Comorbidites of overweight/obesity experienced in adolescence : longitudinal study

Objectives: Adolescent obesity is linked to measurable, asymptomatic metabolic and cardiovascular precursors, but its associations with adolescents’ experienced health and morbidity is less clear. The objective of this paper was to determine (1) Prevalence of comorbidities experienced by overweight/obese adolescents; (2) Associations between timing of overweight/obesity and morbidity.

Methods: Data were drawn from the three waves (1997, 2000, 2005) of the Health of Young Victorians Study (HOYVS), an Australian school-based longitudinal study. The main outcome measures were blood pressure; self- and parent-proxy reported health status (PedsQL, global health); self-reported mental health (SDQ), psychological distress (K-10), physical symptoms, sleep, asthma, and dieting; parent-reported health care needs (CSHCN screener) and visits. Regression methods, adjusted for sociodemographic factors, were used to assess associations with (1) Body mass index (BMI) status (non-overweight, overweight or obese) and (2) Timing of overweight/obesity ( never , childhood only , adolescence only , ‘persistent ).

Results: Of the 923 adolescents (20.2% overweight, 6.1% obese), 63.5% were categorised as ‘never’ overweight/obese, 8.5% as ‘childhood only’, 7.3% as ‘adolescence only’, and 20.8% as ‘persistent’. Current BMI status was strongly associated with poorer physical and global health, hypertension and dieting behaviours. Associations were weaker for emotional morbidity, and there was no clear evidence of association with any other variable. Other than dieting, adolescent morbidity was not associated with resolved childhood overweight/obesity.

Conclusions: Despite poorer overall health, overweight/obese adolescents were not more likely to report specific problems that might prompt health intervention. Morbidity was mainly associated with concurrent, rather than earlier, overweight/obesity.

Improving the uptake of pulmonary rehabilitation in patients with COPD : qualitative study of experiences and attitudes

Background
Pulmonary rehabilitation can improve the quality of life and ability to function of patients with chronic obstructive pulmonary disease (COPD). It may also reduce hospital admission and inpatient stay with exacerbations of COPD. Some patients who are eligible for pulmonary rehabilitation may not accept an offer of it, thereby missing an opportunity to improve their health status.

Aim
To identify a strategy for improving the uptake of pulmonary rehabilitation.

Design of study
Qualitative interviews with patients.

Setting
Patients with COPD were recruited from a suburban general practice in north-east Derbyshire, UK.

Method
In-depth interviews were conducted on a purposive sample of 16 patients with COPD to assess their concerns about accepting an offer of pulmonary rehabilitation. Interviews were analysed using grounded theory.

Results
Fear of breathlessness and exercise, and the effect of pulmonary rehabilitation on coexisting medical problems were the most common concerns patients had about taking part in the rehabilitation. The possibility of reducing the sensation of breathlessness and regaining the ability to do things, such as play with their grandchildren, were motivators to participating.

Conclusion
A model is proposed where patients who feel a loss of control as their disease advances may find that pulmonary rehabilitation offers them the opportunity to regain control. Acknowledging patients' fears and framing pulmonary rehabilitation as a way of ‘regaining control’ may improve patient uptake.

Parental exercise is associated with Australian children's extracurricular sports participation and cardiorespiratory fitness : a cross-sectional study

Background: The relationship between parental physical activity and children's physical activity and cardiorespiratory fitness has not been well studied in the Australian context. Given the increasing focus on physical activity and childhood obesity, it is important to understand correlates of children's physical activity. This study aimed to investigate whether parental exercise was associated with children's extracurricular sports participation and cardiorespiratory fitness.

Methods: The data were drawn from a nationally representative sample (n = 8,484) of 7–15 year old Australian schoolchildren, surveyed as part of the Australian Schools Health and Fitness Survey in 1985. A subset of 5,929 children aged 9–15 years reported their participation in extracurricular
sports and their parents' exercise. Cardiorespiratory fitness was measured using the 1.6 km (1- mile) run/walk and inaddition for children aged 9, 12 or 15 years, using a physical work capacity test (PWC170).

Results: While the magnitude of the differences were small, parental exercise was positively associated with children's extracurricular sports participation (p < 0.001), 1.6 km run/walk time (p < 0.001) and, in girls only, PWC170 (p = 0.013). In most instances, when only one parent was active, the sex of that parent was not an independent predictor of the child's extracurricular sports participation and cardiorespiratory fitness.

Conclusion: Parental exercise may influence their children's participation in extracurricular sports and their cardiorespiratory fitness levels. Understanding the correlates of children's extracurricular sport participation is important for the targeting of health promotion and public health interventions, and may influence children's future health status.

Nurses' perceived barriers to the implementation of a Fall Prevention Clinical Practice Guideline in Singapore hospitals

Background

Theories of behavior change indicate that an analysis of barriers to change is helpful when trying to influence professional practice. The aim of this study was to assess the perceived barriers to practice change by eliciting nurses' opinions with regard to barriers to, and facilitators of, implementation of a Fall Prevention clinical practice guideline in five acute care hospitals in Singapore.
Methods

Nurses were surveyed to identify their perceptions regarding barriers to implementation of clinical practice guidelines in their practice setting. The validated questionnaire, 'Barriers and facilitators assessment instrument', was administered to nurses (n = 1830) working in the medical, surgical, geriatric units, at five acute care hospitals in Singapore.
Results

An 80.2% response rate was achieved. The greatest barriers to implementation of clinical practice guidelines reported included: knowledge and motivation, availability of support staff, access to facilities, health status of patients, and, education of staff and patients.
Conclusion

Numerous barriers to the use of the Fall Prevention Clinical Practice Guideline have been identified. This study has laid the foundation for further research into implementation of clinical practice guidelines in Singapore by identifying barriers to change in acute care settings.

Genetic and environmental influences on variation in balance performance among female twin pairs aged 21-82 years

Genetic and environmental influences on variation in balance performance were measured in 93 monozygous and 83 dizygous female twin pairs aged 21–82 years (mean age, 50.5 years) in Melbourne, Australia, between 1999 and 2003. The authors administered clinical (Lord's Balance Test and Step Test) and laboratory tests of static and dynamic balance from the Chattecx Balance System with and without distractor tasks. The authors conducted factor analysis and estimated genetic and environmental variance components and heritability (defined as additive genetic variance as a proportion of all variance, after adjustment for age) using a multivariate normal model with the statistical package FISHER. Three factors were identified and adjusted for age. Heritability was 46% (standard error (SE), 9) for the "sensory balance tests" factor and 30% (SE, 9) for the "static and dynamic perturbations" factor. For both factors, the remaining variance was attributed to unique environmental effects. There was no evidence that genetic factors influenced variation in the "dynamic weight shift tests" factor, with environmental effects shared by twins accounting for 38% (SE, 7) of variance. Neither genetic nor environmental proportions of variance differed significantly between twin subgroups by age (≤50/>50 years). An age-related decline in performance measures was found across the whole sample. These results imply that balance impairments may have a heritable element.

Population norms and meaningful differences for the Assessment of Quality of Life (AQoL) measure

Objective: The Assessment of Quality of Life (AQoL) instrument is widely used in Australian health research. To assist researchers interpret and report their work, this paper reports population and health status norms, general minimal important differences (MIDs) and effect sizes.

Method: Data from the 1998 South Australian Health Omnibus Survey (n=3,010 population-based respondents) were analysed by gender, age group and health status. Data from four other longitudinal studies were analysed to obtain estimated MIDs.

Results: The mean (SD) AQoL utility score was 0.83 (0.20). Gender and age subgroup differences were apparent; the mean scores for women were consistent until their 50s, when scores declined. Greater variability was observed for males whose scores declined more slowly but consistently between 40–80 years. For both genders, those aged 80+ years had the lowest scores When assessed by health status, those reporting excellent health obtained the highest utility scores; progressive declines were observed with decreasing health status. Effect sizes of 0.13 or greater may reflect important differences between groups A difference in AQoL scores of 0.06 utility points over time suggests a general MID.

Conclusions: AQoL population norms, MIDs and effect sizes can be used as reference points for the interpretation of AQoL data. These findings add to the growing evidence that the AQoL is a robust and sensitive measure that has wide applicability.

Implications: The availability of population norms will assist researchers using the AQoL to more easily interpret and report their work.

Executive women in Australia

Women currently comprise approx. 25% of the Australian workforce in the Australian Bureau of Statistics category of Managers & Administrators. Little is known of their health status. HBA Health Management made available the results of corporate health assessments of 600 female clients in this category to carry out this health status study based on a range of medical, lifestyle and fitness indicators. Comparisons were drawn from women working within other occupational categories. Analysis showed there to be few detrimental health effects associated with being employed as a Manager & Administrator or with being married. Being a mother and employed does have some negative health effects.

Australian patient safety survey

The national telephone survey found that 6.5% of respondents reported experiencing a medical adverse event during the preceding 12 months. Most reported were medication incidents, with misdiagnosis or wrong treatment second most common. Predictors of adverse event reporting included health status, hospital admission, and length of time seeing regular doctor.

Measuring non-economic well-being achievement

Income per capita and most widely reported, non- or non-exclusively income based human well-being indicators are highly correlated among countries. Yet many countries exhibit higher achievement in the latter than predicted by the former. The reverse is true for many other countries. This paper commences by extracting the inter-country variation in a composite of various widely-reported, non-income-based well-being indices not accounted for by variations in income pre capita. This extraction is interpreted inter alia as a measure of non-economic well-being. The paper then looks at correlations between this extraction and a number of new or less widely-used well-being measures, in an attempt to find the measure that best captures these achievements. A number of indicators are examined, including measures of poverty, inequality, health status, education status, gender bias, empowerment, governance and subjective well-being.

Non-economic well-being achievement in Pacific Asia

It is well known that income per capita and most widely reported non-economic well-being achievement measures are highly correlated among countries. Yet many countries exhibit higher achievement in the latter than predicted by the former. The reverse is true for many other countries. This paper commences by extracting the inter-country variation in a composite of three widely reported educational and health status indicators not accounted for by variations in income per capita. This extraction is interpreted inter alia as a measure of non-economic well-being. Using data for a sample of Pacific Asian countries, the paper then looks at correlations between this extraction and a number of new or less widely-used well-being measures, in an attempt to find the measure that best captures these achievements.

An evaluation of a wellness guide for older carers living in the community

Objective: To assess the usefulness and effectiveness of a wellness guide and to identify whether its use by a group of older ‘‘new’’ carers would make them healthier and knowledgeable of community resources. Design and Sample: Pretest, posttest measures of physical and mental health and a questionnaire with associated focus groups. A purposive sample of 21 older carers who were ‘‘new’’ carers was selected for the study. Measures: Locus of control (LOC), Short Form 12, depression anxiety stress scale, and questionnaire. Results: Participants embraced the wellness guide as an excellent resource. It
changed their behavior and improved their health on LOC measures, although changes in physical and mental health were not statistically significant. Conclusions: The wellness guide assisted carers’ preparedness for their role and enhanced their sense of personal control over demanding situations.

Theorising stigma and the experiences of injecting drug users in Australia

This paper examines the stigma of injecting drug use as an underlying factor in the poor health status of
Australian injecting drug users. Drawing on various models of stigma described in the literature, we examine injecting drug users’ experiences. As a case study, examples from Victorian (specifically Melbourne) policy and practice are included to exemplify community and societal attitudes towards injecting drug users and the implications of these for injecting drug user health. We conclude that redressing the negative effects of stigma requires political will, financial support, increased community commitment and a better understanding of the links between the social determinant of health and the poor health status of injecting drug users.Without reducing the stigma of injecting drug use the health of this marginalised population is likely to get worse, which will have broader negative population health effects.

Promoting a team ball game (Lifeball) to older people : who does this game attract and who continues?

Issue addressed: To describe the demographic and health-related characteristics (physical activity, self-reported health status, quality of life and falls history) of older people who enroll in a team-based game, Lifeball, and examine associations between continuation and participant characteristics. Reasons for stopping, participants' perceptions of the game and changes in health-related characteristics over 12 months were examined.

Methods: Telephone surveys were conducted with a cohort of Lifeball players at: baseline, soon after commencing playing and 12 months later.

Results: At baseline, participants were aged 40 to 96 years (mean 67). Most were female (84%), in good to excellent health (86%) and reported being sufficiently (>150 minutes per week) physically active (69%). Almost half (43%) were still playing 12 months later (continuers). Continuers were more likely to perceive Lifeball had helped them to: feel fitter and healthier (91%); improve their social life (73%); and be more active (53%). No significant changes in continuers' physical activity, self-reported health status and quality of life measures were reported. The main reason for stopping playing was illness/injury unrelated to Lifeball.

Conclusions: Lifeball mainly appealed to healthy, active older people.

'Mind and body' : a lifestyle programme for people on antipsychotic medication

Rationale Psychiatric illnesses such as schizophrenia and their treatments have consequences in terms of lifestyle, diet and weight.

Aims and objectives ‘Mind and Body’ is a 10-week programme of weekly sessions aimed to improve the health status of people treated with second generation antipsychotic medications.

Methods The programme focuses on a range of lifestyle strategies including diet and exercise and was conducted at a Community Health Centre by professionally qualified staff. Between 2002 and 2006, 50 participants enrolled in, and 30 completed the programme. Measures of body weight, health status (Short Form-36) and blood markets (plasma glucose, haemoglobin A1c and lipid profile) were collected at commencement and completion of the programme.

Results A modest improvement was demonstrated in mean values for the majority of measures collected.

Conclusions A lifestyle program for people treated with antipsychotic medications is achievable and may be worthwhile although gains may be modest.

The societal benefits of reducing six behavioural risk factors : an economic modelling study from Australia

Background
A large proportion of disease burden is attributed to behavioural risk factors. However, funding for public health programs in Australia remains limited. Government and non-government organisations are interested in the productivity effects on society from reducing chronic diseases. We aimed to estimate the potential health status and economic benefits to society following a feasible reduction in the prevalence of six behavioural risk factors: tobacco smoking; inadequate fruit and vegetable consumption; high risk alcohol consumption; high body mass index; physical inactivity; and intimate partner violence.
Methods
Simulation models were developed for the 2008 Australian population. A realistic reduction in current risk factor prevalence using best available evidence with expert consensus was determined. Avoidable disease, deaths, Disability Adjusted Life Years (DALYs) and health sector costs were estimated. Productivity gains included workforce (friction cost method), household production and leisure time. Multivariable uncertainty analyses and correction for the joint effects of risk factors on health status were undertaken. Consistent methods and data sources were used.
Results
Over the lifetime of the 2008 Australian adult population, total opportunity cost savings of AUD2,334 million (95% Uncertainty Interval AUD1,395 to AUD3,347; 64% in the health sector) were found if feasible reductions in the risk factors were achieved. There would be 95,000 fewer DALYs (a reduction of about 3.6% in total DALYs for Australia); 161,000 less new cases of disease; 6,000 fewer deaths; a reduction of 5 million days in workforce absenteeism; and 529,000 increased days of leisure time.
Conclusions
Reductions in common behavioural risk factors may provide substantial benefits to society. For example, the total potential annual cost savings in the health sector represent approximately 2% of total annual health expenditure in Australia. Our findings contribute important new knowledge about productivity effects, including the potential for increased household and leisure activities, associated with chronic disease prevention. The selection of targets for risk factor prevalence reduction is an important policy decision and a useful approach for future analyses. Similar approaches could be applied in other countries if the data are available.