Biological maturity and primary school children's physical activity : influence of different physical activity assessment instruments

Biological maturation may attenuate hypothesized sex differences in children’s physical activity but overall the evidence for this is equivocal. In this study, we investigated how the selection of different physical activity assessment instruments affects the detected relationship between biological maturation and late primary school children’s physical activity. Altogether, 175 children (97 girls, 78 boys) aged 10.690.3 years completed the PAQ-C self-report questionnaire and wore ActiGraph GT1M accelerometers for 5 consecutive days. Maturity status was predicted by estimating attainment of age at peak height velocity. Following initial exploration of sex differences in PAQ-C (t-test) and multiple ActiGraph outcome variables (MANOVA), the influence of maturity status was controlled using ANCOVA and MANCOVA. Unadjusted analyses revealed that boys were significantly more active than girls according to the PAQ-C (PB0.0001, d0.52) and ActiGraph (PB0.0001, d0.360.72). After controlling for maturity status, the differences in PAQ-C scores increased (P0.001, d0.64), but the significant differences disappeared for the ActiGraph data (P0.36, d0.170.33). The detected relationship between maturity status and late primary school children’s physical activity is dependent on the physical activity assessment tool employed, reflecting the different aspects of physical activity captured by the respective measures.

Evaluation framework underpinning the digital divas programme

In Australia, as elsewhere, women’s participation rates in Information Technology (IT) have been low. IT is the generic term used to refer to the many courses in the Computer Science, and Information Systems disciplines. While there have been a number of intervention programmes implemented aimed at encouraging women into IT and retaining them once there, few have included evaluations of the efficacy of the intervention. Thus little is known about the factors contributing to the success, or lack of success, of the interventions, or of the medium and longer term impacts for the participants. In this paper we briefly describe an intervention programme implemented with girls in the high school years. We present an evaluation framework providing a detailed overview of the aims and processes involved in the evaluation of the programme. Data for the evaluation were embedded within the data gathering methods associated with the research on the intervention itself.

MAAGs: the next generation. A study of the development of medical audit advisory groups and the arrangements for supporting clinical audit in primary care

Background: MAAGs have, historically, been disparate organisations with a lack of central direction, albeit with the same goal: to develop and support the performance of audit in primary care. This goal has been (and is being) achieved in a number of ways all over the country. In the last two years, MAAGs have witnessed many changes in primary care and are adapting themselves to suit these new arrangements at a local level.

Aim: To formalise our knowledge of where MAAGs are going, how they are getting there and the support they are receiving.

Method: A postal questionnaire to the 104 MAAGs in England and Wales, addressing 6 main issues of relevance to the development of MAAGs and the support they are receiving.

Results: At least two MAAGs have dissolved, leaving a possible total of 102 still in existence. Of these, 76 (74.5%) responded to the survey. The composition of the MAAG committee has changed dramatically since the inception of MAAGs in 1990, and staffing levels appear to have risen substantially. MAAGs appear to be more adequately funded by their health authorities than has previously been reported and many are actively seeking additional sources of funding. There is still large variation in levels of MAAG funding. Furthermore, funding is unrelated to the number of GPs or practices served. Security for MAAG staff appears to have been addressed in many areas, with 84% of MAAGs having at least one member of staff on a permanent employment contract. Many MAAGs are developing rolling programmes in an attempt to eliminate the short-sighted approach to the development of clinical audit that has existed since MAAGs were first set up.

Conclusion: Many MAAGs (with the obvious exception of those that have been dissolved) appear to be thriving without central direction or initiative. It is now evident that we were a little hasty in our concerns for the future of MAAGs beyond April 1996. It would seem that many organisations have taken the situation which arose two years ago as an opportunity to grow and develop in ways that may not have been possible within the confines of the Health Circular.

The delivery of a telephone coaching programme to people with type 2 diabetes by practice nurses in Victoria, Australia : a qualitative evaluation

Aim.  To evaluate telephone coaching undertaken by practice nurses in a randomised controlled trial of self-management support for people with type 2 diabetes.

Background.  Qualitative evaluation of the processes that take place in randomised controlled trials has the advantage of providing information on those variables that contribute to the success or failure of the randomised controlled trial. This additional information can be used to improve or modify chronic disease management programme designs.

Methods.  Grounded theory was used to analyse transcriptions of telephone coaching sessions between practice nurses and patient participants in the randomised controlled trial.

Findings.   Analysis of transcriptions found that patient participants had complex multiple medical conditions to manage, as well as maintaining their daily lives. Two approaches to working with this complexity by practice nurses emerged. We characterised one as ‘treat to target’ and the other as ‘personalised care’. While each approach shapes identities available to patients within the relationship with the practice nurse, the impact or effectiveness of these approaches on outcomes has yet to be reported.

Conclusions.  Telephone coaching takes place in complex social contexts as well as complex medical conditions. People with type 2 diabetes must manage their diabetes care and their care of other conditions within their social contexts. This means a constant negotiation of priorities.

Relevance to clinical practice.  Awareness of how health professional support for patients’ self-management becomes a relationship and element of the negotiated identity of patients is important in adapting clinical guideline-based protocols to achieving targets in the management of chronic illness.

Primary science education : reality or myth

Amidst an international call for a re-formed and re-envisaged science education agenda, the actual state of teaching science in primary schools is still much the same as it was 15 years or more ago. Whilst much research has provided insights into possible approaches for primary science education, we still find ‘blockers’ to a fully implemented science curriculum in schools. Pre-service teachers, as part of their assessment in a science education unit, interviewed primary teachers and asked the reason behind the approach to science in schools. The responses were varied, with some schools and teachers paying lip service to science education, whereas, in schools where science is a critical element of the curriculum, it is still mainly through the driving force of one enthusiastic teacher. This research will report on the aggregated responses from the surveys and attempt to identify possible ways forward, as suggested by data analysis.

What do education students value in primary mathematics curriculum?

In this paper the priorities that second year education students hold for primary mathematics content and student learning are presented. Data were collected from students who participated in a tutorial task that was used to engage students in discussion about primary mathematics curriculum. The data were collected annually for four years. Reflections about the mathematics subjects in the course are made within the context of current research and mathematics curriculum policy. Inferences are drawn about education students’ beliefs.

Student views of computer based-mathematics in the middle years : does gender make a difference?

How the use of computers in mathematics classrooms was viewed by students in two middle years mathematics classrooms was the focus of the research described in this paper. The primary data sources consisted of questionnaires, classroom observations supported by videotaping of mathematics lessons, and interviews with two girls and two boys from each class. Thus both qualitative and quantitative methods were used. Girls viewed the computer-based lessons less favourably than did boys. In general, the boys were likely to believe that computers contributed to their experiencing pleasure in these lessons, and to making mathematics more relevant to them. Girls were typically more concerned about whether computers facilitated learning and enabled success in mathematics. The attitudes of students to computer-based mathematics were related to their views of computers.

Using formative research to develop CHANGE! : a curriculum-based physical activity promoting intervention

Background : Low childhood physical activity levels are currently one of the most pressing public health concerns. Numerous school-based physical activity interventions have been conducted with varied success. Identifying effective child-based physical activity interventions are warranted. The purpose of this formative study was to elicit subjective views of children, their parents, and teachers about physical activity to inform the design of the CHANGE! (Children's Health, Activity, and Nutrition: Get Educated!) intervention programme.

Methods : Semi-structured mixed-gender interviews (group and individual) were conducted in 11 primary schools, stratified by socioeconomic status, with 60 children aged 9-10 years (24 boys, 36 girls), 33 parents (4 male, 29 female) and 10 teachers (4 male, 6 female). Questions for interviews were structured around the PRECEDE stage of the PRECEDE-PROCEDE model and addressed knowledge, attitudes and beliefs towards physical activity, as well as views on barriers to participation. All data were transcribed verbatim. Pen profiles were constructed from the transcripts in a deductive manner using the Youth Physical Activity Promotion Model framework. The profiles represented analysis outcomes via a diagram of key emergent themes.

Results : Analyses revealed an understanding of the relationship between physical activity and health, although some children had limited understanding of what constitutes physical activity. Views elicited by children and parents were generally consistent. Fun, enjoyment and social support were important predictors of physical activity participation, though several barriers such as lack of parental support were identified across all group interviews. The perception of family invested time was positively linked to physical activity engagement.

Conclusions : Families have a powerful and important role in promoting health-enhancing behaviours. Involvement of parents and the whole family is a strategy that could be significant to increase children's physical activity levels. Addressing various perceived barriers to such behaviours therefore, remains imperative.

Socioeconomic variation in diet and activity-related behaviours of Australian children and adolescents aged 2–16 years

Background

Evidence for age-related variation in the relationship between obesity-related behaviours and socioeconomic position may assist in the targeting of dietary and physical activity interventions among children.
Objective

To investigate the relationship between different indicators of socioeconomic position and obesity-related behaviours across childhood and adolescence.
Methods

Data were from 4487 children aged 2 to 16 years participating in the cross-sectional 2007 Australian National Children's Nutrition and Physical Activity Survey. Socioeconomic position was defined by the highest education of the primary or secondary carer and parental income. Activity was assessed using recall methods with physical activity also assessed using pedometers. Intake of energy-dense drinks and snack foods, fruits and vegetables was assessed using 2 × 24-h dietary recalls.
Results

A socioeconomic gradient was evident for each dietary measure (although in age-specific analyses, not for energy-dense snacks in older children), as well as television viewing, but not physical activity. Whether each behaviour was most strongly related to parental income or education of the primary or secondary carer was age and sex dependent. The socioeconomic gradient was strongest for television viewing time and consumption of fruit and energy-dense drinks.
Conclusions

A strong socioeconomic gradient in eating behaviours and television viewing time was observed. Relationships for particular behaviours differed by age, sex and how socioeconomic position was defined. Socioeconomic indicators define different population groups and represent different components of socioeconomic position. These findings may provide insights into who should be targeted in preventive health efforts at different life stages.

Which interventions offer best value for money in primary prevention of cardiovascular disease?

Background
Despite many decades of declining mortality rates in the Western world, cardiovascular disease remains the leading cause of death worldwide. In this research we evaluate the optimal mix of lifestyle, pharmaceutical and population-wide interventions for primary prevention of cardiovascular disease.

Methods and Findings
In a discrete time Markov model we simulate the ischaemic heart disease and stroke outcomes and cost impacts of intervention over the lifetime of all Australian men and women, aged 35 to 84 years, who have never experienced a heart disease or stroke event. Best value for money is achieved by mandating moderate limits on salt in the manufacture of bread, margarine and cereal. A combination of diuretic, calcium channel blocker, ACE inhibitor and low-cost statin, for everyone with at least 5% five-year risk of cardiovascular disease, is also cost-effective, but lifestyle interventions aiming to change risky dietary and exercise behaviours are extremely poor value for money and have little population health benefit.

Conclusions
There is huge potential for improving efficiency in cardiovascular disease prevention in Australia. A tougher approach from Government to mandating limits on salt in processed foods and reducing excessive statin prices, and a shift away from lifestyle counselling to more efficient absolute risk-based prescription of preventive drugs, could cut health care costs while improving population health.

Dietary salt intake assessed by 24 h urinary sodium excretion in Australian schoolchildren aged 5–13 years

Objective To measure total daily salt intake using 24 h urinary Na excretion within a sample of Victorian schoolchildren aged 5–13 years and to assess discretionary salt use habits of children and parents.

Design Cross-sectional study.

Setting Completed within a convenience sample of independent primary schools (n 9) located in Victoria, Australia.

Subjects Two hundred and sixty children completed a 24 h urine collection over a school (34 %) or non-school day (66 %). Samples deemed incomplete (n 18), an over-collection (n 1) or that were incorrectly processed at the laboratory (n 3) were excluded.

Results The sample comprised 120 boys and 118 girls with a mean age of 9·8 (sd 1·7) years. The average 24 h urinary Na excretion (n 238) was 103 (sd 43) mmol/24 h (salt equivalent 6·0 (sd 2·5) g/d). Daily Na excretion did not differ by sex; boys 105 (sd 46) mmol/24 h (salt equivalent 6·1 (sd 2·7) g/d) and girls 100 (sd 41) mmol/24 h (salt equivalent 5·9 (sd 2·4) g/d; P = 0·38). Sixty-nine per cent of children (n 164) exceeded the recommended daily Upper Limit for Na. Reported discretionary salt use was common: two-thirds of parents reported adding salt during cooking and almost half of children reported adding salt at the table.

Conclusions The majority of children had salt intakes exceeding the recommended daily Upper Limit. Strategies to lower salt intake in children are urgently required, and should include product reformulation of lower-sodium food products combined with interventions targeting discretionary salt use within the home.

Cross-sectional analysis of association between socioeconomic status and utilization of primary total hip joint replacements 2006-7 : Australian orthopaedic association national joint replacement registry

Background The utilization of total hip replacement (THR) surgery is rapidly increasing, however few data examine whether these procedures are associated with socioeconomic status (SES) within Australia. This study examined primary THR across SES for both genders for the Barwon Statistical Division (BSD) of Victoria, Australia.

Methods Using the Australian Orthopaedic Association National Joint Replacement Registry data for 2006–7, primary THR with a diagnosis of osteoarthritis (OA) among residents of the BSD was ascertained. The Index of Relative Socioeconomic Disadvantage was used to measure SES; determined by matching residential addresses with Australian Bureau of Statistics census data. The data were categorised into quintiles; quintile 1 indicating the most disadvantaged. Age- and sex-specific rates of primary THR per 1,000 person years were reported for 10-year age bands using the total population at risk.

Results Females accounted for 46.9% of the 642 primary THR performed during 2006–7. THR utilization per 1,000 person years was 1.9 for males and 1.5 for females. The highest utilization of primary THR was observed in those aged 70–79 years (males 6.1, and females 5.4 per 1,000 person years). Overall, the U-shaped pattern of THR across SES gave the appearance of bimodality for both males and females, whereby rates were greater for both the most disadvantaged and least disadvantaged groups.

Conclusions Further work on a larger scale is required to determine whether relationships between SES and THR utilization for the diagnosis of OA is attributable to lifestyle factors related to SES, or alternatively reflects geographic and health system biases. Identifying contributing factors associated with SES may enhance resource planning and enable more effective and focussed preventive strategies for hip OA.

Utilisation of primary total knee joint replacements across socioeconomic status in the Barwon Statistical Division, Australia 2006-7 : a cross-sectional study

Objectives There are few Australian data that examine the association between total knee joint replacement (TKR) utilisation and socioeconomic status (SES). This study examined TKR surgeries with a diagnosis of osteoarthritis (OA) performed for residents of Barwon Statistical Division (BSD) for 2006–2007.

Design Cross-sectional.

Setting BSD, South-eastern Victoria, Australia

Participants All patients who underwent a TKR for OA, 2006–2007, and whose residential postcode was identified as within the BSD of Australia, and for whom SES data were available, were eligible for inclusion.

Primary outcome measure Primary TKR data ascertained from the Australian Orthopaedic Association National Joint Replacement Registry. Residential addresses were matched with the Australian Bureau of Statistics census data, and the Index of Relative Socioeconomic Disadvantage was used to determine SES, categorised into quintiles whereby quintile 1 indicated the most disadvantaged and quintile 5 the least disadvantaged. Age-specific and sex-specific rates of TKR utilisation per 1000 person-years were reported for 10-year age bands.

Results Females accounted for 62.7% of the 691 primary TKR surgeries performed during 2006–2007. The greatest utilisation rates of TKR in males was 7.6 observed in those aged >79 years, and in 10.2 in females observed in those aged 70–79 years. An increase in TKR was observed for males in SES quintile four compared to quintile 1 in which the lowest utilisation which was observed (p=0.04). No differences were observed in females across SES quintiles.

Conclusions Further investigation is warranted on a larger scale to examine the role that SES may play in TKR utilisation, and to determine whether any social disparities in TKR utilisation reflect health system biases or geographic differences.

Primary hemiarthroplasty for treatment of proximal humeral fractures

Background: Primary hemiarthroplasty of the shoulder is used to treat complex proximal humeral fractures, although the reported functional results following this method of treatment have varied widely. The aim of this study was to prospectively assess the prosthetic survival and functional outcomes in a large series of patients treated with shoulder hemiarthroplasty for a proximal humeral fracture. By determining the factors that affected the outcome, we also aimed to produce models that could be used clinically to estimate the functional outcome at one year following surgery.

Methods: A thirteen-year observational cohort study of 163 consecutive patients treated with hemiarthroplasty for a proximal humeral fracture was performed. Twenty-five patients died or were lost to follow-up in the first year after treatment, leaving 138 patients who had assessment of shoulder function with use of the modified Constant score at one year postinjury.

Results: The overall rate of prosthetic survival was 96.9% at one year, 95.3% at five years, and 93.9% at ten years. The overall median modified Constant score was 64 points at one year, with a typically good score for pain relief (median, 15 points) and poorer scores, with a greater scatter of values, for function (median, 12 points), range of motion (median, 24 points), and muscle power (median, 14 points). Of the factors that were assessed immediately after the injury, only patient age, the presence of a neurological deficit, tobacco usage, and alcohol consumption were significantly predictive of the one-year Constant score (p < 0.05). Of the factors that were assessed at six weeks postinjury, those that predicted the one-year Constant score included the age of the patient, the presence of a persistent neurological deficit, the need for an early reoperation, the degree of displacement of the prosthetic head from the central axis of the glenoid seen radiographically, and the degree of displacement of the tuberosities seen radiographically.

Conclusions: Primary shoulder hemiarthroplasty performed for the treatment of a proximal humeral fracture in medically fit and cooperative adults is associated with satisfactory prosthetic survival at an average of 6.3 years. Although the shoulder is usually free of pain following this procedure, the overall functional result, in terms of range of motion, function, and power, at one year varies. A good functional outcome can be anticipated for a younger individual who has no preoperative neurological deficit, no postoperative complications, and a satisfactory radiographic appearance of the shoulder at six weeks. The results are poorer in the larger group of elderly patients who undergo this procedure, especially if they have a neurological deficit, a postoperative complication requiring a reoperation, or an eccentrically located prosthesis with retracted tuberosities.