Negative appraisals of insulin therapy are common among adults with Type 2 diabetes using insulin: results from diabetes MILES - Australia cross-sectional survey

AIM: To identify insulin therapy appraisals among adults with Type 2 diabetes using insulin and how negative appraisals relate to clinical, self-care and psychosocial outcomes. METHODS: Diabetes MILES - Australia 2011 was a national survey of adults with diabetes, focused on behavioural and psychosocial issues. Subgroup analyses were conducted on the responses of 273 adults with Type 2 diabetes using insulin (46% women; mean ± sd age: 59 ± 9 years; diabetes duration: 12 ± 7 years; years using insulin: 4 ± 4). They completed validated measures of insulin therapy appraisals (ITAS), depression (PHQ-9), anxiety (GAD-7), diabetes distress (PAID) and diabetes-specific self-efficacy (DES-SF). RESULTS: Insulin was perceived to be very important, and its benefits (e.g. improves health) were endorsed by most (82%). Fifty-one per cent believed that taking insulin means their diabetes has become worse; 51% that insulin causes weight gain; 39% that they have 'failed to manage' their diabetes. Those with the greatest and least 'ITAS negative' scores did not differ by diabetes duration or years using insulin, or by average number of insulin injections or blood glucose checks per day. Those with more negative insulin appraisals were significantly younger (Mean Diff. = 5 years, P < 0.001), less satisfied with recent blood glucose levels (P < 0.001, d = 0.63), had reduced diabetes-specific self-efficacy (P < 0.001, d = 0.7), and were more likely to report depressive symptoms, anxiety or diabetes distress (all P < 0.001, d = 0.65-1.1). CONCLUSIONS: Negative insulin therapy appraisals are common among adults with Type 2 diabetes using insulin, and are associated with lower general and diabetes-specific emotional well-being, reduced diabetes-specific self-efficacy and satisfaction with blood glucose.

Muscle strength and areal bone mineral density at the hip in women: a cross-sectional study

BACKGROUND: Muscle strengthening exercises are promoted for building and maintaining a healthy skeleton. We aimed to investigate the relationship between muscle strength and areal bone mineral density (BMD) at the hip in women aged 26-97 years.

METHODS: This cross-sectional study utilises data from 863 women assessed for the Geelong Osteoporosis Study. Measures of hip flexor and abductor strength were made using a hand-held dynamometer (Nicholas Manual Muscle Tester). The maximal measure from three trials on each leg was used for analyses. BMD was measured at the hip using dual energy x-ray absorptiometry (DXA; Lunar DPX-L). Total lean mass, body fat mass and appendicular lean mass were determined from whole body DXA scans. Linear regression techniques were used with muscle strength as the independent variable and BMD as the dependent variable. Models were adjusted for age and indices of body composition.

RESULTS: Measures of age-adjusted hip flexor strength and hip abductor strength were positively associated with total hip BMD. For each standard deviation (SD) increase in hip flexor strength, the increase in mean total hip BMD (SD) was 10.4 % (p = 0.009). A similar pattern was observed for hip abductor strength, with an increase in mean total hip BMD of 22.8 % (p = 0.025). All associations between hip muscle strength and total hip BMD were independent of height, but were nullified after adjusting for appendicular lean mass or total lean mass.

CONCLUSIONS: There was a positive association observed between muscle strength and BMD at the hip. However, this association was explained by measures of lean mass.

Cross-sectional and longitudinal associations between parents' and preschoolers' physical activity and TV viewing: the HAPPY Study

Background: Parental modelling has been shown to be important for school-aged children’s physical activity (PA) and television (TV) viewing, yet little is known about its impact for younger children. This study examined cross-sectional and three-year longitudinal associations between PA and TV viewing behaviours of parents and their preschool children. Method: In 2008-9 (T1), parents in the HAPPY cohort study (n=450) in Melbourne, Australia self-reported their weekly PA and TV viewing, and proxy-reported their partner’s PA and TV viewing, and their 3-5 year-old preschool child’s TV viewing. Children’s PA was assessed via accelerometers. Repeat data collection occurred in 2011-12 (T2). Results: Mothers’ and fathers’ PA were associated with PA among preschool girls at T1, but not boys. Parents’ TV viewing times were significant correlates of girls’ and boys’ TV viewing at T1. Longitudinally, mothers’ PA at baseline predicted boys’ PA at T2, while sex-specific associations were found for TV viewing, with mothers’ and fathers’ TV viewing at T1 associated with girls’ and boys’ TV viewing respectively at T2. Conclusions: The PA and TV viewing of both parents are significantly associated with these behaviours in preschool children. The influence of the sex-matched parent appears to be important longitudinally for children’s TV viewing&period.

Excessive daytime sleepiness and falls among older men and women: cross-sectional examination of a population-based sample

Background: Excessive daytime sleepiness (EDS) has been associated with an increased risk for falls among clinical samples of older adults. However, there is little detailed information among population-representative samples. The current study aimed to assess the relationship between EDS and falls among a cohort of population-based older adults. Methods: This study assessed 367 women aged 60-93years (median 72, interquartile range 65-79) and 451 men aged 60-92years (median 73, interquartile range 66-80) who participated in the Geelong Osteoporosis Study between the years 2001 and 2008. Falls during the prior year were documented via self-report, and for men, falls risk score was obtained using an Elderly Fall Screening Test (EFST). Sleepiness was assessed using the Epworth Sleepiness Scale (ESS), and scores of≥10 indicated EDS. Differences among those with and without EDS in regard to falls were tested using logistic regression models. Results: Among women, 50 (13.6 %) individuals reported EDS. Women with EDS were more likely to report a fall, and were more likely to report the fall occurring outside. EDS was similarly associated with an increased risk of a fall following adjustment for use of a walking aid, cases of nocturia and antidepressant medication use (adjusted OR∈=∈2.54, 95 % CI 1.24-5.21). Multivariate modelling revealed antidepressant use (current) as an effect modifier (p∈<∈.001 for the interaction term). After stratifying the data by antidepressant medication use, the association between EDS and falls was sustained following adjustment for nocturia among antidepressant non-users (adjusted OR∈=∈2.63, 95 % CI 1.31-5.30). Among men, 72 (16.0 %) individuals reported EDS. No differences were detected for men with and without EDS in regard to reported falls, and a trend towards significance was noted between EDS and a high falls risk as assessed by the EFST (p∈=∈0.06), however, age explained this relationship (age adjusted OR∈=∈2.20, 95 % CI 1.03-1.10). Conclusions: For women, EDS is independently associated with at least one fall during the previous year, and this is more likely to occur whilst located outside. Amelioration of EDS may assist in improving functional outcomes among these individuals by reducing the risk for falls.

Cross-sectional study of 24-hour urinary electrolyte excretion and associated health outcomes in a convenience sample of Australian primary schoolchildren: the salt and other nutrients in children (SONIC) study protocol

BACKGROUND: Dietary sodium and potassium are involved in the pathogenesis of cardiovascular disease. Data exploring the cardiovascular outcomes associated with these electrolytes within Australian children is sparse. Furthermore, an objective measure of sodium and potassium intake within this group is lacking. OBJECTIVE: The primary aim of the Salt and Other Nutrient Intakes in Children ("SONIC") study was to measure sodium and potassium intakes in a sample of primary schoolchildren located in Victoria, Australia, using 24-hour urine collections. Secondary aims were to identify the dietary sources of sodium and potassium, examine the association between these electrolytes and cardiovascular risk factors, and assess children's taste preferences and saltiness perception of manufactured foods. METHODS: A cross-sectional study was conducted in a convenience sample of schoolchildren attending primary schools in Victoria, Australia. Participants completed one 24-hour urine collection, which was analyzed for sodium, potassium, and creatinine. Completeness of collections was assessed using collection time, total volume, and urinary creatinine. One 24-hour dietary recall was completed to assess dietary intake. Other data collected included blood pressure, body weight, height, waist and hip circumference. Children were also presented with high and low sodium variants of food products and asked to discriminate salt level and choose their preferred variant. Parents provided demographic information and information on use of discretionary salt. Descriptive statistics will be used to describe sodium and potassium intakes. Linear and logistic regression models with clustered robust standard errors will be used to assess the association between electrolyte intake and health outcomes (blood pressure and body mass index/BMI z-score and waist circumference) and to assess differences in taste preference and discrimination between high and low sodium foods, and correlations between preference, sodium intake, and covariates. RESULTS: A total of 780 children across 43 schools participated. The results from this study are expected at the end of 2015. CONCLUSIONS: This study will provide the first objective measure of sodium and potassium intake in Australian schoolchildren and improve our understanding of the relationship of these electrolytes to cardiovascular risk factors. Furthermore, this study will provide insight into child taste preferences and explore related factors. Given the cardiovascular implications of consuming too much sodium and too little potassium, monitoring of these nutrients during childhood is an important public health initiative.

Neighbourhood environment, sitting time and motorised transport in older adults: a cross-sectional study in Hong Kong

OBJECTIVES: Sitting time is a public health concern. This study examined associations of objectively measured neighbourhood environmental attributes with non-transport sitting time and motorised transport in 484 Hong Kong older adults. Neighbourhood attributes encouraging walking may help older adults replace some sitting time at home and on motorised transport with light-to-moderate-intensity activities such as strolling around the neighbourhood or walking to/from neighbourhood destinations. Thus, we hypothesised environmental attributes found to be related to walking would show associations with non-transport sitting time and motorised transport opposite to those seen for walking. DESIGN: Cross-sectional. SETTING: Hong Kong, an ultradense urban environment. PARTICIPANTS: 484 ethnic Chinese Hong Kong residents aged 65+ recruited from membership lists of four Hong Kong Elderly Health Centres representing catchment areas of low and high transport-related walkability stratified by socioeconomic status (response rate: 78%). PRIMARY AND SECONDARY OUTCOME MEASURES: Attributes of participants' neighbourhood environments were assessed by environmental audits, while non-transport sitting time and motorised transport were ascertained using the International Physical Activity Questionnaire-Long Form (Chinese version). RESULTS: Daily non-transport sitting minutes were 283 (SD=128) and motorised transport 23 (SD=28). Prevalence of signs of crime/disorder, streetlights, public facilities (toilets and benches) and pedestrian safety were independently negatively related, and sloping streets positively related, to sitting outcomes. Places of worship in the neighbourhood were predictive of more, and prevalence of public transit points of less, non-transport sitting. Associations of either or both sitting outcomes with prevalence of food/grocery stores and presence of parks were moderated by path obstructions and signs of crime/disorder. CONCLUSIONS: The findings suggest that access to specific destinations and relatively low-cost, minimal impact modifications to the urban form, such as street lighting, public toilets, benches and public transit points, could potentially reduce sitting time and associated negative health outcomes in Hong Kong older adults.

A meta-analysis of cross sectional studies investigating language in maltreated children

Purpose: In this review article, meta-analysis was used to summarize research investigating language skills in maltreated children. Method: A systematic search of published studies was undertaken. Studies were included in the meta-analysis if they investigated language skills in groups comprising maltreated and nonmaltreated children. Studies were selected if these 2 groups of children were of comparable age and from a similar socioeconomic background. Results: A total of 26 studies were identified that met the inclusion criteria. Results from the meta-analysis showed that maltreated children demonstrated consistently poorer language skills with respect to receptive vocabulary (k = 19; standardized mean difference [SMD] = .463; 95% confidence interval [CI; .293, .634]; p < .001), expressive language (k = 4; SMD =.860; 95% CI [.557, 1.163]; p < .001), and receptive language (k = 9; SMD =.528; 95% CI [.220, .837]; p < .001). Conclusion: Together, these results indicate a reliable association between child maltreatment and poor language skills.

UV protection performance of textiles affected by fiber cross-sectional shape

Abstract
In this study, a model was set up for simulating the effects of varying fiber cross-sectional shapes on ultraviolet protection of fibers. The fiber diameter and fiber type were also involved in the model setting. Experiments of diffuse reflectance spectra measurement on natural (wool, cotton, silk), regenerated (bamboo viscose) and synthetic (polyester, nylon) fibers were conducted to verify the model predicted results. When a more complex shape was assumed as the fiber cross-section for model calculation, the predicted results have a better agreement with the actual results. The effects on ultraviolet absorption from fibers with different cross-sectional shapes were investigated at a single fiber, fiber bundle and yarn levels. With the same material, when the fiber cross-sectional area and the areal coverage of a single fiber were constant, the triangular shape had the lowest ultraviolet transmittance and the highest ultraviolet reflectance for a single fiber and also for a fiber bundle. The difference of fiber cross-sectional shapes was also significant in the ultraviolet protection of a single yarn.

Cross-sectional averages versus principal components

In spite of the increased use of factor-augmented regressions in recent years, little is known regarding the relative merits of the two main approaches to estimation and inference, namely, the cross-sectional average and principal component estimators. By providing a formal comparison of the approaches, the current paper fills this gap in the literature.

Alcohol-related crime in city entertainment precincts: Public perception and experience of alcohol-related crime and support for strategies to reduce such crime

INTRODUCTION AND AIMS: Bars, pubs and taverns in cities are often concentrated in entertainment precincts that are associated with higher rates of alcohol-related crime. This study assessed public perception and experiences of such crime in two city entertainment precincts, and support for alcohol-related crime reduction strategies. DESIGN AND METHODS: A cross-sectional household telephone survey in two Australian regions assessed: perception and experiences of crime; support for crime reduction strategies; and differences in such perceptions and support. RESULTS: Six hundred ninety-four people completed the survey (32%). Most agreed that alcohol was a problem in their entertainment precinct (90%) with violence the most common alcohol-related problem reported (97%). Almost all crime reduction strategies were supported by more than 50% of participants, including visitors to the entertainment precincts, with the latter being slightly less likely to support earlier closing and restrictions on premises density. Participants in one region were more likely to support earlier closing and lock-out times. Those at-risk of acute alcohol harm were less likely to support more restrictive policies. DISCUSSION AND CONCLUSIONS: High levels of community concern and support for alcohol harm-reduction strategies, including restrictive strategies, provide policy makers with a basis for implementing evidence-based strategies to reduce such harms in city entertainment precincts. [Tindall J, Groombridge D, Wiggers J, Gillham K, Palmer D, Clinton-McHarg T, Lecathelinais C, Miller P. Alcohol-related crime in city entertainment precincts: Public perception and experience of alcohol-related crime and support for strategies to reduce such crime. Drug Alcohol Rev 2015].

A systematic review of reliable and valid tools for the measurement of patient participation in healthcare

INTRODUCTION: Patient participation in healthcare is recognised internationally as essential for consumer-centric, high-quality healthcare delivery. Its measurement as part of continuous quality improvement requires development of agreed standards and measurable indicators. AIM: This systematic review sought to identify strategies to measure patient participation in healthcare and to report their reliability and validity. In the context of this review, patient participation was constructed as shared decision-making, acknowledging the patient as having critical knowledge regarding their own health and care needs and promoting self-care/autonomy. METHODS: Following a comprehensive search, studies reporting reliability or validity of an instrument used in a healthcare setting to measure patient participation, published in English between January 2004 and March 2014 were eligible for inclusion. RESULTS: From an initial search, which identified 1582 studies, 156 studies were retrieved and screened against inclusion criteria. Thirty-three studies reporting 24 patient participation measurement tools met inclusion criteria, and were critically appraised. The majority of studies were descriptive psychometric studies using prospective, cross-sectional designs. Almost all the tools completed by patients, family caregivers, observers or more than one stakeholder focused on aspects of patient-professional communication. Few tools designed for completion by patients or family caregivers provided valid and reliable measures of patient participation. There was low correlation between many of the tools and other measures of patient satisfaction. CONCLUSION: Few reliable and valid tools for measurement of patient participation in healthcare have been recently developed. Of those reported in this review, the dyadic Observing Patient Involvement in Decision Making (dyadic-OPTION) tool presents the most promise for measuring core components of patient participation. There remains a need for further study into valid, reliable and feasible strategies for measuring patient participation as part of continuous quality improvement.