Dr Xu is a Research Fellow at University of Technology, Sydney, with expertise in aged care, public health, nutrition epidemiology, chronic disease prevention and biostatistics. Dr Xu has nursing degree in China (2009), Masters by research of advanced nursing study in the United Kingdom (2011), Masters of Public Health (2012) and PhD (2016) at the University of Newcastle, Australia.
Dr Xu is an executive member of NSW, Australian Association of Gerontology (AAG), a member of the 2019 AAG Conference planning committee, a member of the 2019 Emerging Researchers in Ageing (ERA) Conference planning committee; and an ECR representative on the UTS Faculty of Health Research Committee. Dr Xu is also an affiliate member of Cardiovascular Society of Australia and New Zealand (CSANZ), an executive member of the CSANZ Cardiovascular Nursing Council, and active in the NSW Cardiovascular Research Network's Rising Stars Network for Early and Mid-Career Researchers.
Dr Xu has attracted $401,000 of research funding through a combination of funders including: The National Heart Foundation fellowship, Uniting, University of Technology Sydney, University of Newcastle and SPHERE - Age and Ageing Clinical Academic Group. Dr Xu has been working on numbers of projects include the ARC Linkage-funded project and NHMRC Partnership Project-funded projects. Dr Xu has also contributed to various government and non-government report, such as: United Nations, Department of Economic and Social Affairs; World Health Organization, Chinese Center for Disease Control and Prevention and Uniting.
- Australian Association of Gerontology (AAG)
- Cardiac Society of Australia and New Zealand (CSANZ)
- Heart Foundation NSW Cardiovascular Research Network (CVRN)
- CVRN early and mid-career researchers’ network
- CSANZ Cardiovascular Nursing Council Executive
- 2019 AAG National Conference Planning Committee
- 2019 Emerging Researchers in Ageing National Conference Planning Committee
- UTS Faculty of Health Research Committee
- AAG NSW Executive
- AAG Student and Early Career Professional Development and Events Committee
- AAG Culturally and Linguistically Diverse Special interest group
Can supervise: YES
Chronic disease prevention and management
Nutitional assessment in aged care
Public Health Implications of an Ageing Population
Cao, Y, Xu, X & Shi, Z 2020, 'Trajectories of Dietary Patterns, Sleep Duration, and Body Mass Index in China: A Population-Based Longitudinal Study from China Nutrition and Health Survey, 1991-2009.', Nutrients, vol. 12, no. 8.View/Download from: Publisher's site
No study has used trajectories of dietary patterns to examine their effects on sleep duration and body mass index over time in the Chinese population. We analyzed data from adults participating in the China Health and Nutrition Survey between 1991 and 2009. Dietary intake was measured by a 24-h recall method over three consecutive days. Height and body weight were measured, and sleep duration was self-reported. Multivariable mixed linear models were applied to examine the association between trajectories of dietary patterns (using a latent class model) and sleep duration as well as BMI. Four trajectories of a traditional pattern (characterized by rice, meat, and vegetables) and three trajectories of a modern pattern (characterized by fast food, milk, and deep-fried food) were identified. Participants with a high and rapid increase trajectory of the modern dietary pattern had the shortest sleep duration (β = -0.26; 95% CI: -0.40, -0.13). Participants with a high and stable intake of the traditional dietary pattern had the lowest BMI (β = -1.14; 95% CI: -1.41, -0.87), while the participants with a high and rapid increase trajectory of the modern dietary pattern had the highest BMI (β = 0.74; 95% CI: 0.34, 1,15). A rapid increase in the modern dietary pattern is associated with shorter sleep duration and higher BMI.
Li, X, Zhou, Y & Xu, X 2020, 'Factors associated with the psychological well-being among front-line nurses exposed to COVID-2019 in China: A predictive study.', Journal of nursing management.View/Download from: Publisher's site
AIMS:To evaluate psychological well-being and factors associated to posttraumatic stress disorder (PTSD) among front-line nurses during the COVID-19 pandemic. BACKGROUND:Coronavirus disease-2019 (COVID-19) is a pandemic that has posed a public health emergency of international concern. Psychological well-being of front-line nurses is a big concern during the COVID-19 pandemic. METHODS:With a predictive study design, a same survey was sent separately at two time points (i.e. before and after nurses worked at COVID-19 units) between January and March 2020 among 356 front-line nurses in First Affiliated Hospital of Bengbu Medical College, Anhui, China. RESULTS:Of a total 356 front-line nurses, stress level and the prevalence of PTSD were significantly increased after they worked at COVID-19 units. Nurses who had work experience less than 2 years was significantly associated with a high risk of developing PTSD. Nurses who worked in COVID-19 inpatients wards had significantly higher odds of being PTSD (Odds Ratio [OR]=21.9, 95% Confidence Interval [CI]: 5.08; 94.5) than those who worked in other COVID-19 related units. Resilience was negatively associated with PTSD (OR=0.96, 95% CI: 0.93; 0.99). CONCLUSION:Nurses had significantly increased risk to develop PTSD during COVID-19 pandemic. IMPLICATIONS FOR NURSING MANAGEMENT:Clinical and policy strategies to support front-line nurses' psychological well-being, particularly young nurses, in response to COVID-19 crisis are urgently needed.
Perry, L, Dunbabin, J, Xu, X, Lowe, J, Acharya, S, James, S & Steinbeck, KS 2020, 'Service use of young people with Type 1 diabetes after transition from paediatric to adult-based diabetes health care.', Australian health review : a publication of the Australian Hospital Association, vol. 44, no. 4, pp. 601-608.View/Download from: Publisher's site
Objective The aim of this study was to determine, in the first 2 years after the last planned appointment with paediatric diabetes services for young people with Type 1 diabetes (T1D): (1) the number of planned and unplanned healthcare contacts and HbA1c measurements made; (2) factors linked to diabetes-related service use; and (3) factors predictive of the number of planned and unplanned service contacts, and of meeting the minimum number of planned service contacts. Methods Healthcare records of a major public healthcare provider in Australia were audited for preventive and acute service use by young people with T1D transferring from paediatric to adult public healthcare services. Statistical analyses included use of t-tests and logistic regression modelling. Results Of 172 young people with T1D, 21% had no planned specialist care and 49% accessed acute services for diabetes-related matters. Residents of metropolitan areas and users of continuous subcutaneous insulin infusion therapy were more likely to access specialist care and were less likely to use acute services for unplanned care. Those achieving a minimum of nine planned care contacts in 2 years had a shorter duration between the last paediatric and first adult healthcare contact. Conclusions Lack of specialist care in early adult years and non-metropolitan relative disadvantage compromise the present and future health of young people with diabetes. What is known about the topic? Well-managed transition is thought to offer the best chance of achieving cost-effective continuing engagement with specialist services for planned preventive care, effective T1D self-management and deferral or early attention to diabetes-related vascular complications. However, transition is commonly reported as problematic. What does this paper add? The findings of this study indicate a positive trend but continuing need to improve transition care for young people with T1D, especially those living in non-metropolitan areas and...
Li, J, Xu, X, Jiang, Y, Hansbro, NG, Hansbro, PM, Xu, J & Liu, G 2020, 'Elastin is a key factor of tumor development in colorectal cancer.', BMC cancer, vol. 20, no. 1.View/Download from: Publisher's site
BACKGROUND:Colorectal cancer (CRC) is the most common cancer and a leading cause of death worldwide. Extracellular matrix (ECM) proteins regulate tumor growth and development in CRC. Elastin (ELN) is a component of ECM proteins involved in the tumor microenvironment. However, the role of ELN in CRC remains unclear. METHODS:In this study, we analyzed ELN gene expression in tumors from CRC patients and adjacent non-tumor colon tissues and healthy controls from two existing microarray datasets. ELN protein was measured in human normal colon cells and colon cancer epithelial cells and tumor development was assessed in colon epithelial cells cultured in medium with or without ELN peptide on plates coated with ELN recombinant protein. Control plates were coated with PBS only. RESULTS:We found ELN gene expression was increased in tumors from CRC patients compared to adjacent non-tumor tissues and healthy controls. ELN protein was increased in cancer cells compared to normal colon epithelial cells. Transforming growth factor beta (TGF-β) was a key cytokine to induce production of ECM proteins, but it did not induce ELN expression in colon cancer cells. Matrix metalloproteinase 9 (MMP9) gene expression was increased, but that of MMP12 (elastase) did not change between CRC patients and control. Tissue inhibitor of metalloproteinases 3 (TIMP3) gene expression was decreased in colon tissues from CRC patients compared to healthy controls. However, MMP9, MMP12 and TIMP3 proteins were increased in colon cancer cells. ELN recombinant protein increased proliferation and wound healing in colon cancer epithelial cells. This had further increased in cancer cells incubated in plates coated with recombinant ELN coated plate and in culture media containing ELN peptide. A potential mechanism was that ELN induced epithelial mesenchymal transition with increased alpha-smooth muscle actin and vimentin proteins but decreased E-cadherin protein. Tumor necrosis factor alpha (TNF) mRNA was als...
Xu, J, Xu, X, Jiang, L, Dua, K, Hansbro, PM & Liu, G 2020, 'SARS-CoV-2 induces transcriptional signatures in human lung epithelial cells that promote lung fibrosis.', Respiratory research, vol. 21, no. 1.View/Download from: Publisher's site
BACKGROUND:Severe acute respiratory syndrome (SARS)-CoV-2-induced coronavirus disease-2019 (COVID-19) is a pandemic disease that affects > 2.8 million people worldwide, with numbers increasing dramatically daily. However, there is no specific treatment for COVID-19 and much remains unknown about this disease. Angiotensin-converting enzyme (ACE)2 is a cellular receptor of SARS-CoV-2. It is cleaved by type II transmembrane serine protease (TMPRSS)2 and disintegrin and metallopeptidase domain (ADAM)17 to assist viral entry into host cells. Clinically, SARS-CoV-2 infection may result in acute lung injury and lung fibrosis, but the underlying mechanisms of COVID-19 induced lung fibrosis are not fully understood. METHODS:The networks of ACE2 and its interacting molecules were identified using bioinformatic methods. Their gene and protein expressions were measured in human epithelial cells after 24 h SARS-CoV-2 infection, or in existing datasets of lung fibrosis patients. RESULTS:We confirmed the binding of SARS-CoV-2 and ACE2 by bioinformatic analysis. TMPRSS2, ADAM17, tissue inhibitor of metalloproteinase (TIMP)3, angiotensinogen (AGT), transformation growth factor beta (TGFB1), connective tissue growth factor (CTGF), vascular endothelial growth factor (VEGF) A and fibronectin (FN) were interacted with ACE2, and the mRNA and protein of these molecules were expressed in lung epithelial cells. SARS-CoV-2 infection increased ACE2, TGFB1, CTGF and FN1 mRNA that were drivers of lung fibrosis. These changes were also found in lung tissues from lung fibrosis patients. CONCLUSIONS:Therefore, SARS-CoV-2 binds with ACE2 and activates fibrosis-related genes and processes to induce lung fibrosis.
Allida, S, Du, H, Xu, X, Prichard, R, Chang, S, Hickman, LD, Davidson, PM & Inglis, SC 2020, 'mHealth education interventions in heart failure.', The Cochrane database of systematic reviews, no. 7.View/Download from: Publisher's site
BACKGROUND:Heart failure (HF) is a chronic disease with significant impact on quality of life and presents many challenges to those diagnosed with the condition, due to a seemingly complex daily regimen of self-care which includes medications, monitoring of weight and symptoms, identification of signs of deterioration and follow-up and interaction with multiple healthcare services. Education is vital for understanding the importance of this regimen, and adhering to it. Traditionally, education has been provided to people with heart failure in a face-to-face manner, either in a community or a hospital setting, using paper-based materials or video/DVD presentations. In an age of rapidly-evolving technology and uptake of smartphones and tablet devices, mHealth-based technology (defined by the World Health Organization as mobile and wireless technologies to achieve health objectives) is an innovative way to provide health education which has the benefit of being able to reach people who are unable or unwilling to access traditional heart failure education programmes and services. OBJECTIVES:To systematically review and quantify the potential benefits and harms of mHealth-delivered education for people with heart failure. SEARCH METHODS:We performed an extensive search of bibliographic databases and registries (CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, IEEE Xplore, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform (ICTRP) Search Portal), using terms to identify HF, education and mHealth. We searched all databases from their inception to October 2019 and imposed no restriction on language of publication. SELECTION CRITERIA:We included studies if they were conducted as a randomised controlled trial (RCT), involving adults (≥ 18 years) with a diagnosis of HF. We included trials comparing mHealth-delivered education such as internet and web-based education programmes for use on smartphones and tablets (including apps) and other mobile devices, S...
Inglis, SC, Naismith, C, White, K, Hendriks, JM, Bray, J, Hickman, LD, Aldridge, C, Bardsley, K, Cameron, J, Candelaria, D, Cartledge, S, Du, H, Ferguson, C, Martin, L, Selkow, T, Xu, X, Wynne, R, Driscoll, A, Gallagher, R, Clark, R & Davidson, PM 2020, 'CSANZ COVID-19 Cardiovascular Nursing Care Consensus Statement: Executive Summary', Heart Lung and Circulation.View/Download from: Publisher's site
Xu, X, Ling, M, Inglis, SC, Hickman, L & Parker, D 2020, 'Eating and healthy ageing: a longitudinal study on the association between food consumption, memory loss and its comorbidities.', International journal of public health, vol. 65, no. 5, pp. 571-582.View/Download from: Publisher's site
OBJECTIVES:To explore the longitudinal association between food groups and memory loss and comorbid heart disease and diabetes (both Type 1 and 2) for people living in New South Wales, Australia. METHODS:We assessed 139,096 adults (aged 45 years and over) from the 45 and Up Study who completed both baseline (2006-2009) and follow-up (2012-2015) surveys. Mixed linear and generalized estimating equation models were used to examine the longitudinal associations. RESULTS:High consumption of fruit, vegetable and protein-rich food associated with lower odds of memory loss. High consumption of fruit and vegetables also associated with lower odds of comorbid heart disease (p ≤ 0.001). People who aged ≥ 80 years with low consumption of cereals had the highest odds of memory loss and comorbid heart disease than people in other age groups (p < 0.01). CONCLUSIONS:The results highlighted the longitudinal association of fruit and vegetable in relation to memory loss and comorbid heart disease. Age effects on cereals consumption which have an influence on memory loss and comorbid heart disease.
Hosie, A, Kochovska, S, Ries, N, Gilmore, I, Parker, D, Sinclair, C, Sheehan, C, Collier, A, Caplan, GA, Visser, M, Xu, X, Lobb, E, Sheahan, L, Brown, L, Lee, W, Sanderson, CR, Amgarth-Duff, I, Green, A, Edwards, L & Agar, MR 2020, 'Older Persons' and Their Caregivers' Perspectives and Experiences of Research Participation With Impaired Decision-Making Capacity: A Scoping Review.', The Gerontologist.View/Download from: Publisher's site
BACKGROUND AND OBJECTIVES:Human research ethics statements support equitable inclusion of diverse groups. Yet older people are under-represented in clinical research, especially those with impaired decision-making capacity. The aim of this study was to identify perspectives and experiences of older persons and their caregivers of research participation with impaired decision-making capacity. RESEARCH DESIGN AND METHODS:Scoping review of literature and online sources in January-February 2019 (updated June 2020) according to Joanna Briggs Institute methodology and PRISMA Extension for Scoping Reviews. English-language peer-reviewed research articles and Australian online narratives were included. Data were tabulated and narratively synthesized. RESULTS:From 4171 database records and 93 online resources, 22 articles (2000-2019, 82% United States, 16 first authors) and one YouTube webinar (2018) were initially included; updated searches yielded an additional article (2020) and YouTube webinar (2020). Studies were heterogeneous in terminology, methods and foci, with hypothetical scenarios, quantitative analyses and examination of proxy consent predominating. Participants (n=7331) were older persons (71%), caregivers of older persons with dementia/cognitive impairment (23%) and older persons with dementia/cognitive impairment (6%). Synthesis identified two themes: willingness to participate and decision-making approaches. DISCUSSION AND IMPLICATIONS:Research participation by older persons with dementia may be optimized through reducing risks and burdens and increasing benefits for participants, greater consumer input into study development, and shared and supported decision-making. Older persons' and caregivers' perspectives and experiences of research participation with impaired decision-making capacity require investigation in a greater range of countries and conditions other than dementia, and dissemination through more varied media.
Li, J, Shao, D, Xu, X, Zhang, Y, Jiang, Y & Hall, J 2019, 'Cognitive behavior stress management during pregnancy: a randomized controlled trial.', Contemporary nurse, vol. 55, no. 6, pp. 543-553.View/Download from: Publisher's site
BACKGROUND:Pregnancy stress could lead to adverse health outcomes for both mother and child. Few studies have explored the effectiveness of stress management strategy among pregnant women. OBJECTIVES/AIMS/HYPOTHESES:To examine the effectiveness of cognitive-behavioral stress management for pregnant women. DESIGN:Randomized Controlled Trial. METHODS:100 pregnant women (at 6-8 week of pregnancy) were selected by convenience sampling. Participants in the control group (N = 50) received routine prenatal examination and health education, while those in the intervention group (N = 50) received cognitive-behavioral stress management. Pregnancy Pressure Scale was measured at baseline and 39th weeks of pregnancy. RESULTS:Pregnancy Pressure Scale score increased in both intervention and control groups. However, the score in the intervention group was significantly lower than those in the control group (p < 0.01). CONCLUSIONS:Cognitive-behavioral stress managment can effectively reduce pregnant women's stress levels. IMPACT STATEMENT:Nurses and midwives should conduct cognitive-behavioral stress management to help pregnant women reduce their stress.
INTRODUCTION:High iron intake has been shown to be associated with poor cognition. We aimed to examine the association between iron-related dietary pattern (IDP) and cognitive function in Chinese adults. METHOD:Longitudinal study data from the China Health and Nutrition Survey (CHNS) during 1991-2006 were used (N = 4852, ≥55 years old). Dietary intake was obtained from a 3-day food record during home visits. Reduced rank regression was used to construct IDP with iron intake as a response variable. Cognitive function was assessed in 1997, 2000, 2004 and 2006. Multivariable mixed linear regression and logistic regression were used in the analyses. RESULTS:IDP was characterised by high intake of fresh vegetable, wheat, legume, beverage, offal, rice and whole grain. High IDP intake was associated with poor cognition. In fully adjusted models, across the quartiles of IDP, the odds ratio (95% CI) for poor cognitive function were: 1.00, 1.06 (0.86-1.30), 1.24 (0.99-1.54), and 1.50 (1.17-1.93), respectively. There was a borderline significant interaction between IDP and meat intake (p interaction 0.085). The association between high IDP and poor cognition was only observed among those with no or low intake of meat. With the adjustment of carbohydrate or iron intake, the IDP and cognition association became non-significant. IDP was positively associated with lead intake. The association between IDP and poor cognition was partly mediated by lead intake. CONCLUSIONS:Iron-related dietary pattern is associated with poor cognition in Chinese adults, partly due to high intake of carbohydrate, iron and lead.
Zhang, M, Lin, L, Xu, X, Wu, X, Jin, Q & Liu, H 2019, 'Noninvasive screening tool to detect undiagnosed diabetes among young and middle-aged people in Chinese community', International Journal of Diabetes in Developing Countries, vol. 39, no. 3, pp. 458-462.View/Download from: Publisher's site
Zhu, N, Xu, P, Ma, J, Liang, Y, Xu, X & Li, J 2019, 'Patients, caregivers and nurses' attitudes toward patients' participation in knee and hip joint replacement pain management: a Q-methodology study.', Contemporary nurse, vol. 55, no. 6, pp. 507-521.View/Download from: Publisher's site
Background: Patients are often not actively involved in their acute pain management.Objectives: To understand the attitudes of patients, family caregivers and nurses to patient participation in pain management after their knee or hip joint replacement.Design: Q-methodological design.Methods: 45 participants were recruited, included 15 patients, 15 caregivers and 15 nurses. Forty-nine statements were rank-ordered in a Q-sort table.Results: Four factors which explained 65% of the variance were identified from factor analysis. They are named "Endurers", "Supporters", "Worriers" ,and "Wabblers".Conclusion: Each group have a significant knowledge deficit in pain management. Patients and caregivers were more likely to have a passive attitude and false cognition towards pain and analgesic drugs. Nurses often play a role as a supporter, however, it is hard for them to understand their important role in facilitating patient involvement in their pain management.
Xu, X, Parker, D, Inglis, SC & Byles, J 2019, 'Can regular long-term breakfast cereals consumption benefits lower cardiovascular diseases and diabetes risk? A longitudinal population-based study.', Annals of Epidemiology, vol. 37, pp. 43-50.e3.View/Download from: Publisher's site
PURPOSE:Studies indicate breakfast cereals may reduce the risk of overweight, cardiovascular diseases, and diabetes, but a limited number of longitudinal studies have explored these relationships, indicating the need for further assessment. METHODS:We used 45 and Up Study data to examine the longitudinal association between breakfast cereals (and different categories of cereals) and heart disease, stroke, and diabetes. Dietary consumption was assessed by a short food frequency questionnaire. Diagnosed heart disease, stroke, and diabetes were self-reported. Generalized estimating equation models were used to examine the longitudinal associations. RESULTS:Of a total of 142,503 participants (aged 45 years and older), people in the older age group (aged 80 or older) had significantly higher breakfast cereal consumption (P < .001) than those in the younger age group (aged 45-64 years). A significantly inverse association was found between breakfast muesli and heart disease, stroke, and diabetes across all age groups. Associations between other categories of breakfast cereals (biscuit, bran, and oat cereals) and these three diseases differed by age groups. A positive association was found between oat cereals and diabetes for people in the younger age groups (aged 80 years and younger), but not for people in the older age group (aged 80 years and older). CONCLUSIONS:The benefit of breakfast muesli consumption was highlighted in prevention of these three diseases. The result suggests that age-specific dietary guidelines, with a particular focus on the types of breakfast cereals consumption in prevention of chronic diseases for older people need to be developed.
Liu, H, Hall, JJ, Xu, X, Mishra, GD & Byles, JE 2018, 'Differences in food and nutrient intakes between Australian- and Asian-born women living in Australia: Results from the Australian Longitudinal Study on Women's Health.', Nutrition & dietetics: the journal of the Dietitians Association of Australia, vol. 75, no. 2, pp. 142-150.View/Download from: Publisher's site
To determine differences in food and nutrient intakes between Australian- and Asian-born women living in Australia.Data were obtained from the Australian Longitudinal Study on Women's Health, including 6461 women born in Australia or Asia who completed food frequency questionnaires in 2001 and 2013. Diet was assessed using the Dietary Questionnaire for Epidemiological Studies version 2. Longitudinal generalised estimating-equation modelling was performed to determine the effect of country of birth and survey year on fruit and vegetable intake.Asian-born women ate more cereals, soybeans and fish but less vegetables, legumes, dairy, meat and meat products than Australian-born women both in 2001 and in 2013. Asian-born women ate less cereals, rice and noodles, meat and its products (P < 0.05) in 2013 than in 2001. The earlier people came to Australia, the less their rice and noodle intake per day. However, the reverse was demonstrated regarding vegetable intake. Asian-born women had a lower daily intake of fat, calcium, zinc, thiamin, riboflavin, folate and retinol compared with those born in Australia.Asian-born women living in Australia show different food and nutrient intakes from Australian-born women, although their diets tend to deviate from typical Asian characteristics and approach a Western diet.
Nyongesa, C, Xu, X, Hall, J, Macharia, W, Yego, F & Hall, B 2018, 'Factors influencing choice of skilled attendance at delivery: evidence from the Kenya Demographic Health Survey.', BMC Pregnancy and Childbirth, vol. 18, pp. 1-6.View/Download from: Publisher's site
In Kenya, skilled attendance at delivery is well below the international target of 90% and the maternal mortality ratio is high at 362 (CI 254–471) per 100,000 live births despite various interventions. The preventative role of skilled attendance at delivery makes it a benchmark indicator for safe motherhood.
Maternal health data from the Service Provision Assessment Survey, a subset of the 2010 Kenya Demographic Health Survey was analyzed. Logistic regression models were employed using likelihood ratio test to explore association between choice of skilled attendance and predictor variables.
Overall, 94.8% of women are likely to seek skilled attendance at delivery. Cost, education level, number of antenatal visits and sex of provider were strongly associated with client's intention to deliver with a skilled birth attendant at delivery. Women who reported having enough money set aside for delivery were 4.34 (p < 0.002, 95% CI: 1.73; 10.87) times more likely to seek skilled attendance. Those with primary education and above were 6.6 times more likely to seek skilled attendance than those with no formal education (p < 0.001, 95% CI: 3.66; 11.95). Women with four or more antenatal visits were 5.95 (p < 0.018, 95% CI: 1.35; 26.18) times more likely to seek skilled attendance. Compared to men, female providers impacted more on the client's plan (OR = 2.02 (p < 0.014, 95% CI: 1.35; 3.53).
Interventions aimed at improving skilled attendance at delivery should include promotion of formal education of women and financial preparation for delivery. Whenever circumstances permit, women should be allowed to choose gender of preferred professional attendant at delivery.
Xu, X, Byles, JE, Shi, Z & Hall, JJ 2018, 'Dietary patterns, dietary lead exposure and hypertension in the older Chinese population', Asia Pacific Journal of Clinical Nutrition, vol. 27, no. 2, pp. 451-459.View/Download from: Publisher's site
Background and Objectives: With rapid population ageing and an increasing rate of hypertension in China, this study aims to examine the association between dietary patterns, dietary lead and hypertension among older Chinese population. Methods and Study Design: We analysed the 2009 China Health and Nutrition Survey data (2,634 individuals with dietary and hypertension measurement data, aged ≥60 years). Dietary data were obtained using 24 hour-recall over three consecutive days. Dietary lead intake is based on a published systematic review of food lead concentration and dietary lead exposure in China. Factor analysis was used to identify dietary patterns. Poisson regression and multinomial logistic regression models were used to explore the association between dietary patterns and hypertension. Results: The prevalence of hypertension was 47.0% in men and 48.9% in women. Traditional dietary pattern (high intake of rice, pork and vegetables) was significantly inversely associated with known hypertension. In the fully adjusted model, compared with the lowest quartile of traditional dietary pattern, the highest quartile had a lower risk of known hypertension, with Relative Risk Ratio=0.69 (95% CI: 0.50; 0.95). However, associations between modern dietary pattern and hypertension differed by urbanization; an inverse, positive and null association was seen in low, medium and high urbanization. Additionally, dietary lead showed a significant positive association with hypertension and known hypertension. Conclusions: Policies that facilitate and promote healthy diets, and the availability of healthy foods particularly at the regional and local levels, are important for the prevention of hypertension.
Yang, L, Jiang, Y, Xu, S, Bao, L, Parker, D, Xu, X & Li, J 2018, 'Evaluation of frailty status among older people living in urban communities by Edmonton Frail Scale in Wuhu, China: a cross-sectional study.', Contemporary nurse, vol. 54, no. 6, pp. 630-639.View/Download from: Publisher's site
BACKGROUND:Few studies have explored the factors that are associated with frailty among older people. OBJECTIVE:To investigate the frailty status and examine the sociodemographic factors that are associated with of older peoples' frailty status in China. DESIGN:Cross-sectional study. METHODS:We used convenience sampling to recruit the participants (aged 60 and above) from four communities in an urban area of Wuhu, Anhui, China. Participants completed a questionnaire which included the Edmonton Frail Scale (EFS) and sociodemographic factorsWe used convenience sampling to recruit the participants (aged 60 and above) from four communities in an urban area of Wuhu, Anhui, China. Participants completed a questionnaire which included the Edmonton Frail Scale (EFS) and sociodemographic factors. RESULTS:Of 306 participants, the percentage of participants with a robust score (0-4) on the EFS was 71.9%, 14.1% had an apparently vulnerable score (5-6), and 14.0% had a frail score (7-17). Age, chronic disease status and marital status were significantly associated with frailty. CONCLUSIONS:There are a high percentage of frail older Chinese adults in the urban area. The present study findings could provide better understanding of the factors associated with frailty status of this population.
Perry, L, Xu, X, Gallagher, R, Nicholls, R, Sibbritt, D & Duffield, C 2018, 'Lifestyle Health Behaviors of Nurses and Midwives: The 'Fit for the Future' Study.', International journal of environmental research and public health, vol. 15, no. 5.View/Download from: Publisher's site
Nurses and midwives (nurses) are the principle role models and health educators for the wider population. This study sought to identify the health-related behaviors of the nursing workforce of New South Wales (NSW), Australia, compared to contemporary recommendations for healthy living and to the Australian general population, matched by gender and age. An electronic cross-sectional survey delivered in 2014⁻2015 recruited 5041 nurses through the NSW Nurses and Midwives Association and professional networks. Validated health behavior measures were collected and compared to Australian National Health Survey data. Compared with younger nurses, older nurses reported greater adherence to fruit and vegetable guideline recommendations, but were more likely to be overweight or obese. Younger nurses (25⁻34 years) had the highest risk of harmful drinking. Compared with the Australian general population, slightly higher percentages of nurses met dietary recommendations and slightly fewer were obese, had central adiposity or smoked. Nurses had lower physical activity levels and higher levels of risky drinking across most gender and age groups. Many nurses have lifestyle health behaviors that place them at high risk for developing non-communicable diseases, sometimes at higher risk than the Australian population to whom they deliver health education. Health promotion strategies for nurses are urgently required.
Xu, X, Parker, D, Shi, Z, Byles, J, Hall, J & Hickman, L 2018, 'Dietary Pattern, Hypertension and Cognitive Function in an Older Population: 10-Year Longitudinal Survey', Frontiers in Public Health, vol. 6, no. 201, pp. 1-13.View/Download from: Publisher's site
Background: There is a paucity of studies that have explored the association between dietary pattern and cognitive function, and whether there is an interaction between dietary pattern and hypertension in relation to older people's cognitive functioning.
Methods: We analyzed data from the China Health and Nutrition (CHNS) survey. Dietary data have been collected since 1991, and cognitive function interview data were collected between 1997 and 2006. We analyzed ten years of data, including 4,847 participants with 10,658 observations (aged ≥55 years). Exploratory factor analysis was used to identify dietary patterns. Cognitive function measures include cognitive global scores and verbal memory scores. Linear mixed models were used to investigate the association between dietary patterns, hypertension and cognitive function.
Results: Three dietary patterns were identified by factor analysis, named "Traditional Chinese," "Protein-rich," and "Starch-rich" dietary pattern. A Protein-rich dietary pattern (high intake of milk, eggs and soymilk) was significantly associated with higher cognitive global scores and verbal memory scores, while the starch-rich dietary pattern (high intake of salted vegetable and legumes) was significantly associated with lower cognitive global and verbal memory scores. In addition, we found that participants with hypertension were independently associated with significant low cognitive function.
Conclusion: The study reinforces the importance of diet in preventing cognitive decline among the older population. Identification of older populations who had hypertension should be targeted in intervention studies to maintain their cognitive health.
Liu, H, Byles, JE, Xu, X, Zhang, M, Wu, X & Hall, JJ 2017, 'Evaluation of successful aging among older people in China: Results from China health and retirement longitudinal study', GERIATRICS & GERONTOLOGY INTERNATIONAL, vol. 17, no. 8, pp. 1183-1190.View/Download from: Publisher's site
Xu, X, Hall, J, Byles, J & Shi, Z 2017, 'Dietary pattern, serum magnesium, ferritin, C-reactive protein and anaemia among older people', CLINICAL NUTRITION, vol. 36, no. 2, pp. 444-451.View/Download from: Publisher's site
Blay, N, Roche, M, Duffield, C & Xu, X 2017, 'Intrahospital transfers and adverse patient outcomes: An analysis of administrative health data.', Journal of Clinical Nursing, vol. 26, no. 23-24, pp. 4927-4935.View/Download from: Publisher's site
To determine whether there was an association between intra-hospital transfers and adverse outcomes.Transfers between clinical units and between beds on the same unit are routine aspects of an episode of care in acute hospitals. The rate of these transfers per episode has increased in response to high occupancy levels, a decline in bed numbers, and increased demand for hospital services. The impact of the number of transfers between both wards and beds on patient outcomes is not widely explored.Retrospective cross sectional design using hospital administrative data.Data were extracted from existing hospital administrative datasets for one large metropolitan hospital for the financial year 2008-09 in Australia (n = 14,133). Descriptive analyses and logistic regression models were developed for each of 3 selected patient outcomes.Nearly one-tenth of patients (9.2%) experienced a fall with injury, 3.8% of surgical patients a wound infection and 0.1% a complication from medication errors. For each bed or ward transfer, the odds of falls and wound infections increased. Medication errors were not associated with either bed or ward moves.Hospitals should minimise the number of bed and ward transfers per episode of care in order to reduce the likelihood of adverse patient outcomes. Current bed management policies and practices should be evaluated and further refined to address this need. Additional strategies include improving coordination and communication during and after transfer.Nurses must consider the potential cost of intrahospital transfers on patients, length of stay and bed availability.
Dimitrelis, S, Perry, L, Gallagher, R, Duffield, C, Sibbritt, D, Nicholls, R & Xu, X 2017, 'Does nurses' role, health or symptoms influence their personal use of ingestible complementary and alternative medicines?', Complementary Therapies in Medicine, vol. 35, pp. 39-46.View/Download from: Publisher's site
To investigate the influence of work-related characteristics, health, health behaviours and symptoms on ingestible biologically-based Complementary and Alternative Medicine (CAM) use within the Australian nursing and midwifery workforce.CAM use is widespread worldwide, but there is little research into nurses' and midwives' personal use of ingestible CAM in Australia.An online survey in 2014-15 used validated instruments and items to examine use of ingestible biologically-based CAM (herbs, foods and vitamins, minerals, amino acids, enzymes and other supplements), and the health and work-related characteristics of 5041 nurses and midwives recruited through the New South Wales Nurses and Midwives Association and professional networks.A small proportion of nurses (6.8%) identified as personal CAM users. Most were female, older, worked in foundational roles (frontline Registered and Enrolled Nurses/Midwives) and used one CAM, most commonly a multivitamin, although Vitamin D, Fish Oil, Calcium and Glucosamine±Chondroitin were also common. In comparison to non-users, CAM users were less likely to take sick days or indulge in risky drinking, but more likely to be symptomatic (with stiff joints, bodily/joint pain, severe tiredness, allergies, indigestion/heartburn), diagnosed with osteoarthritis and to adhere to healthy diet recommendations.Findings showed a credible pattern of front line workers with physically demanding workloads that impact their physical health and are linked to frequent symptoms, using CAM treatments and achieving some success in being able to continue working and avoid sickness absence. Further investigation is warranted to protect and maintain the health of the nursing and midwifery workforce.
Nicholls, R, Perry, L, Gallagher, R, Duffield, C, Sibbritt, D & Xu, X 2017, 'The personal cancer screening behaviours of nurses and midwives.', Journal of Advanced Nursing, vol. 73, no. 6, pp. 1403-1420.View/Download from: Publisher's site
AIM: The aim of this study was to identify the personal cancer screening behaviours of nurses and midwives in New South Wales, Australia, and identify factors predictive of cancer screening uptake. BACKGROUND: The nursing workforce may have a higher risk for some cancers and is ageing. In Australia, more than 40% are over 50 years - an age where cancer incidence rises rapidly, but when screening may reduce cancer mortality. Nurses and midwives are important health role models for the population, but their engagement in cancer screening is unknown. DESIGN: A cross-sectional survey conducted in 2014-2015. METHODS: Data were obtained from the 'Fit for the Future' study on 5041 working nurses and midwives in New South Wales, Australia and analyses were conducted on subsets of age-eligible respondents. Demographic, geographical and occupational data were analysed in relation to population-based screening for breast, cervical and bowel cancers and opportunistic screening for prostate and skin cancer screening participation, in line with Australian recommendations. RESULTS: Nurses' and midwives' recent screening rates were higher than the Australian general population across relevant age groups. Compared with full-time nurses and midwives, part-time/casual/pool workers were significantly more likely to undertake cervical, breast and bowel screening. Compared with those working office hours, shift workers were significantly less likely to undertake breast and bowel screening, but more likely to undertake skin screening. CONCLUSIONS: Disparities in reported screening prevalence and factors predictive of screening uptake indicate opportunities for targeted strategies to inform and/or promote workforce engagement with screening programmes and protect the health of this ageing workforce.
Perry, L, Xu, X, Duffield, CM, Gallagher, R, Nicholls, R & Sibbritt, D 2017, 'Health, workforce characteristics, quality of life and intention to leave: The 'Fit for the Future' survey of Australian nurses and midwives', Journal of Advanced Nursing, vol. 73, no. 11, pp. 2745-2756.View/Download from: Publisher's site
To examine the quality of life of nurses and midwives in New South Wales, Australia and compare values with those of the Australian general population; to determine the influence of workforce, health and work life characteristics on quality of life and its effect on workforce intention to leave.
Few studies have examined nurses' and midwives' quality of life and little is known of its effects on workforce longevity.
This was a cross-sectional survey conducted in 2014-2015.
The "Fit for the Future" electronic survey, delivered to nurses and midwives, examined demographic, work and health-related factors, which were compared with Australian general population normative values for physical and mental components of quality of life (the Short Form-12). Univariate and multivariate logistic regression models assessed associations with workforce intention to leave.
Physical and mental component scores, calculated for 4,592 nurses and midwives, revealed significantly higher physical but lower mental component scores than the general population. Physical component scores decreased with increasing age; higher scores were seen in nurses with better health indices and behaviours. Mental well-being scores increased with increasing age; in nurses who reported job satisfaction, no work injury, sleep problems or frequent pain and non-smokers. The odds of intention to leave decreased with increasing mental well-being.
Managers and decision-makers should heed study recommendations to implement health promotion strategies for nurses and midwives, aiming to improve mental health, specifically to promote workforce retention.
Liu, H, Byles, JE, Xu, X, Zhang, M, Wu, X & Hall, JJ 2016, 'Association between nighttime sleep and successful aging among older Chinese people', SLEEP MEDICINE, vol. 22, pp. 18-24.View/Download from: Publisher's site
Liu, H, Xu, X, Hall, JJ, Wu, X & Zhang, M 2016, 'Differences in depression between unknown diabetes and known diabetes: results from China health and retirement longitudinal study', INTERNATIONAL PSYCHOGERIATRICS, vol. 28, no. 7, pp. 1191-1199.View/Download from: Publisher's site
Xu, X, Byles, J, Shi, Z, McElduff, P & Hall, J 2016, 'Dietary pattern transitions, and the associations with BMI, waist circumference, weight and hypertension in a 7-year follow-up among the older Chinese population: a longitudinal study', BMC PUBLIC HEALTH, vol. 16.View/Download from: Publisher's site
Xu, X, Byles, JE, Shi, Z & Hall, JJ 2015, 'Evaluation of older Chinese people's macronutrient intake status: results from the China Health and Nutrition Survey', BRITISH JOURNAL OF NUTRITION, vol. 113, no. 1, pp. 159-171.View/Download from: Publisher's site
Xu, X, Hall, J, Byles, J & Shi, Z 2015, 'Dietary Pattern Is Associated with Obesity in Older People in China: Data from China Health and Nutrition Survey (CHNS)', NUTRIENTS, vol. 7, no. 9, pp. 8170-8188.View/Download from: Publisher's site
Xu, X 2016, 'COPD RISK AND FRUIT/VEGETABLE CONSUMPTION AMONG OLDER CHINESE PEOPLE', GERONTOLOGIST, USA.
Xu, X 2016, 'Nurses' and midwives' diets: are they malnourished?', AuSPEN Annual Conference.
Xu, X & Byles, J, 'Dietary pattern – what is it and why does it matter?'.