissue mass of the waist hip area, not its musculoskeletal constituency.
Adipose Tissue↗
After Hurricane Floyd passed: investigating the social determinants of disaster preparedness and recovery.
In September 1999, Hurricane Floyd struck eastern North Carolina. Investigators from the health promotion study "Health Works for Women/Health Works in the Community" responded by initiating a focused research study, "Health Works After the Flood." Participatory research involving a multilevel design and qualitative methods was applied to investigate how community preparedness, response, and recovery are affected by social factors such as social capital, social cohesion, and collective efficacy. This article presents evidence from qualitative research conducted for "Health Works After the Flood" and links these findings to observations regarding current conceptualizations of social capital and related concepts.
Community Networks↗
Cigarette smoking, mental health and social support: data from a northwestern First Nation.
BACKGROUND: The prevalence of smoking is high in many Aboriginal Canadian communities; rates of 50% are not uncommon. Aboriginal Canadians suffer a severe burden of smoking-related disease. Research in other populations has linked depression and smoking. It is not known whether mental health or affective measures are related to smoking for any of Canada's First Nations, and this study sought to answer this question. Understanding relations between affect and smoking behaviour is requisite to mounting anti-smoking interventions. METHODS: Smoking status and psychosocial measures including depression, mastery, affect balance and social support were obtained in a community-based chronic disease survey for a rural Interior Salishan First Nation in British Columbia (Plateau area). Persons surveyed were on-reserve residents (n=187), overweight (body mass index > or = 25 kg/m2), with mean age of 44.1 years (standard deviation 15.0). RESULTS: The prevalence of smoking was 48.1%. Adjusted for age, sex and body mass index, smokers relative to nonsmokers had higher (p<0.010) depression (mean 21.3 [CI 95%, 19.1-23.4] vs. 16.1 [14.1-18.0]) and negative affect (18.6 [14.9-22.3] vs. 11.0 [7.6-14.4]), and lower mastery (36.4 [35.5-37.3] vs. 38.1 [37.2-38.9]). A positive relationship between mastery and social support was greater for nonsmokers (p=0.046). CONCLUSION: Depression and negative affect are associated with smoking among overweight persons in a rural First Nation in British Columbia. Furthermore, smoking is inversely related to mastery, and this relation varies with social support. Longitudinal study is required to determine whether smoking influences mental health and mastery, or the reverse.
Adolescent↗
Advancing the population health agenda: encouraging the integration of social theory into population health research and practice.
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California↗