Prevention of type 2 diabetes in a primary health care setting interim results from the Greater Green Triangle (GGT) Diabetes Prevention Project

Although clinical trials have shown that lifestyle modifications reduce the risk of type 2 diabetes, translating lessons from trials to primary care remains a challenge. The aim of the study was to evaluate efficacy and feasibility of primary care-based diabetes prevention model with modest resource requirements in rural Australia. Three hundred and eleven subjects with at least a moderate risk of type 2 diabetes participated in a combined dietary and physical activity intervention. Clinical measurements and fasting blood samples were taken at the baseline and after intervention. After 3 months intervention, total (change −3.5%, p < 0.001) and LDL cholesterol (−4.8%, p < 0.001) plasma levels as well as body mass index (−2.5%, p < 0.001), weight (−2.5%, p < 0.001), and waist (−1.6%, p < 0.001) and hip (−2.7%, p < 0.001) circumferences reduced significantly. A borderline reduction was found in triglyceride levels (−4.8%, p = 0.058) while no changes were observed in HDL cholesterol (+0.6%, p = 0.525), glucose (+0.06%, p = 0.386), or systolic (−0.98%, p = 0.095) or diastolic (−1.06%, p = 0.134) blood pressure levels. In conclusion, a lifestyle intervention improved health outcomes – especially obesity and blood lipids – in a population at high risk of developing type 2 diabetes. Our results suggest that the present model is effective and feasible to carry out in primary care settings.

Robustness in health research : do differences in health measures, techniques, and time frame matter?

Survey-based health research is in a boom phase following an increased amount of health spending in OECD countries and the interest in ageing. A general characteristic of survey-based health research is its diversity. Different studies are based on different health questions in different datasets; they use different statistical techniques; they differ in whether they approach health from an ordinal or cardinal perspective; and they differ in whether they measure short-term or long-term effects. The question in this paper is simple: do these differences matter for the findings? We investigate the effects of life-style choices (drinking, smoking, exercise) and income on six measures of health in the US Health and Retirement Study (HRS) between 1992 and 2002: (1) self-assessed general health status, (2) problems with undertaking daily tasks and chores, (3) mental health indicators, (4) BMI, (5) the presence of serious long-term health conditions, and (6) mortality. We compare ordinal models with cardinal models; we compare models with fixed effects to models without fixed-effects; and we compare short-term effects to long-term effects. We find considerable variation in the impact of different determinants on our chosen health outcome measures; we find that it matters whether ordinality or cardinality is assumed; we find substantial differences between estimates that account for fixed effects versus those that do not; and we find that short-run and long-run effects differ greatly. All this implies that health is an even more complicated notion than hitherto thought, defying generalizations from one measure to the others or one methodology to another.

Differences within and between travel preference, planned travel and choice behavior of Australians traveling to Asian and oversea destinations

This study seeks to examine differences in travel preference, travel intention and destination choice behavior of an aggregated set of Australian travelers. Additionally the study seeks to relate income, age, gender, life cycle and life style of Australians to the preference, planning and choice of Asian and overseas destinations. A large representative sample of 49,000 Australian respondents is utilized. Binomial regression is used to profile travelers to Asia and overseas in general. Specific significant variables and differences are highlighted. There are consistent relationships between travel preference, planning and choice and the set of independent variables of income, life cycle and life style. Age nor gender are not consistently related to travel planning or travel choice. It is apparent that a combination of demographics, e.g. age, income and life cycle, combined with life style will provide a more valuable basis for segmentation of Asian and overseas travel markets. The study aims to profile potential Australian tourists thereby making a contribution to tourism knowledge and market segmentation practice.

The other side of social exclusion : interrogating the role of the privileged in reproducing inequality

As the chapters in this book demonstrate, social exclusion is a key concept used to understand various forms of inequality in contemporary capitalist societies. I argue in this chapter that while the concept of social exclusion has been important in illustrating the structural dimensions of unequal social relations and examining the costs of those relations for excluded groups, it has done little to address those of us who benefit most from existing social divisions and inequalities. Nor do most of the writings on social exclusion examine how these inequalities are reproduced by and through the daily practices and life-style pursuits of privileged groups.

In this chapter I will interrogate the concept of privilege as the other side of social exclusion and will argue that the lack of critical interrogation of the position of the privileged side of social divisions allows the privileged to reinforce their dominance. I aim to make privilege more visible and consider the extent to which those who are privileged can overcome their own self interest in the maintenance of dominance to enable them to challenge it.

Perceptions of athletic competence and fear of negative evaluation during physical education

Background. Physical education (PE) aims to enhance self-esteem, develop sporting interests and to encourage a physically active life-style. However, little is known about how a fear of negative evaluation (FNE), the socially evaluative aspect of social anxiety, affects children's attitudes to PE.

Aim. The aim of the study was to investigate the relationships between perceived athletic competence and FNE within PE lessons, specifically looking at differences between boys and girls and primary and secondary schools.

Sample. The participants were 192 children in three primary schools (N=85, mean age=9.5±1.1 years) and two secondary schools (N=107, mean age=14.5±0.8 years) from rural areas of North Wales and the Midlands region of England.

Methods. The participants completed the Brief-FNE Scale and the Self-Perception Profile for Children immediately post-lesson on one occasion.

Results. Girls had higher FNE but lower perceptions of athletic competence than did boys. Older girls had higher FNE and lower perceived competence than the remaining three groups. Additionally, a significant and reverse but weak correlation was observed between girls' perceived athletic competence and FNE.

Conclusions. The findings suggest that girls with a high FNE report lower perceptions of their athletic competence. Individuals who are high in FNE behave in ways to avoid the prospect of being evaluated negatively. However, they may seek feedback from significant others as a signal that unfavourable evaluations have been avoided. Therefore, positive, encouraging feedback used in child-centred learning strategies may foster feelings of competence in boys and girls and could reduce the girls' social anxiety.

Population-level changes to promote cardiovascular health

Background: Cardiovascular diseases (CVD) cause 1.8 million premature (<75 years) death annually in Europe. The majority of these deaths are preventable with the most efficient and cost-effective approach being on the population level. The aim of this position paper is to assist authorities in selecting the most adequate management strategies to prevent CVD.

Design and Methods: Experts reviewed and summarized the published evidence on the major modifiable CVD risk factors: food, physical inactivity, smoking, and alcohol. Population-based preventive strategies focus on fiscal measures (e.g. taxation), national and regional policies (e.g. smoke-free legislation), and environmental changes (e.g. availability of alcohol).

Results: Food is a complex area, but several strategies can be effective in increasing fruit and vegetables and lowering intake of salt, saturated fat, trans-fats, and free sugars. Tobacco and alcohol can be regulated mainly by fiscal measures and national policies, but local availability also plays a role. Changes in national policies and the built environment will integrate physical activity into daily life.

Conclusion: Societal changes and commercial influences have led to the present unhealthy environment, in which default option in life style increases CVD risk. A challenge for both central and local authorities is, therefore, to ensure healthier defaults. This position paper summarizes the evidence and recommends a number of structural strategies at international, national, and regional levels that in combination can substantially reduce CVD.

Area-level socioeconomic status and incidence of abnormal glucose metabolism : the Australian diabetes, obesity and lifestyle (AusDiab) study

OBJECTIVE--To examine the role of area-level socioeconomic status (SES) on the development of abnormal glucose metabolism (AGM) using national, population-based data.

RESEARCH DESIGN AND METHODS--The Australian Diabetes, Obesity and Lifestyle (AusDiab) study is a national, population-based, longitudinal study of adults aged [greater than or equal to] 25 years. A sample of 4,572 people provided complete baseline (1999 to 2000) and 5-year follow-up (2004 to 2005) data relevant for these analyses. Incident AGM was assessed using fasting plasma glucose and 2-h plasma glucose from oral glucose tolerance tests, and demographic, socioeconomic, and behavioral data were collected by interview and questionnaire. Area SES was defined using the Index of Relative Socioeconomic Disadvantage. Generalized linear mixed models were used to examine the relationship between area SES and incident AGM, with adjustment for covariates and correction for cluster design effects.

RESULTS--Area SES predicted the development of AGM, after adjustment for age, sex, and individual SES. People living in areas with the most disadvantage were significantly more likely to develop AGM, compared with those living in the least deprived areas (odds ratio 1.53; 95% CI 1.07-2.18). Health behaviors (in particular, physical activity) and central adiposity appeared to partially mediate this relationship.

CONCLUSIONS--Our findings suggest that characteristics of the physical, social, and economic aspects of local areas influence diabetes risk. Future research should focus on identifying the aspects of local environment that are associated with diabetes risk and how they might be modified.

The prevalence and risk factors of epiretinal membranes: the Melbourne collaborative cohort study

Purpose
To determine the prevalence of epiretinal membranes (ERMs) in Melbourne, Australia and its risk factors in this population.

Methods
The Melbourne Collaborative Cohort Study is a prospective study investigating the role of diet and life style in the causation of common chronic diseases. Eighty-six percent of participants were of Northern European origin born in Australia or United Kingdom and 14% were migrants from Greece or Italy (Southern European origin). Nonmydriatic digital retinal photography was implemented at Melbourne Collaborative Cohort Study follow-up. The ERMs were recorded as cellophane macular reflex without retinal folds or preretinal macular fibrosis (PMF) with retinal folds.

Results
A total of 22,406 participants had retinal photography, 95% (n = 21,241) were eligible for ERM grading. The ERM prevalence were 8.9% (1,882); cellophane macular reflex, 4.9% (1,047); and preretinal macular fibrosis, 3.9% (835). After adjustment for age, sex, level of education, smoking status, level of cholesterol, body mass index, waist-to-hip ratio, waist measurement, blood pressure, diabetes, and stroke, increasing age and Southern European ethnicity was significantly associated with ERMs. Overall, in Southern Europeans, ERMs odd ratio was 1.97 (95% confidence intervals, 1.67–2.31), P < 0.001; preretinal macular fibrosis was 1.82 (95% confidence intervals, 1.43–2.31), P < 0.001; and cellophane macular reflex was 1.93 (1.57–2.38), P < 0.001.

Conclusion
In an older Australian population, the prevalence of ERMs was 8.9% and was almost two times higher in participants of Southern European origin than Northern European origin.

Landscapes in transition : local perceptions of indigenous and European settlement changes along the Victorian coast

Around the world coastal areas are witnessing dramatic changes due to the consequences of the growth of human settlements. Rapid urban expansion in coastal settlements due to ‘life style migration’ impacts negatively on environmental coastal amenities that are the driving factor behind the attraction of these areas. The Victorian Coast in Australia is under stress, with the growth pattern of coastal settlements in a sprawling linear fashion resulting in devastating effects on the natural coastal environment, biodiversity and the loss of cultural heritage. The Victorian coast is rich in history, and the coastal towns are often described in literature as places with ‘sense of place’, or referred to as place character. This place character has been formed over many years with the interaction between social histories and natural environments woven together across time. This paper reviews the transition of the landscapes along the Great Ocean Road coastal region, and ask the question how can a potential Generative Plan be developed to establish a process to keep the place character of coastal towns. The proposed plan considers the interrelationships of nature and people as fundamental to forming place character, from the time of Indigenous habitation before European settlement, to the current day of rapid increased developments scattered along this coast.

Breaking up prolonged sitting reduces resting blood pressure in overweight/obese adults

To compare the effect of 7 h of prolonged sitting on resting blood pressure with a similar duration of sitting combined with intermittent brief bouts of light-intensity or moderate-intensity physical activity.

Associations between economic hardship and markers of self-management in adults with type 2 diabetes: results from Diabetes MILES - Australia

A socioeconomic gradient exists in Australia for type 2 diabetes mellitus (T2DM). It remains unclear whether economic hardship is associated with T2DM self-management behaviours.

The effects of progressive resistance training combined with a whey-protein drink and vitamin D supplementation on glycaemic control, body composition and cardiometabolic risk factors in older adults with type 2 diabetes: study protocol for a randomized c

While physical activity, energy restriction and weight loss are the cornerstone of type 2 diabetes management, less emphasis is placed on optimizing skeletal muscle mass. As muscle is the largest mass of insulin-sensitive tissue and the predominant reservoir for glucose disposal, there is a need to develop safe and effective evidence-based, lifestyle management strategies that optimize muscle mass as well as improve glycaemic control and cardiometabolic risk factors in people with this disease, particularly older adults who experience accelerated muscle loss.

Type 2 diabetes care in North Karelia Finland: do area-level socio-economic factors affect processes and outcomes?

This research assessed the impact of area-level socio-economic factors on the prevalence and outcomes of type 2 diabetes in North Karelia, Finland.

Cost-effectiveness of interventions to prevent cardiovascular disease in Australia's indigenous population

Cardiovascular disease is the leading cause of disease burden in Australia's Indigenous population, and the greatest contributor to the Indigenous 'health gap'. Economic evidence can help identify interventions that efficiently address this discrepancy.