Management of tendinopathy

Overuse disorders of tendons, or tendinopathies, present a challenge to sports physicians, surgeons, and other health care professionals dealing with athletes. The Achilles, patellar, and supraspinatus tendons are particularly vulnerable to injury and often difficult to manage successfully. Inflammation was believed central to the pathologic process, but histopathologic evidence has confirmed the failed healing response nature of these conditions. Excessive or inappropriate loading of the musculotendinous unit is believed to be central to the disease process, although the exact mechanism by which this occurs remains uncertain. Additionally, the location of the lesion (for example, the midtendon or osteotendinous junction) has become increasingly recognized as influencing both the pathologic process and subsequent management.

The mechanical, vascular, neural, and other theories that seek to explain the pathologic process are explored in this article. Recent developments in the nonoperative management of chronic tendon disorders are reviewed, as is the rationale for surgical intervention. Recent surgical advances, including minimally invasive tendon surgery, are reviewed. Potential future management strategies, such as stem cell therapy, growth factor treatment, and gene transfer, are also discussed.

Association of western and traditional diets with depression and anxiety in women

Objective: Key biological factors that influence the development of depression are modified by diet. This study examined the extent to which the high-prevalence mental disorders are related to habitual diet in 1,046 women ages 20–93 years randomly selected from the population.

Method: A diet quality score was derived from answers to a food frequency questionnaire, and a factor analysis identified habitual dietary patterns. The 12-item General Health Questionnaire (GHQ-12) was used to measure psychological symptoms, and a structured clinical interview was used to assess current depressive and anxiety disorders.

Results: After adjustments for age, socioeconomic status, education, and health behaviors, a "traditional" dietary pattern characterized by vegetables, fruit, meat, fish, and whole grains was associated with lower odds for major depression or dysthymia and for anxiety disorders. A "western" diet of processed or fried foods, refined grains, sugary products, and beer was associated with a higher GHQ-12 score. There was also an inverse association between diet quality score and GHQ-12 score that was not confounded by age, socioeconomic status, education, or other health behaviors.

Conclusions: These results demonstrate an association between habitual diet quality and the high-prevalence mental disorders, although reverse causality and confounding cannot be ruled out as explanations. Further prospective studies are warranted.

Physical activity levels of normal-weight and overweight girls and boys during primary school recess

Objective: This study aimed to compare moderate-to-vigorous physical activity (MVPA) and vigorous physical activity (VPA) in normal-weight and overweight boys and girls during school recess.

Research Methods and Procedures: Four hundred twenty children, age 6 to 10 years, were randomly selected from 25 schools in England. Three hundred seventy-seven children completed the study. BMI was calculated from height and weight measurements, and heart rate reserve thresholds of 50% and 75% reflected children's engagement in MVPA and VPA, respectively.

Results: There was a significant main effect for sex and a significant interaction between BMI category and sex for the percent of recess time spent in MVPA and VPA. Normal-weight girls were the least active group, compared with overweight boys and girls who were equally active. Fifty-one boys and 24 girls of normal weight achieved the 40% threshold; of these, 30 boys and 10 girls exceeded 50% of recess time in MVPA. Eighteen overweight boys and 22 overweight girls exceeded the 40% threshold, whereas 8 boys and 8 girls exceeded the 50% threshold.

Discussion: Overweight boys were significantly less active than their normal-weight male counterparts; this difference did not hold true for girls. Even though nearly double the number of normal-weight children achieved the 40% of MVPA during recess compared with overweight children, physical activity promotion in school playgrounds needs to be targeted not only at overweight but at other health parameters, as 40 overweight children met the 40% MVPA target proposed for recess

The self-reported personal wellbeing of a sample of Australian injecting drug users

Aims To examine the self-reported personal wellbeing of a sample of Australian injecting drug users (IDU) using a standardized instrument and determine the key correlates of variations in self-reported personal wellbeing.

Design, setting and participants Cross-sectional survey of 881 Australian IDU.

Measurements Self-reported personal wellbeing collected using the Personal Wellbeing Index (PWI).

Findings IDU scored significantly lower than the general Australian population on the PWI and all subscales. Lower PWI scores were associated with a range of socio-demographic, drug use and other health and social characteristics. Across all PWI subscales, lower personal wellbeing scores were associated with unemployment, past 6-month mental health problems and more frequent injecting (all P < 0.05).

Conclusions The PWI is sufficiently sensitive to distinguish between IDU and the general population, and to identify key correlates of PWI among IDU. Some domains canvassed within the scale, such as health, standard of living and life achievements, are well within the scope of current intervention strategies, such as pharmacotherapy maintenance treatment and housing and employment support services. This suggests that the PWI could be useful in clinical settings by allowing structured identification of the areas of a person's life to be addressed as a part of a treatment regimen. In order to inform targeted prevention and intervention efforts, longitudinal studies of PWI and its correlates among IDU are required.

Daring to Care : is spirituality sustainable in organizations providing healthcare?

Healthcare workers are challenged to dare to care enough to provide a service that is holistic. This involves being in tune with their own spirituality and the spiritual needs of their patients or clients. Spirituality and compassion are important concepts in the ministry of nurses and other health professionals. Compassion also has links with mercy, although there is debate as to whether mercy is the same as compassion for deserving or undeserving sufferers. However, healthcare workers need to care for sufferers even if their suffering is not deserved, where such compassion is intrinsic and/or out of duty. It involves acting altruistically. Faith-based organizations are best equipped to undertake this holistic ministry but as they are becoming increasingly reliant on government funding to help finance expensive health services they encounter rationalistic pressures from these funding sources may restrict the way they deliver these services. Decision and policymakers are encouraged to embrace altruistic values rather than the egoistic values of economic rationalism, not least because the nature of healthcare has an inherent emphasis on altruistic emotions, especially compassion.

Vitamin D deficiency may play a role in depression

Vitamin D is known to be widely deficient in Western populations. The implications of this in terms of bone health are increasingly understood, yet its impact on other health areas, particularly mental health, is unclear. Recent data suggests that hypovitaminosis D may be common, especially in the elderly. Other studies have suggested that low levels of vitamin D are associated with poor mood. There are a number of trials that have suggested a role for Vitamin D in the supplementary treatment of depression. Dose may be a critical issue, as sun exposure and dietary intake may be low and high doses may be required.

Exercise and Sports Science Australia position statement on exercise training and chronic heart failure

Chronic heart failure (CHF) is a complex syndrome characterised by progressive decline in left ventricular function, low exercise tolerance and raised mortality and morbidity. Regular exercise participation has been shown to be a safe and effective treatment modality in the majority of CHF patients, partially reversing some of the maladaptations evident in myocardial and skeletal muscle function, and resulting in improvements in physical fitness and quality of life, and perhaps reduced mortality. The volume and intensity of exercise that is recommended depends on the syndrome severity, however in most patients it should consist of a combination of low-to-moderate intensity aerobic (endurance) exercise on most days of the week and individually prescribed low-to-moderate intensity resistance (strength) training at least twice per week. Additionally, all patients should be closely monitored prior to and during exercise for contraindications by an appropriately trained health professional. The purpose of this statement is to inform and guide exercise practitioners and health professionals in the safe and effective prescription and supervision of exercise for patients with CHF.

Breakfast size is related to body mass index for men, but not women

The objective of this study was to examine the effect of self-reported breakfast size, daily eating, and other health habits on body mass index (BMI). We hypothesized that a consumption of a substantial breakfast compared with skipping or small breakfasts would be associated with lower BMI. Three independent, cross-sectional, screening surveys were conducted by Sydney Adventist Hospital in 1976, 1986, and 2005 in the surrounding community. The archived survey forms of 384 men and 338 women in 1976, 244 men and 229 women in 1986, and 270 men and 62 women in 2005 were randomly selected. Body mass index was determined from height and weight measured by hospital staff. The reported amount consumed at breakfast was one of several eating habits that predicted BMI for men but not women. It explained 5% to 6% of the variance in male BMI in all 3 years examined. As the reported breakfast amount increased, men's BMI decreased. Lifestyle confounders including vegetarianism and physical activity did not affect this relationship. However, the consumption of breakfast was significantly positively associated with consumption of cereals, bread, fruit, and spreads, while coffee consumption was significantly associated with smaller breakfasts or breakfast skipping. The consumption of relatively large breakfasts may influence BMI in men, and its promotion may help reduce the prevalence of obesity in Australia and elsewhere.

Managing depression in patients with vision impairment : a descriptive study of practitioners' beliefs and confidence

Aim: Depression is common in older adults with vision impairment yet it often remains unidentified and untreated.
Eye health professionals (EHPs) and rehabilitation workers (RWs) may be able to assist in detecting depression. This study identified EHPs’ and RWs’ beliefs about depression and confidence in working with patients with vision
impairment and depression.
Methods: A self-administered cross-sectional survey of 94 EHPs and RWs assessed beliefs about the symptoms and treatment for depression, and confidence in working with depressed people with vision impairment.
Results: Participants showed awareness of both the symptoms and treatment options for depression. However,
some important misconceptions were identified and many symptoms of depression were commonly attributed to
vision loss. Participants lacked confidence in communicating about depression with patients and their families.
Conclusions: Training programs are needed to enable EHPs and RWs to confidently identify depression and
discuss appropriate treatment and referral options with their patients.

Quantities of foods consumed by 12- to 24-month-old New Zealand children

Aim:  The present study aimed to estimate small, median and large daily quantities of frequently consumed foods and identify which food groups are important sources of key micronutrients for 12- to 24-month-old New Zealand children.

Methods:  A community-based cross-sectional survey was conducted in three cities in the South Island of New Zealand. Healthy toddlers (n = 188) were randomly selected using multistage sampling. Three non-consecutive 1-day weighed food records were collected from each child and the frequencies and daily quantities of foods and beverages, and important sources of iron and zinc, were determined.

Results:  Fifty percent or more of the children consumed the following foods at least once over 3 days (median gram intake among toddlers who consumed the food): milk (366 g), white bread (29 g), banana (70 g), potato (34 g), cheese (12 g), apple (39 g), ‘Weetbix’ whole-wheat breakfast cereal (16 g), yeast extract spread (‘Marmite’, ‘Vegemite’) (2 g), carrot (17 g) and margarine (4 g). Dairy, cereals and the meat/fish/poultry/eggs/nuts food group were the most important sources of iron and zinc in the toddlers' diets, providing 69.1% of iron and 86.3% of zinc.

Conclusion:  This research provides dietitians, other health professionals, researchers and policy-makers with detailed information on daily quantities of foods and beverages frequently consumed by toddlers that can be used for dietetic counselling, dietary assessment, and to develop food-based dietary guidelines specifically for toddlers.

Communication pathways in community aged care: an Australian study

Background:
Health and social care practitioners collaborate in discharge planning for older people. Difficulties securing timely and quality discharge information and unclear role boundaries can be challenging. There are limited reports in the literature describing community-based practitioners' roles communicating client information.

Aim:
To describe the roles of community-based practitioners in communication of older clients' information in an Australian context.

Design:
A descriptive and exploratory qualitative research design was applied.

Methods:
Four focus groups were conducted in 2009 with a small sample (n = 16) of district nurses, practice nurses and aged care case managers.

Results:
All participants described communication as a core characteristic of their role focused on minimising risks for older people. Participants valued dialogue with other health and social care providers in real time with an emphasis on telephone communication, face-to-face meetings, and case conferences. Telephone communication was considered important where there was an urgent need to problem solve. Written communication was noted as less effective.

Conclusions:
There is an increasing need for stronger models of communication in community-based settings to facilitate safe, efficient and sustainable health and social outcomes for older people.

Implications for practice:
There is limited available research with this focus to guide practice. Findings from this exploratory study indicate a number of important areas for further research: (i) to understand how communication feedback systems and pathways between community and inpatient providers could improve information exchange and (ii) to describe community nurses' roles in communication and medication risks for older people.

Cambodian migrant women's postpartum experiences in Victoria, Australia

Objective: to explore the postpartum experiences of Cambodian born migrant women who gave birth for the first time in Victoria, Australia between 2000 and 2010. Design: an ethnographic study with 35 women using semi-structured and unstructured interviews and participant observation; this paper draws on interviews with 20 women who fit the criteria of first time mothers who gave birth in an Australian public hospital. Setting: the City of Greater Dandenong, Victoria Australia. Participants: twenty Cambodian born migrant women aged 23-30 years who gave birth for the first time in a public hospital in Victoria, Australia. Findings: after one or two home visits by midwives in the first 10 day postpartum women did not see a health professional until 4-6 weeks postpartum when they presented to the MCH centre. Women were home alone, experienced loneliness and anxiety and struggled with breast feeding and infant care while they attempted to follow traditional Khmer postpartum practices. Implications for practice: results of this study indicate that Cambodian migrant women who are first time mothers in a new country with no female kin support in the postpartum period experience significant emotional stress, loneliness and social isolation and are at risk of developing postnatal depression. These women would benefit from the introduction of a midwife-led model of care, from antenatal through to postpartum, where midwives provide high-intensity home visits, supported by interpreters, and when required refer women to professionals and community services such as Healthy Mothers Healthy Babies (Victoria Department of Health, 2011) for up to 6 weeks postpartum

Improving gambling survey research using dual-frame sampling of landline and mobile phone numbers

Gambling prevalence studies are typically conducted within a single (landline) telephone sampling frame. This practice continues, despite emerging evidence that significant differences exist between landline and mobile (cell) phone only households. This study utilised a dual-frame (landline and mobile) telephone sampling methodology to cast light on the extent of differences across groups of respondents in respect to demographic, health, and gambling characteristics.

A total of 2,014 participants from across Australian states and territories ranging in age from 18 to 96 years participated. Interviews were conducted using computer assisted telephone interviewing technology where 1,012 respondents from the landline sampling frame and 1,002 from the mobile phone sampling frame completed a questionnaire about gambling and other health behaviours. Responses across the landline sampling frame, the mobile phone sampling frame, and the subset of the mobile phone sampling frame that possessed a mobile phone only (MPO) were contrasted.

The findings revealed that although respondents in the landline sample (62.7 %) did not significantly differ from respondents in the mobile phone sample (59.2 %) in gambling participation in the previous 12 months, they were significantly more likely to have gambled in the previous 12 months than the MPO sample (56.4 %). There were no significant differences in internet gambling participation over the previous 12 months in the landline sample (4.7 %), mobile phone sample (4.7 %) and the MPO sample (5.0 %). However, endorsement of lifetime problem gambling on the NODS-CLiP was significantly higher within the mobile sample (10.7 %) and the MPO sample (14.8 %) than the landline sample (6.6 %).

Our research supports previous findings that reliance on a traditional landline telephone sampling approach effectively excludes distinct subgroups of the population from being represented inresearch findings. Consequently, we suggest that research best practice necessitates the use of a dual- rame sampling methodology. Despite inherent logistical and cost issues, this approach  needs to become the norm in gambling survey research.

Integrated depression management: a proposed trial of a new model of care in a low vision rehabilitation setting

Purpose:
Depression is a common problem among people with visual impairment and contributes to functional decline. This article presents a study protocol to evaluate a new model of care for those patients with depressive symptoms in which psychological treatment is integrated into low vision rehabilitation services. Low vision staff will be trained to deliver "problem solving therapy for primary care" (PST-PC), an effective psychological treatment developed specifically for delivery by non-mental health care staff. PST-PC is delivered in 8 weekly telephone sessions of 30-45 minutes duration and 4 monthly maintenance sessions. We predict this new integrated model of care will significantly reduce depressive symptoms and improve the quality of life for people with visual impairment.

Methods and Design:
A randomized controlled trial of PST-PC will be implemented nationally across low vision rehabilitation services provided by Vision Australia. Clients who screen positive for depressive symptoms and meet study criteria will be randomized to receive PST-PC or usual care, consisting of a referral to their general practitioner for more detailed assessment and treatment. Outcome measures include depressive symptoms and behaviors, quality of life, coping and psychological adjustment to visual impairment. Masked assessments will take place pre- and post-intervention as well as at 6- and 12-month follow-up.

Conclusion:
We anticipate that this innovative service delivery model will lead to sustained improvements in clients' quality of life in a cost effective manner and provide an innovative service delivery model suitable for other health care areas in which depression is co-morbid.