I am a Post-doctoral Research Fellow at University of Technology, Sydney, with expertise in aged care, public health, nursing, nutrition epidemiology, health policy, health service, chronic disease prevention and biostatistics. I am award 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.
My PhD project titled ‘Dietary intake, diet quality, dietary pattern and Nutrition-Related Non-Communicable Diseases (NR-NCDs) among older Chinese population’, was designed to improve people’s diet in the prevention of NR-NCDs. This project is significant as it fills the knowledge gap on diet and nutrition status in the older population. The project results have been produced a ‘Policy brief’ which proposed policy recommendations for the Chinese Nutrition Society.
I have been working on numbers of projects include the ARC Linkage-funded project entitled “Fit for Future: Safeguarding the health & well-being of the NSW nursing & midwifery workforce”, and NHMRC Partnership Project-funded study of health service use and clinical outcomes of people with Type 1 diabetes. I have also contributed to various government and non-government report, such as: United Nations, Department of Economic and Social Affairs; World Health Organization and Chinese Center for Disease Control and Prevention.
- Australian Association of Gerontology (AAG)
- The Cardiac Society of Australia and New Zealand (CSANZ)
- AAG Culturally and Linguistically Diverse (CALD) Special interest grounp
- AAG Student and Early Career Professional Development and Events group
Scholarships and awards
- PhD scholarship, University of Newcastle, Australia (2013-2016): International Postgraduate Research Scholarship (UNIPRS), and Research Scholarship Central (UNRSC); $ 26, 682 per year;
- Research Training Scheme, University of Newcastle, Australia (2013-2016): $3,000 per year;
- RHD Thesis Submission Initiative, University of Newcastle, Australia (2016): $1,000;
- Center of Excellence in Population Ageing Research, University of New South Wales (2014): Travel Grant $1,500;
- Natural Science Grants of Anhui, China (2012- 2013): 50,000 RMB;
- Master of Science in Advanced Nursing Studies in University of Bedfordshire, UK (2010-2011): Scholarship for postgraduate academic excellence;
- Bachelor degree of Clinic Nursing, Bengbu Medical College, China (2006-2009): Award First Class Scholarship for academic excellence.
Can supervise: YES
Aged care, Public health, Nursing, Nutrition epidemiology, Health policy, Health service, Chronic disease prevention and Biostatistics.
Nutitional assessment in aged care
Public Health Implications of an Ageing Population
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.View/Download from: Publisher's site
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: UTS OPUS or 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.
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: UTS OPUS or 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, 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: UTS OPUS or 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.
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: UTS OPUS or 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.
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: UTS OPUS or 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.
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: UTS OPUS or 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.
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: UTS OPUS or 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: UTS OPUS or 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.
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: UTS OPUS or Publisher's site
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
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: UTS OPUS or 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: UTS OPUS or 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.
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: UTS OPUS or Publisher's site
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
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: UTS OPUS or Publisher's site
Xu, X, Hall, J, Byles, J & Shi, Z 2015, 'Assessing Dietary Quality of Older Chinese People Using the Chinese Diet Balance Index (DBI)', PLOS ONE, vol. 10, no. 3.View/Download from: UTS OPUS or 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 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?'.