Physical activity, activity change, and their correlates in a population-based sample of colorectal cancer survivors

Background: Physical activity can provide benefits to cancer survivors, including reduced symptoms and treatment side effects, improved overall quality of life, and decreased risk of other chronic diseases.

Purpose: The aim of the study was to describe physical activity before and after diagnosis of colorectal cancer and to examine the associations with sociodemographic and disease-related variables.

Methods: Telephone interviews were conducted with 1,996 colorectal cancer survivors recruited through a cancer registry.

Results: In comparison to prediagnosis activity levels, there were 21% fewer participants meeting the physical activity and health guideline (150 min of moderate-intensity physical activity per week) postdiagnosis. Meeting the guideline postdiagnosis was associated with being male, living outside of the state capital city, having a higher education, having a healthy body mass index, not smoking, having had surgery only, and no reported fatigue. Attributes associated with a decrease in physical activity following diagnosis were being female, living within the state capital city, having a lower level of education, having a stoma, having adjuvant therapy, and experiencing fatigue.

Conclusions: There is considerable scope for targeted interventions to increase the physical activity of colorectal cancer survivors, particularly for those groups that we have identified as being less active and/or have reduced their activity.

Australian Mothers' notions of risk and uncertainty in relation to their pre-teen children

In this article we examine the ways discourses of risk manifested and played out within and across two groups of Australian mothers living in two large urban centres in Australia: the first comprised of mothers who had a pre-teen child diagnosed with an eating disorder (n = 13); the second of mothers who had a pre-teen child without the symptoms or diagnosis of an eating disorder (n = 13). In 2011 and 2012, we conducted in-depth interviews with the mothers in their homes on their ideas about health and their relationships with their children. An analysis of the data collected from these interviews indicated that having a pre-teen child diagnosed with an eating disorder had a decisive impact on how the mothers constituted and responded to risk. For mothers, who had a pre-teen child with an eating disorder, risk was intensified by bio-medical discourses. The particular intensifications of risk limited the ways in which mothers could act and often threatened to undermine their abilities as competent carers. By contrast, the mothers who did not have a pre-teen child with an eating disorder spoke about risk less directly, and with less sense of immediacy. Where these mothers acknowledged risk discourses particularly in regard to health, they were in a stronger position to negotiate them. Our analysis indicates that the ways in which mothers responded to risk is contingent on circumstances and contexts. Mothers’ responses to risk were related to the calculability of the risk and their perceived capacity to manage it.

Job strain exposures vs. stress-related workers’ compensation claims in Victoria, Australia: developing a public health response to job stress

We present a comparative analysis of patterns of exposure to job stressors and stress-related workers’ compensation (WC) claims to provide an evaluation of the adequacy of claims-driven policy and practice. We assessed job strain prevalence in a 2003 population-based survey of Victorian [Australia] workers and compared these results with stress-related WC statistics for the same year. Job strain prevalence was higher among females than males, and elevated among lower vs. higher occupational skill levels. In comparison, claims were higher among females than males, but primarily among higher skill-level workers. There was some congruence between exposure and WC claims patterns. Highly exposed groups in lower socio-economic positions were underrepresented in claims statistics, suggesting that the WC insurance perspective substantially underestimates the job stress problems for these groups. Thus to provide a sufficient evidence base for equitable policy and practice responses to this growing public health problem, exposure or health outcome data are needed as an essential complement to claims statistics.

Relationship between Clinical Macular Changes and Retinal Function in Age-Related Macular Degeneration

Purpose

Different patterns of Australian adults' knowledge of foods and nutrients related to metabolic disease risk

A nationwide survey of 2022 consumers was conducted in Australia in late 2011. A short list of questions about knowledge of the nutrient composition of common foods was administered along with questions about the respondents’ food attitudes, demographics, school education and dieting practices. Overall, the results showed that nutrition knowledge was relatively high. Latent class analysis showed two groups of consumers with ‘high’ and ‘low’ knowledge of nutrition. Higher knowledge was positively associated with age, female sex, university education, experience of home economics or health education at school, having a chronic disease, and attitudes to food issues, and negatively with type 1 diabetes or the use of diabetes-control diets. The implications of the findings for nutrition communication are discussed.

The impact of interventions to prevent obesity or improve obesity related behaviours in children (0-5 years) from socioeconomically disadvantaged and/or indigenous families: a systematic review

Background
Children from disadvantaged families including those from low socioeconomic backgrounds and Indigenous families have higher rates of obesity, making early intervention a priority. The aim of this study was to systematically review the literature to examine the effectiveness of interventions to prevent obesity or improve obesity related behaviours in children 0-5 years from socioeconomically disadvantaged or Indigenous families.

Methods
Searches of major electronic databases identified articles published from 1993–2013 targeting feeding practices, anthropometric, diet, activity or sedentary behaviour outcomes. This was supplemented with snowballing from existing reviews and primary studies. Data extraction was undertaken by one author and cross checked by another. Quality assessments included both internal and external validity.

Results
Thirty-two studies were identified, with only two (both low quality) in Indigenous groups. Fourteen studies had a primary aim to prevent obesity. Mean differences between intervention and control groups ranged from -0.29 kg/m2 to -0.54 kg/m2 for body mass index (BMI) and -2.9 to -25.6% for the prevalence of overweight/obesity. Interventions initiated in infancy (under two years) had a positive impact on obesity related behaviours (e.g. diet quality) but few measured the longer-term impact on healthy weight gain. Findings amongst pre-schoolers (3–5 years) were mixed, with the more successful interventions requiring high levels of parental engagement, use of behaviour change techniques, a focus on skill building and links to community resources. Less than 10% of studies were high quality. Future studies should focus on improving study quality, including follow-up of longer-term anthropometric outcomes, assessments of cost effectiveness, acceptability in target populations and potential for implementation in routine service delivery.

Conclusion
There is an urgent need for further research on effective obesity prevention interventions for Indigenous children. The findings from the growing body of intervention research focusing on obesity prevention amongst young children from socioeconomically disadvantaged families suggest intervention effects are modest but promising. Further high quality studies with longer term follow up are required.

Interleukin-6 and tumor necrosis factor-α are not increased in patients with type 2 diabetes: Evidence that plasma interleukin-6 is related to fat mass and not insulin responsiveness

Aims/hypothesis. Our aim was to examine the possible direct relationship of interleukin-6 and TNFα with insulin sensitivity in humans. Methods. We carried out two series of euglycaemic-hyperinsulinaemic clamp experiments. In the first (CLAMP1), skeletal muscle mRNA expression and plasma concentrations of IL-6 and TNFα were examined in patients with Type 2 diabetes (n=6), subjects matched for age (n=6), and young healthy (n=11) control subjects during a 120-min supra-physiological hyperinsulinaemic (40 mU·m -2·min-1) euglycaemic clamp. In the second series of experiments (CLAMP2), patients with Type 2 diabetes (n=6) and subjects matched for age (n=7) were studied during a 240-min high-physiological hyperinsulinaemic (7 mU·m-2·min-1) euglycaemic clamp, during which arterial and venous (femoral and subclavian) blood samples were measured for IL-6 and TNFα flux. Results. In both experiments the glucose infusion rate in the patients was markedly lower than that in the other groups. In CLAMP1, basal skeletal muscle IL-6 and TNFα mRNA were the same in all groups. They were not affected by insulin and they were not related to the glucose infusion rate. In CLAMP2, neither cytokine was released from the arm or leg during insulin stimulation in either group. In both experiments plasma concentrations of these cytokines were similar in the patients and in the control subjects, although in CLAMP1 the young healthy control group had lower (p<0.05) plasma IL-6 concentrations. Using data from all subjects, a strong positive correlation (r=0.85; p<0.00001) was observed between basal plasma IL-6 and BMI. Conversely, a negative relationship (r=-0.345; p<0.05) was found between basal plasma TNFα and BMI, although this was not significant when corrected for BMI. When corrected for BMI, no relationship was observed between either basal plasma IL-6 or TNFα and GIR. Conclusions/interpretation. These data show that the increased circulating IL-6 concentrations seen in patients with Type 2 diabetes are strongly related to fat mass and not insulin responsiveness, and suggest that neither IL-6 nor TNFα are indicative of insulin resistance.

Personality disorders and physical comorbidities in adults from the United States: data from the national epidemiologic survey on alcohol and related conditions.

There is a paucity of research examining the relationship between personality disorders (PDs) and chronic physical comorbidities. Consequently, we investigated associations between individual PDs and PD Clusters, and various common disease groups [cardiovascular disease (CVD), diabetes, arthritis and gastrointestinal disease (GI)] in a nationally representative survey of adults from the United States.

Disease burden evaluation of fall-related events in the elderly due to hypoglycemia and other diabetic complications: a clinical review

A hypoglycemia-induced fall is common in older persons with diabetes. The etiology of falls in this population is usually multifactorial, and includes microvascular and macrovascular complications and age-related comorbidities, with hypoglycemia being one of the major precipitating causes. In this review, we systematically searched the literature that was available up to March 31, 2014 from MEDLINE/PubMed, Embase, and Google Scholar using the following terms: hypoglycemia; insulin; diabetic complications; and falls in elderly. Hypoglycemia, defined as blood glucose <4.0 mmol/L (70 mg/dL) requiring external assistance, occurs in one-third of elderly diabetics on glucose-lowering therapies. It represents a major barrier to the treatment of diabetes, particularly in the elderly population. Patients who experience hypoglycemia are at a high risk for adverse outcomes, including falls leading to bone fracture, seizures, cognitive dysfunction, and prolonged hospital stays. An increase in mortality has been observed in patients who experience any one of these events. Paradoxically, rational insulin therapy, dosed according to a patient's clinical status and the results of home blood glucose monitoring, so as to achieve and maintain recommended glycemic goals, can be an effective method for the prevention of hypoglycemia and falls in the elderly. Contingencies, such as clinician-directed hypoglycemia treatment protocols that guide the immediate treatment of hypoglycemia, help to limit both the duration and severity of the event. Older diabetic patients with or without underlying renal insufficiency or other severe illnesses represent groups that are at high risk for hypoglycemia-induced falls and, therefore, require lower insulin dosages. In this review, the risk factors of falls associated with hypoglycemia in elderly diabetics were highlighted and management plans were suggested. A target hemoglobin A1c level between 7% and 8% seems to be more appropriate for this population. In addition, the first-choice drugs should have good safety profiles and have the lowest probability of causing hypoglycemia - such as metformin (in the absence of significant renal impairment) and incretin enhancers - while other therapies that may cause more frequent hypoglycemia should be avoided.

Are racist attitudes related to experiences of racial discrimination? Within sample testing utilising nationally representative survey data

Although the relationship between an individual's racist attitudes and discriminatory behaviours has been widely studied, the association between racist attitudes among perpetrators and experiences of racism among targets has been under-examined. Based on data from the 2001-8 Australian Challenging Racism Project survey, this paper details a novel method to investigate the link between racist attitudes and experiences of discrimination utilising two separate models linked by nomination of cultural or ethnic groups who do not fit into Australian society (i.e., out-groups). Those identified as out-groups were more likely to report experiences of discrimination than those who were not nominated as out-groups. Overall, out-group nomination by those with racist attitudes strongly predict experiences of discrimination among these same target out-groups, OR=2.2, F(6, 12,348)=78.61, p<.001. Racist attitudes are related to racist behaviours among perpetrators that are, in turn, related to experiences of racial discrimination among targets. This study demonstrates that attitudes not only affect majority group behaviour but also drive the resulting experiences of discrimination for minority group members.

Age- and sex-related patterns of first fracture and fracture prevalence

There are few data documenting the pattern of prevalent fracture across the entire adult age range, so we aimed to address this gap by investigating the prevalence of fractures in an Australian cohort. All-cause (ever) fractures were identified for males and females enrolled in the Geelong Osteoporosis Study (Australia) using a combination of radiology-confirmed and self-reported data. First fractures were used to generate age-related frequencies of individuals who had ever sustained a fracture. Of 1,538 males and 1,731 females, 927 males and 856 females had sustained at least one fracture since birth. The proportion of all prevalent fractures in the 0-10 year age group was similar for both sexes (~10 %). In males, the proportion with prevalent fracture increased to 34.1 % for age 11-20 year. Smaller increases were observed into mid-life, reaching a plateau at ~50 % from mid to late life. The age-related prevalence of fracture for females showed a more gradual increase until mid-life. For adulthood prevalent fractures, approximately 20 % of males had sustained a first adulthood fracture in the 20-30 year age group, with a gradual increase up to the oldest age group (49.1 %), while females showed an exponential pattern of increase from the 20-30 year age group (6.8 %) to the oldest age group (60.4 %). In both sexes, those who had not sustained a fracture in childhood or early adulthood generally appeared to remain fracture-free until at least the sixth decade. When considering the prevalence of adulthood fractures across the age groups, males showed a gradual increase while females showed an exponential increase.

Enhancing and assessing group and team learning in architecture and related design contexts

EXECUTIVE SUMMARYTeamwork skills are essential in the design industry where practitioners negotiate often-conflicting design options in multi-disciplinary teams. Indeed, many of the bodies that accredit design courses explicitly list teamwork skills as essential attributes of design graduates e.g., the Australian Institute of Architects (AIA), Royal Institute of British Architects (RIBA), the National Council of Architectural Registration Boards (NCARB) of the United States and the Institution of Engineers, Australia (IEAust). In addition to the need to meet the demands of the accrediting bodies, there are many reasons for the ubiquitous use of teamwork assignments in design schools. For instance, teamwork learning is seen as being representative of work in practice where design is nearly always a collaborative activity. Learning and teaching in teamwork contexts in design education are not without particular challenges. In particular, two broad issues have been identified: first, many students leave academia without having been taught the knowledge and skills of how to design in teams; second, teaching, assessment and assignment design need to be better informed by a clear understanding of what leads to effective teamwork and the learning of teamwork skills. In recognition of the lack of a structured approach to integrating teamwork learning into the curricula of design programs, this project set out to answer three primary research questions: • How do we teach teamwork skills in the context of design? • How do we assess teamwork skills?• How do design students best learn teamwork skills?In addition, four more specific questions were investigated:1. Is there a common range of learning objectives for group-and-team-work in architecture and related design disciplines that will enable the teaching of consistent and measurable outcomes?2. Do group and team formation methods, learning styles and team-role preferences impact students’ academic and course satisfaction outcomes?3. What combinations of group-and-team formation methods, teaching and assessment models significantly improve learning outcomes?4. For design students across different disciplines with different learning styles and cultural origins, are there significant differences in performance, student satisfaction (as measured through questionnaires and unit evaluations), group-and-team working abilities and student participation?To elucidate these questions, a design-based research methodology was followed comprising an iterative series of enquiries: (a) A literature review was completed to investigate: what constitutes effective teamwork, what contributes to effectiveness in teams, what leads to positive design outcomes for teams, and what leads to effective learning in teams. The review encompassed a range of contexts: from work-teams in corporate settings, to professional design teams, to education outside of and within the design disciplines. The review informed a theoretical framework for understanding what factors impact the effectiveness of student design teams. (b) The validity of this multi-factorial Framework of Effectiveness in Student Design Teams was tested via surveys of educators’ teaching practices and attitudes, and of students’ learning experiences. 638 students and 68 teachers completed surveys: two pilot surveys for participants at the four partner institutions, which then informed two national surveys completed by participants from the majority of design schools across Australia. (c) The data collected provided evidence for 22 teamwork factors impacting team effectiveness in student design teams. Pedagogic responses and strategies to these 22 teamwork factors were devised, tested and refined via case studies, focus groups and workshops. (d) In addition, 35 educators from a wide range of design schools and disciplines across Australia attended two National Teaching Symposiums. The first symposium investigated the wider conceptualisation of teamwork within the design disciplines, and the second focused on curriculum level approaches to structuring the teaching of teamwork skills identified in the Framework.The Framework of Effectiveness in Student Design Teams identifies 22 factors impacting effective teamwork, along with teaching responses and strategies that design educators might use to better support student learning. The teamwork factors and teaching strategies are categorised according to three groups of input (Task Characteristics, Individual Level Factors and Team Level Factors), two groups of processes (Teaching Practice & Support Structures and Team Processes), and three categories of output (Task Performance, Teamwork Skills, and Attitudinal Outcomes). Eight of the 22 teamwork factors directly relate to the skills that need to be developed in students, one factor relates to design outputs, and the other thirteen factors inform pedagogies that can be designed for better learning outcomes. In Table 10 of Section 4, we outline which of the 22 teamwork factors pertain to each of five stakeholder groups (curriculum leaders, teachers, students, employers and the professional bodies); thus establishing who will make best use the information and recommendations we make. In the body of this report we summarise the 22 teamwork factors and teaching strategies informed by the Framework of Effectiveness in Student Design Teams, and give succinct recommendations arising from them. This material is covered in depth by the project outputs. For instance, the teaching and assessment strategies will be expanded upon in a projected book on Teaching Teamwork in Design. The strategies are also elucidated by examples of good practice presented in our case studies, and by Manuals on Teamwork for Teachers and Students. Moreover, the project website ( visited by representatives of stakeholder groups in Australia and Canada), is seeding a burgeoning community of practice that promises dissemination, critical evaluation and the subsequent refinement of our materials, tools, strategies and recommendations. The following three primary outputs have been produced by the project in answer to the primary research questions:1. A theoretical Framework of Effectiveness in Student Design Teams;2. Manuals on Teamwork for Teachers and Students (available from the website);3. Case studies of good/innovative practices in teaching and assessing teamwork in design;In addition, five secondary outputs/outcomes have been produced that provide more nuanced responses:4. Detailed recommendations for the professional accrediting bodies and curriculum leaders;5. Online survey data (from over 700 participants), plus Team Effectiveness Scale to determine the factors influencing effective learning and successful outputs for student design teams;6. A community of practice in policy, programs, practice and dialogue;7. A detailed book proposal (with sample chapter), submitted to prospective publishers, on Teaching Teamwork in Design; 8. An annotated bibliography (accessed via the project website) on learning, teaching and assessing teamwork.The project has already had an international impact. As well as papers presented in Canada and New Zealand, the surveys were participated in by six Canadian schools of architecture, whose teaching leaders also provided early feedback on the project aims and objectives during visits made to them by the project leader. In addition, design schools in Vancouver, Canada, and San Diego in the USA have already utilised the Teacher’s Manual, and in February 2014 the project findings were discussed at Tel Aviv University in a forum focusing on the challenges for sustainability in architectural education.

Dealing with alcohol-related problems in the night-time economy: a study protocol for mapping trends in harm and stakeholder views surrounding local community level interventions

This project will provide a comprehensive investigation into the prevalence of alcohol-related harms and community attitudes in the context of community-based interventions being implemented to reduce harm in two regional centres of Australia. While considerable experimentation and innovation to address these harms has occurred in both Geelong and Newcastle, only limited ad-hoc documentation and analysis has been conducted on changes in the prevalence of harm as a consequence, leaving a considerable gap in terms of a systematic, evidence-based analysis of changes in harm over time and the need for further intervention. Similarly, little evidence has been reported regarding the views of key stakeholder groups, industry, government agencies, patrons or community regarding the need for, and the acceptability of, interventions to reduce harms. This project will aim to provide evidence regarding the impact and acceptability of local initiatives aimed at reducing alcohol-related harms.

MicroRNAs: biogenesis, roles for carcinogenesis and as potential biomarkers for cancer diagnosis and prognosis

MicroRNAs (miRNAs) are short non-coding RNAs of 20-24 nucleotides that play important roles in carcinogenesis. Accordingly, miRNAs control numerous cancer-relevant biological events such as cell proliferation, cell cycle control, metabolism and apoptosis. In this review, we summarize the current knowledge and concepts concerning the biogenesis of miRNAs, miRNA roles in cancer and their potential as biomarkers for cancer diagnosis and prognosis including the regulation of key cancer-related pathways, such as cell cycle control and miRNA dysregulation. Moreover, microRNA molecules are already receiving the attention of world researchers as therapeutic targets and agents. Therefore, in-depth knowledge of microRNAs has the potential not only to identify their roles in cancer, but also to exploit them as potential biomarkers for cancer diagnosis and identify therapeutic targets for new drug discovery.

A critical ethnography of communication processes involving the management of oral chemotherapeutic agents by patients with a primary diagnosis of colorectal cancer: study protocol.

AIM: To describe the protocol used to examine the processes of communication between health professionals, patients and informal carers during the management of oral chemotherapeutic medicines to identify factors that promote or inhibit medicine concordance. BACKGROUND: Ideally communication practices about oral medicines should incorporate shared decision-making, two-way dialogue and an equality of role between practitioner and patient. While there is evidence that healthcare professionals are adopting these concordant elements in general practice there are still some patients who have a passive role during consultations. Considering oral chemotherapeutic medications, there is a paucity of research about communication practices which is surprising given the high risk of toxicity associated with chemotherapy. DESIGN: A critical ethnographic design will be used, incorporating non-participant observations, individual semi-structured and focus-group interviews as several collecting methods. METHODS: Observations will be carried out on the interactions between healthcare professionals (physicians, nurses and pharmacists) and patients in the outpatient departments where prescriptions are explained and supplied and on follow-up consultations where treatment regimens are monitored. Interviews will be conducted with patients and their informal carers. Focus-groups will be carried out with healthcare professionals at the conclusion of the study. These several will be analysed using thematic analysis. This research is funded by the Department for Employment and Learning in Northern Ireland (Awarded February 2012). DISCUSSION: Dissemination of these findings will contribute to the understanding of issues involved when communicating with people about oral chemotherapy. It is anticipated that findings will inform education, practice and policy.