Public sector residential aged care: identifying novel associations between quality indicators and other demographic and health-related factors

Objective : To explore associations among quality indicators (QI; e.g. pressure ulcers, falls and/or fractures, physical restraint, use of multiple medications, unplanned weight loss) of the Victorian Public Sector Residential Aged Care Services (VPSRACS) with other demographic and health-related factors.

Methods : Data for 380 residents over a 3-month period were extracted retrospectively from client databases at four VPSRAC facilities.

Results : Four significant logistic regression models were developed. The strongest models related to falls and polypharmacy. Significant associations for these models included the following: (1) residents with a higher body mass index were 6% less likely (95% confidence interval (CI) 1%–11%) to fall, whereas high levels of cognitive impairment increased the risk of falling by 8% (95% CI 2%–14%); (2) being ambulant with a gait aid more than doubled the risk of falling compared with non-ambulant residents (95% CI 19%–546%); and (3) higher cognitive impairment was associated with a 6% (95% CI 1%–11%) reduction in the likelihood of polypharmacy.

Conclusions : Identification of significant relationships between the VPSRACS QI and other demographic and health-related factors is a preliminary step towards a more in-depth understanding of the factors that influence the QI and predict adverse events.

Mental health-related risk factors for violence : using the evidence to guide mental health triage decision making

Mental health clinicians working in emergency crisis assessment teams or mental health triage roles are required to make rapid and accurate risk assessments. The assessment of violence risk at triage is particularly pertinent to the early identification and prevention of patient violence, and to enhancing the safety of clinical staff and the general public. To date, the evidence base for mental health triage violence risk assessment has been minimal. This study aimed to address this evidence gap by identifying best available evidence for mental health-related risk factors for patientinitiated violence.We conducted a systematic review based on the National Health and Medical Research Council of Australia’s methodology for systematic reviews. A total of 6847 studies were retrieved, of which 326 studies met the study inclusion criteria. Of these studies, 277 met inclusion criteria but failed the quality appraisal process, thus a total of 49 studies were included in the final review. The risk factors that achieved the highest evidence grading were predominantly related to dynamic clinical factors immediately observable in the patient’s general appearance, behaviour and speech. These factors included hostility/anger, agitation, thought disturbance, positive symptoms of schizophrenia, suspiciousness and irritability.

Supplement use is associated with health status and health-related behaviors in the 1946 British birth cohort.

Use of dietary supplements may be one of a number of health-related behaviors that cluster together. The current study investigated the underlying diet, health-related characteristics, and behaviors of users and nonusers of dietary supplements in a longitudinal study of health. Participants (n = 1776) completed a 5-d food diary including information on dietary supplement use (vitamins, minerals, and nutraceuticals) at age 53 y. Sociodemographic information and data on smoking, alcohol, and physical activity were obtained along with anthropometric measurements, blood pressure, and a blood sample (nonfasting subjects). A significantly greater percentage of women reported supplement use compared with men (45.1 vs. 25.2%). Supplement use was associated with lower BMI, lower waist circumference, higher plasma folate and plasma vitamin B-12 concentrations, nonsmoking, participation in physical activity, and nonmanual social class in women and with plasma folate concentrations and participation in physical activity in men. Nonsupplement users tended to be nonconsumers of breakfast cereals, fruit, fruit juice, yogurt, oily fish, and olive oil and had lower dietary intakes of potassium, magnesium, phosphorus, iron, and vitamin C even after adjustment for sociodemographic and behavioral factors. Overall, supplement users tended to differ from nonsupplement users on a range of health-related behaviors and health status indicators, although there were fewer significant associations in men. Similarly, dietary supplements users tended to have underlying diets that, were healthier and those taking supplements may be the least likely to need them. These results support the notion of a clustering of healthy behaviors and cardiovascular risk factors, particularly for women.

Insights from research on cross-cultural validation of health-related questionnaires : the role of bilingual project workers and lay participants

This article discusses the recruitment and training of bilingual project workers and their role in data gathering; the level of comprehension of the interviewees with regard to the nature of the task and its alien nature; the contribution of social customs and expectations; the vagaries of language; the researchers' level of comprehension of data collected across a range of languages; the feelings of loss of control by the researchers over the research process; and issues of communication with bilingual project workers. The authors draw on two studies designed to assess the adequacy of questionnaire translations from English into four ethnic minority languages: Cantonese, Punjabi, Urdu and Sylheti. Bilingual project workers were recruited to carry out interviews and focus groups with the lay communities and to feed back results in English to the researchers. The authors conclude that researchers should be aware of the influence of social and contextual factors when carrying out research with ethnic minority participants mediated by bilingual project workers.

Determinants of health-related quality of life in people with Parkinson’s disease: a path analysis

Purpose:
To identify the demographic factors, impairments and activity limitations that contribute to health-related quality of life (HRQOL) in people with idiopathic Parkinson’s disease (PD).

Method:
Two hundred and ten individuals with idiopathic PD who participated in the baseline assessment of a randomized clinical trial were included. The Parkinson’s Disease Questionnaire-39 summary index was used to quantify HRQOL. In order to provide greater clarity regarding the determinants of HRQOL, path analysis was used to explore the relationships between the various predictors in relation to the functioning and disability framework of the International Classification of Functioning model.

Results:
The two models of HRQOL that were examined in this study had a reasonable fit with the data. Activity limitations were found to be the strongest predictor of HRQOL. Limitations in performing self-care activities contributed the most to HRQOL in Model 1 (β = 0.38; p < 0.05), while limitations in functional mobility had the largest contribution in Model 2 (β = −0.31; p < 0.0005). Self-reported history of falls was also found to have a significant and direct relationship with HRQOL in both models (Model 1 β = −0.11; p < 0.05; Model 2 β = −0.21; p < 0.05).

Conclusions:
Health-related quality of life in PD is associated with self-care limitations, mobility limitations, self-reported history of falls and disease duration. Understanding how these factors are inter-related may assist clinicians focus their assessments and develop strategies that aim to minimize the negative functional and social sequelae of this debilitating disease.

Rural living and health-related quality of life in Australians with Parkinson's disease

Introduction: The motor and non-motor symptoms associated with idiopathic Parkinson’s disease (PD) may compromise the health-related quality of life (HRQOL) of some individuals living with this debilitating condition. Although growing evidence suggests that PD may be more prevalent in rural communities, there is little information about the life quality of these individuals. This study examines whether HRQOL ratings vary in relation to rural and metropolitan life settings.
Methods: An analytic cross-sectional study was conducted to compare the HRQOL of two separate samples of people with PD living in metropolitan Melbourne and rural Victoria. The metropolitan sample consisted of 210 individuals who had participated in the baseline assessment for an existing clinical trial. The rural sample comprised 24 participants who attended community-based rehabilitation programs and support groups in rural Victoria. Health-related quality of life was quantified using the Parkinson’s Disease Questionnaire-39 (PDQ-39).
Results: The HRQOL of participants in rural Australia differed from individuals living in a large metropolitan city (p=0.025). Participants in rural Australia reported worse overall HRQOL, after controlling for differences in disease duration. Their overall HRQOL was lower than for city dwellers. Rural living was also found to be a significant negative predictor of HRQOL (β=0.14; 95% CI -1.27 to -0.08; _p=0.027).
Conclusion: The findings of this study suggest that some people with PD living in rural Victoria perceive their HRQOL to be relatively poor. In order to minimise the debilitating consequences of this disease, further studies examining the factors that may contribute to the HRQOL of individuals living in rural and remote areas are required.

Relationship between overweight and health-related quality of life in secondary school children in Fiji: results from a cross-sectional population-based study

Objective
To investigate the relationship between excess weight (overweight and obesity) and health-related quality of life (HRQoL) in a sample of secondary school children in Fiji, by gender, age and ethnicity.

Methods
The study comprised 8947 children from forms 3–6 (age 12–18 years) in 18 secondary schools on Viti Levu, the main island of Fiji. Body mass index (BMI) was calculated from measured height and weight, and weight status was classified according to the International Obesity Task Force recommendations. HRQoL was measured by the self-report version of the Pediatric Quality of Life Inventory 4.0.

Results
HRQoL was similar in children with obesity and normal weight. Generally, this was replicated when analyzed separately by gender and ethnicity, but age stratification revealed disparities. In 12–14-year-old children, obesity was associated with better HRQoL, owing to better social and school functioning and well-being, and in 15–18-year olds with poorer HRQoL, owing to worse physical, emotional and social functioning and well-being (Cohen’s d 0.2–0.3). Children with a BMI in the overweight range also reported a slightly lower HRQoL than children with a BMI in the normal weight range, but although statistically significant, the size of this difference was trivial (Cohen’s d <0.2).

Discussion
The results suggest that, overall there is no meaningful negative association between excess weight and HRQoL in secondary school children in Fiji. This is in contradiction to the negative relationship between excess weight and HRQoL shown in studies from other countries and cultures. The assumption that a large body size is associated with a lower quality of life cannot be held universally. Although a generally low HRQoL among children in Fiji may be masking or overriding the potential effect of excess weight on HRQoL, socio-economic and/or socio-cultural factors, may help to explain these relationships.

Parent-related factors associated with service use for adolescent emotional and behavioural problems

 Investigation parent and family factors associated with service use for adolescent emotional and behavioural problems, finding that parent problem recognition, sociodemographic variables, prior service use, and parental overcontrol were significantly associated with service use longitudinally. Predictors of parent problem perception were also identified, extending existing research and models.

Effects of patient-, environment- and medication-related factors on high-alert medication incidents.

To measure the rate of medication incidents associated with the prescription and administration of high-alert medications and to identify patient-, environment- and medication-related factors associated with these incidents.

Comorbid depression and health-related quality of life in patients with coronary artery disease.

This article reviews recent studies relating to the impact of depression and its treatment on the health-related quality of life (HRQOL) of patients with coronary artery disease (CAD).

Associations of diet quality with health-related quality of life in older Australian men and women

This study investigated associations between diet quality measures and quality of life two years later. Adults 55-65 years participating in the Wellbeing, Eating and Exercise for a Long Life (WELL) study in Victoria, Australia (n = 1150 men and n = 1307 women) completed a postal survey including a 111-item food frequency questionnaire in 2010. Diet quality in 2010 was assessed via the dietary guideline index (DGI), recommended food score (RFS) and Mediterranean diet score (MDS). The RAND 36-item survey assessed health-related quality of life in 2012. Associations were assessed using logistic regression adjusted for covariates. In men, DGI and RFS were associated with better reported energy (OR = 1.79, CI: 1.25, 2.55 and OR = 1.56, CI: 1.11, 2.19 respectively), and DGI was additionally associated with better general health (OR = 1.54, 95% CI: 1.08, 2.20), and overall mental component summary scale (OR = 1.51, CI: 1.07, 2.15) in the fully adjusted model. In women, associations between two indices of diet quality (DGI, RFS) physical function (OR = 1.66, CI: 1.19, 2.31 and OR = 1.70, CI: 1.21, 2.37 respectively) and general health (OR = 1.83, CI: 1.32, 2.54 and OR = 1.54, CI: 1.11, 2.14 respectively) were observed. DGI was also associated with overall physical component summary score (OR = 1.56, CI: 1.12, 2.17). Additional associations between emotional wellbeing and DGI (OR = 1.40, CI: 1.01, 1.93) and RFS (OR = 1.44, CI: 1.04, 1.99), and MDS and energy (OR = 1.53, CI: 1.11, 2.10) were observed in the fully adjusted model, in women only. Older adults with better quality diets report better health-related quality of life, with additional associations with emotional wellbeing observed in women.

Relationship of the perceived social and physical environment with mental health-related quality of life in middle-aged and older adults: mediating effects of physical activity

BACKGROUND: Mental health conditions are among the leading non-fatal diseases in middle-aged and older adults in Australia. Proximal and distal social environmental factors and physical environmental factors have been associated with mental health, but the underlying mechanisms explaining these associations remain unclear. The study objective was to examine the contribution of different types of physical activity in mediating the relationship of social and physical environmental factors with mental health-related quality of life in middle-aged and older adults. METHODS: Baseline data from the Wellbeing, Eating and Exercise for a Long Life (WELL) study were used. WELL is a prospective cohort study, conducted in Victoria, Australia. Baseline data collection took place in 2010. In total, 3,965 middle-aged and older adults (55-65 years, 47.4% males) completed the SF-36 Health Survey, the International Physical Activity Questionnaire, and a questionnaire on socio-demographic, social and physical environmental attributes. Mediation analyses were conducted using the MacKinnon product-of-coefficients test. RESULTS: Personal safety, the neighbourhood physical activity environment, social support for physical activity from family or friends, and neighbourhood social cohesion were positively associated with mental health-related quality of life. Active transportation and leisure-time physical activity mediated 32.9% of the association between social support for physical activity from family or friends and mental health-related quality of life. These physical activity behaviours also mediated 11.0%, 3.4% and 2.3% respectively, of the relationship between the neighbourhood physical activity environment, personal safety and neighbourhood social cohesion and mental health-related quality of life. CONCLUSIONS: If these results are replicated in future longitudinal studies, tailored interventions to improve mental health-related quality of life in middle-aged and older adults should use a combined strategy, focusing on increasing physical activity as well as social and physical environmental attributes.

Self-management support and training for patients with chronic and complex conditions improves health-related behaviour and health outcomes

The Sharing Health Care SA chronic disease self-management (CDSM) project in rural South Australia was designed to assist patients with chronic and complex conditions (diabetes, cardiovascular disease and arthritis) to learn how to participate more effectively in the management of their condition and to improve their self-management skills. Participants with chronic and complex conditions were recruited into the Sharing Health Care SA program and offered a range of education and support options (including a 6-week peer-led chronic disease self-management program) as part of the Enhanced Primary Care care planning process. Patient self-reported data were collected at baseline and subsequent 6-month intervals using the Partners in Health (PIH) scale to assess self-management skill and ability for 175 patients across four data collection points. Health providers also scored patient knowledge and self-management skills using the same scale over the same intervals. Patients also completed a modified Stanford 2000 Health Survey for the same time intervals to assess service utilisation and health-related lifestyle factors. Results show that both mean patient self-reported PIH scores and mean health provider PIH scores for patients improved significantly over time, indicating that patients demonstrated improved understanding of their condition and improved their ability to manage and deal with their symptoms. These results suggest that involvement in peer-led self-management education programs has a positive effect on patient self-management skill, confidence and health-related behaviour.

Discovering latent affective dynamics among individuals in online mental health-related communities

Discovering dynamics of emotion and mood changes for individuals has the potential to enhance the diagnosis and treatment of mental disorders. In this paper we study affective transitions and dynamics among individuals in online mental health communities. Using social media as form of 'sensor', we crawl a large dataset of blogs posted by online communities whose descriptions declared to be associated with affective disorder conditions such as depression, anxiety, or autism. We then apply nonnegative matrix factorization model to extract the common and individual factors of affective transitions across groups of individuals in different levels of affective disorders. We examine the latent patterns of emotional transitions and investigate the effects of emotional transitions across the cohorts. Our framework is novel as it utilizes social media as an online sensing platform of mood and emotional dynamics. Hence, our work has implication in constructing systems to screen individuals and communities at high risks of mental health problems in online settings.