Clustering of diet, physical activity and sedentary behaviour among Australian children: cross-sectional and longitudinal associations with overweight and obesity

BACKGROUND/OBJECTIVES: Evidence suggests diet, physical activity (PA) and sedentary behaviour cluster together in children, but research supporting an association with overweight/obesity is equivocal. Furthermore, the stability of clusters over time is unknown. The aim of this study was to examine the clustering of diet, PA and sedentary behaviour in Australian children and cross-sectional and longitudinal associations with overweight/obesity. Stability of obesity-related clusters over 3-years was also examined. SUBJECTS/METHODS: Data were drawn from the baseline (T1: 2002/03) and follow-up waves (T2: 2005/06) of the Health Eating and Play Study. Parents of Australian children aged 5-6 (n=87) and 10-12 years (n=123) completed questionnaires. Children wore accelerometers and height and weight were measured. Obesity-related clusters were determined using K-medians cluster analysis. Multivariate regression models assessed cross-sectional and longitudinal associations between cluster membership, and BMI z-score and weight status. Kappa statistics assessed cluster stability over time. RESULTS: Three clusters, labelled 'most Healthy', 'Energy-dense (ED) consumers who watch TV' and 'high sedentary behaviour/low moderate-to-vigorous physical activity' were identified at baseline and at follow-up. No cross-sectional associations were found between cluster membership, and BMI z-score or weight status at baseline. Longitudinally, children in the 'ED consumers who watch TV' cluster had a higher odds of being overweight/obese at follow-up (OR=2.8; 95% CI: 1.1, 6.9; P<0.05). Tracking of cluster membership was fair to moderate in younger (K=0.24; P=0.0001) and older children (K=0.46; P<0.0001). CONCLUSIONS: This study identified an unhealthy cluster of TV viewing with ED food/drink consumption which predicted overweight/obesity in a small longitudinal sample of Australian children. Cluster stability was fair to moderate over three years and is a novel finding. Prospective research in larger samples is needed to examine how obesity-related clusters track over time and influence the development of overweight and obesity.International Journal of Obesity accepted article preview online, 24 April 2015. doi:10.1038/ijo.2015.66.

Evaluation of follistatin as a therapeutic in models of skeletal muscle atrophy associated with denervation and tenotomy

Follistatin is an inhibitor of TGF-β superfamily ligands that repress skeletal muscle growth and promote muscle wasting. Accordingly, follistatin has emerged as a potential therapeutic to ameliorate the deleterious effects of muscle atrophy. However, it remains unclear whether the anabolic effects of follistatin are conserved across different modes of non-degenerative muscle wasting. In this study, the delivery of a recombinant adeno-associated viral vector expressing follistatin (rAAV:Fst) to the hind-limb musculature of mice two weeks prior to denervation or tenotomy promoted muscle hypertrophy that was sufficient to preserve muscle mass comparable to that of untreated sham-operated muscles. However, administration of rAAV:Fst to muscles at the time of denervation or tenotomy did not prevent subsequent muscle wasting. Administration of rAAV:Fst to innervated or denervated muscles increased protein synthesis, but markedly reduced protein degradation only in innervated muscles. Phosphorylation of the signalling proteins mTOR and S6RP, which are associated with protein synthesis, was increased in innervated muscles administered rAAV:Fst, but not in treated denervated muscles. These results demonstrate that the anabolic effects of follistatin are influenced by the interaction between muscle fibres and motor nerves. These findings have important implications for understanding the potential efficacy of follistatin-based therapies for non-degenerative muscle wasting.

An improved consensus-based group decision making model with heterogeneous information

In group decision making (GDM) problems, it is natural for decision makers (DMs) to provide different preferences and evaluations owing to varying domain knowledge and cultural values. When the number of DMs is large, a higher degree of heterogeneity is expected, and it is difficult to translate heterogeneous information into one unified preference without loss of context. In this aspect, the current GDM models face two main challenges, i.e., handling the complexity pertaining to the unification of heterogeneous information from a large number of DMs, and providing optimal solutions based on unification methods. This paper presents a new consensus-based GDM model to manage heterogeneous information. In the new GDM model, an aggregation of individual priority (AIP)-based aggregation mechanism, which is able to employ flexible methods for deriving each DM's individual priority and to avoid information loss caused by unifying heterogeneous information, is utilized to aggregate the individual preferences. To reach a consensus more efficiently, different revision schemes are employed to reward/penalize the cooperative/non-cooperative DMs, respectively. The temporary collective opinion used to guide the revision process is derived by aggregating only those non-conflicting opinions at each round of revision. In order to measure the consensus in a robust manner, a position-based dissimilarity measure is developed. Compared with the existing GDM models, the proposed GDM model is more effective and flexible in processing heterogeneous information. It can be used to handle different types of information with different degrees of granularity. Six types of information are exemplified in this paper, i.e., ordinal, interval, fuzzy number, linguistic, intuitionistic fuzzy set, and real number. The results indicate that the position-based consensus measure is able to overcome possible distortions of the results in large-scale GDM problems.

Interprofessional collaborative practice across Australasia: an emergent and effective community of practice

Individuals involved in fostering interprofessional collaborative practice in health are employed in the education, practice and political arenas. While the need to innovate and develop optimal training and practice is not new, the uniqueness of interprofessional collaborative practice is that it exists across professional backgrounds and transcends traditional hierarchies (entry-level to senior practitioners). As such, alternate models of support are required to assist champions to progress learning and innovation. One such model is a group of educators and practitioners networking across Australasia, resulting in the Australasian Community of Interprofessional Collaborative Practice (ACoIPCP). ACoIPCP is a lively community of practice (CoP) group across Australia and New Zealand, which is abreast of current activity in the relevant arenas and provides members with an avenue to share information and, therefore, respond appropriately to changes in the environment. Membership includes likeminded individuals who work in the area of interprofessional collaboration from a broad range of perspectives in both health education and practice. This paper describes the development of ACoIPCP and its aims, activities and achievements. By developing a community of practice framework in a cross-organisational environment, ACoIPCP members have been able to support one another, share resources, seek feedback and learn with and from one another to foster interprofessional collaborative practice within educational, clinical and political settings. Information about the processes and outcomes of ACoIPCP may provide guidance to others interested in facilitating learning and innovation through a community of practice model.

A comparative study of guided wave propagation in timber poles with isotropic and transversely isotropic material models

Guided wave (GW) has been used for many years in non-destructive testing (NDT). There are various ways to generate the guided wave, including impact or impulse either manually or using devices. Although the method of impact or impulse is considered to be simple and practical in guided wave generation, it produces waves with broadband frequencies, which often make analysis much more difficult. The frequency bandwidth produced by manual impacts is usually at the low end, and is therefore justified when dealing with one dimensional wave propagation assumption in low strain integrity testing of cylindrical structures. Under such assumption if the velocity is known accurately, NDTs can produce reasonably good results for the condition assessment of the structure. However, for guided wave propagation in timber pole-like structures, it is rather complicated as timber is an orthotropic material and wave propagation in an orthotropic medium exhibits different characteristics from that in isotropic medium. It is possible to obtain solutions for guided wave propagation in orthotropic media for cylindrical structures, even though the orthotropic material greatly complicates GW propagation. In this paper, timber has been considered as a transversely isotropic (i.e. simplified orthotropic) material and a comparative study of GW propagation in a timber pole is conducted considering isotropic and transversely isotropic modelling. Phase velocity, group velocity and attenuation are the main parameters for this comparative study. Moreover, tractionfree situation and embedded geotechnical condition are also taken into consideration to evaluate the effect of boundary. Displacement profile, wave propagation pattern and power flow at particular frequency are utilized to determine different displacement components of longitudinal and flexural waves along and across the timber pole. Effect of temperature and moisture content (in terms of modulus of elasticity) in timber pole is also compared to show the variation in phase velocity.

“You’re a whole group of people singing”: sharing and learning together in The Choir of the Hawthorn U3A

For older people group music making can assist them remain independent and active in the community. Across Melbourne there are many non-competitive leisure based choirs made of older, active volunteer participants. This paper presents the findings of a phenomenological qualitative case study that was undertaken with members of The Choir of the U3A Hawthorn. This group is auspiced by the international University of the Third Age (U3A) that promotes life-long learning and personal fulfilment amongst older people. In 2008 we began a large joint ongoing research project between Deakin University and Monash University, Well-being and ageing: community, diversity and the arts in Victoria. In 2013 members of the U3A Hawthorn Choir were interviewed about their perceived benefits concerning active music engagement in choir membership. Participants recounted joining the group for different reasons including a positive attitude to singing, convenience, and a desire for social connectedness. Those interviewed considered ongoing choir membership an effective use of leisure time that also provided opportunities for shared learning and personal validation. The data were analysed using Interpretative Phenomenological Analysis and are reported under two themes: Music engagement and Social connections. Membership of the Hawthorn U3A choir provided participants opportunities for friendship, companionship, happiness, a sense of belonging, and acceptance. This resilient community music group (first formed in 1996) has maintained a busy schedule of rehearsals and performances. This music making offers significant ways for older people to maintain well-being and contribute to the wider community.

Considering Aboriginal palliative care models: the challenges for mainstream services

This review discusses palliative care and end-of-life models of care for Aboriginal people in the Australian state New South Wales, and considers Aboriginal palliative care needs by reflecting on recent literature and lessons derived from Aboriginal consultation. Aboriginal people in Australia account for a very small proportion of the population, have poorer health outcomes and their culture demonstrates a clear resistance to accessing mainstream health services which are viewed as powerful, isolating and not relevant to their culture, way of life, family and belief systems. Aboriginal people regard their land as spiritual and their culture dictates that an Aboriginal person needs to know their origins, emphasising the value placed on kin and also demonstrating a strong desire to remain within their own country. Currently Aboriginal people tend to not access palliative care services in mainstream facilities; and there is very little data on Aboriginal admissions to palliative care centres. Over the last two decades only two models of palliative care focusing on and developed in Aboriginal communities have been implemented. The seminal contribution to Aboriginal Palliative Care was in the form of a resource kit developed to support palliative care providers to examine their practice for cultural appropriateness for Aboriginal and Torres Strait Islanders. The "living model" coming from this project is adaptive and flexible, enabling implementation in different Aboriginal country as a participative process with community input. The Australian government"s National Indigenous Palliative Care Needs Study similarly indicated that Australian empirical research on Aboriginal palliative care service provision is in its infancy, and comprehensive data on the rates of Aboriginal access to palliative care services did not exist. What literature does exist is drawn together in an argument for the development and need for culturally specific Aboriginal palliative care models, which are culturally appropriate, locally accessible and delivered in collaboration and partnership with Aboriginal controlled health services. This is essential because Aboriginal people are a minority cultural group who are disconnected from mainstream health service delivery, and have a sense of cultural isolation when accessing mainstream services. It is preferable that palliative care is delivered in a collaboration between Aboriginal Controlled Health Service and mainstream palliative care services to ensure a dignified end of life for the Aboriginal person. These collaborations and partnerships are fundamental to ensure that a critical mass of Aboriginal clinicians are trained and experienced in end of life care and palliation. Developing palliative care programs within Aboriginal communities and training Aboriginal Health Workers, promoted and developed in partnership with the Aboriginal community, are important strategies to enhance palliative care service provision. Further partnerships should be championed in this collaborative process, acknowledging a need for palliative care models that fit with Aboriginal peoples" community values, beliefs, cultural/ spiritual rituals, heritage and place.

A combination of omega-3 fatty acids, folic acid and B-group vitamins is superior at lowering homocysteine than omega-3 alone: a meta-analysis

The aim of the study was to assess whether omega-3 polyunsaturated fatty acid supplementation alone or in combination with folic acid and B-group vitamins is effective in lowering homocysteine. The Medline Ovid, Embase and Cochrane databases were searched for randomized-controlled trial studies that intervened with omega-3 supplementation (with or without folic acid) and measured changes in homocysteine concentration. Studies were pooled using a random effects model for meta-analysis. Three different models were analyzed: all trials combined, omega-3 polyunsaturated fatty acid trials, and omega-3 polyunsaturated fatty acids with folic acid and B-group vitamin trials. Nineteen studies were included, consisting of 3267 participants completing 21 trials. Studies were heterogeneous; varying by dose, duration and participant health conditions. Across all trials, omega-3 supplementation was effective in lowering homocysteine by an average of 1.18μmol/L (95%CI: (-1.89, -0.48), P=.001). The average homocysteine-lowering effect was greater when omega-3 supplementation was combined with folic acid and B-group vitamins (-1.37μmol/L, 95%CI: (-2.38, -0.36), P<.01) compared to omega-3 supplementation alone (-1.09μmol/L 95%CI: (-2.04, -0.13), P=.03). Omega-3 polyunsaturated fatty acid supplementation was associated with a modest reduction in homocysteine. For the purposes of reducing homocysteine, a combination of omega-3s (0.2-6g/day), folic acid (150 - 2500μg/day) and vitamins B6 and B12 may be more effective than omega-3 supplementation alone.

Nurse-led group consultation intervention reduces depressive symptoms in men with localised prostate cancer: a cluster randomised controlled trial

BACKGROUND: Radiotherapy for localised prostate cancer has many known and distressing side effects. The efficacy of group interventions for reducing psychological morbidity is lacking. This study investigated the relative benefits of a group nurse-led intervention on psychological morbidity, unmet needs, treatment-related concerns and prostate cancer-specific quality of life in men receiving curative intent radiotherapy for prostate cancer.

METHODS: This phase III, two-arm cluster randomised controlled trial included 331 men (consent rate: 72 %; attrition: 5 %) randomised to the intervention (n = 166) or usual care (n = 165). The intervention comprised four group and one individual consultation all delivered by specialist uro-oncology nurses. Primary outcomes were anxious and depressive symptoms as assessed by the Hospital Anxiety and Depression Scale. Unmet needs were assessed with the Supportive Care Needs Survey-SF34 Revised, treatment-related concerns with the Cancer Treatment Scale and quality of life with the Expanded Prostate Cancer Index -26. Assessments occurred before, at the end of and 6 months post-radiotherapy. Primary outcome analysis was by intention-to-treat and performed by fitting a linear mixed model to each outcome separately using all observed data.

RESULTS: Mixed models analysis indicated that group consultations had a significant beneficial effect on one of two primary endpoints, depressive symptoms (p = 0.009), and one of twelve secondary endpoints, procedural concerns related to cancer treatment (p = 0.049). Group consultations did not have a significant beneficial effect on generalised anxiety, unmet needs and prostate cancer-specific quality of life.

CONCLUSIONS: Compared with individual consultations offered as part of usual care, the intervention provides a means of delivering patient education and is associated with modest reductions in depressive symptoms and procedural concerns. Future work should seek to confirm the clinical feasibility and cost-effectiveness of group interventions.

Political justice, schooling and issues of group identity

This article explores issues associated with schooling and political justice. Such issues are understood in light of the contention surrounding howWestern schooling contexts might best represent marginalised groups—in ways that accord them a political voice. The significance of group identity politics is explored drawing on international debates associated with ethnically segregated schooling. A postcolonial theorising of group identity highlights the ways in which segregated schooling can both support and undermine politically just representation for marginalised students. This theorising draws attention to the problematic notion of voice in linking representation to identity in reductionist ways. The arguments presented point to the significance of people and their politics, rather than their membership to a particular identity group, in pursuing equity for marginalised groups. The article argues the imperative of understanding group identity as an aspect of negotiated social practice that can be drawn on in strategic and critical ways to address matters of political injustice.

Selecting umbrella species for conservation: a test of habitat models and niche overlap for beach-nesting birds

Umbrella species are rarely selected systematically from a range of candidate species. On sandy beaches, birds that nest on the upper beach or in dunes are threatened globally and hence are prime candidates for conservation intervention and putative umbrella species status. Here we use a maximum-likelihood, multi-species distribution modeling approach to select an appropriate conservation umbrella from a group of candidate species occupying similar habitats. We identify overlap in spatial extent and niche characteristics among four beach-nesting bird species of conservation concern, American oystercatchers (Haematopus palliatus), black skimmers (Rynchops niger), least terns (Sterna antillarum) and piping plovers (Charadrius melodus), across their entire breeding range in New Jersey, USA. We quantify the benefit and efficiency of using each species as a candidate umbrella on the remaining group. Piping plover nesting habitat encompassed 86% of the least tern habitat but only 15% and 13% of the black skimmer and American oystercatcher habitat, respectively. However, plovers co-occur with all three species across 66% of their total nesting habitat extent (~ 649 ha), suggesting their value as an umbrella at the local scale. American oystercatcher nesting habitat covers 100%, 99% and 47% of piping plover, least tern and black skimmer habitat, making this species more appropriate conservation umbrellas at a regional scale. Our results demonstrate that the choice of umbrella species requires explicit consideration of spatial scale and an understanding of the habitat attributes that an umbrella species represents and to which extent it encompasses other species of conservation interest. Notwithstanding the attractiveness of the umbrella species concept, local conservation interventions especially for breeding individuals in small populations may still be needed.